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 Developments in science and technology generate public concern about the use of science in shaping human life and society. Governments and health authorities are increasingly required to develop policies concerning ethically contentious medical research (for example, the use of human embryos in stem cell research and cloning for research purposes). This policy-making occurs in the context of diverse (and changing) values held by the citizenry. Where public policy is developed in areas recognised as ethically contentious, the policy-making process is thought to demand public consultation and expert input from a range of identified stakeholders. This complex array of information, values and potential impacts of policy decisions raises a basic question for societies about the possibility of democratically legitimate policy.
In this paper I draw on research that I have been pursuing for past decade on the relationship between political philosophy, which addresses questions like: What are the limits to legitimate state authority? What rights do citizens have? When should a state intervene in the affairs of a foreign nation? When should a state intervene in the private affairs of citizens? and bioethics, addressing questions like: Should a patient be permitted to choose euthanasia? What does it mean to give informed consent' to an experimental medical procedure? Is it ever legitimate for a doctor to withhold information from a patient? Is human embryonic stem cell research ethically defensible? These two areas of philosophy are developed so that the big picture that frames current debates about bioethics policy can be more clearly understood.
In this paper I focus on the challenges facing liberal democracies in developing policy on bioethical issues that can claim to be politically legitimate, democratically defensible and respectful of ethical disagreement, using the recent debates about embryo research and cloning as an example. I develop an approach to deliberative democracy and justification that emphasises the significance of the process of policy development for establishing the contestable legitimacy of policy outcomes. Policy- makers who draw on the recommended processes outlined will be better able to claim that their policies are democratically legitimate and can defend the reasoning that led to their decisions in the face of opposing values and opinion.
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