Fleck Leonard M
Center for Bioethics and Social Justice, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
Camb Q Healthc Ethics. 2024 Mar 11:1-15. doi: 10.1017/S0963180124000124.
Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely resolve) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research.
罗尔斯式的公共理性能否充分证明那些规范或限制生物伦理学（以及更广泛的社会领域）中有争议的医学和技术干预措施的公共政策是合理的呢？这些干预措施包括堕胎、医生协助死亡、对胚胎进行CRISPR - cas9基因编辑、代孕母亲、对八细胞胚胎进行植入前基因诊断等等。本文的第一部分简要阐述了界定罗尔斯式政治自由主义的核心概念。本文的后半部分则展示了对罗尔斯式公共理性的承诺如何能够缓解（而非完全解决）当今许多与生物伦理学上有争议的医学干预措施相关的政策分歧。公共理性的目标是通过消除分歧中违反公共理性规范的特征来缩小分歧的范围。公共理性的规范是维护这个社会的自由主义、多元主义和民主特征在政治上所必需的那些规范。剩下的是需要通过正常的民主审议程序来解决的合理分歧。从公共理性角度探讨的具体问题包括对过高医疗成本的个人责任、器官移植中死亡的形而上学定义的效用，以及通过体外受精产生的多余胚胎的道德地位和/或它们在医学研究中的使用。
