A number of bioethicists strongly advocate a mechanism known as “rational democratic deliberation” for addressing in a way that is fair and legitimate some of the controversial ethical and policy issues related to medicine and health care policy. I am among them. Unfortunately, whether and how deliberative outcomes can actually alter public policy is not quite clear. Many will recognize the public educational value of deliberative efforts but stop far short of holding that they should have a direct and substantial role in shaping public policy.
To my mind, Fukuyama and Furger are committed to only a minimalist conception of democratic deliberation. They are correct to doubt the commitment of scientists and industry leaders in reprogenetics to self-regulation. But they are excessively skeptical of the public’s capacity to engage in fair and reasonable deliberations about these matters. They would welcome [End Page 22]
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public input through Web-based citizen panels and very broad surveys, but they would filter the results of this input through a special reprogenetics advisory board and other standard regulatory mechanisms, which suggests they do not regard the public input as being either trustworthy or sufficiently accountable.
That brings me to the central question of this essay. Could rational democratic deliberation yield a sufficiently trustworthy and politically legitimate system for national regulation of the industries and health professionals connected to reprogenetics, even given the acrimony associated with abortion (which would never be far off) and threats to professional autonomy and basic personal liberties? I think so, although I will have to mention some qualifications. In particular, the deliberative process needs to include a broad and diverse range of people, it must be transparent to the public, and it should reflect a commitment that policy proposals will be both reasonable and supported with reasons.
Our key question has two dimensions—one empirical, one normative. I will say a few things pertinent to the empirical dimension, but most of what I want to say is about the normative aspects. To give a more concrete focus to my discussion, we might imagine the deliberative effort focusing on four issues:
• Should there be public funding for embryonic stem cell research, including publicly provided payments to women to produce embryos for research purposes?
• Should there be any restrictions on parents’ use of preimplantation genetic diagnosis to choose the genetic endowment of their possible future children?
• Should there be public funding for research aimed at giving us the capacity to do germline genetic engineering of eight-cell embryos?
• Should therapeutic cloning research be permitted, including payments to women to produce excess ova for research purposes?
Why should these questions not be answered through democratic deliberation? The short answer would be: because there would be no accountability, no assurance of neutrality or impartiality in setting the deliberative agenda or feeding information into the deliberative process, no assurance of fair representation, a risk of inflaming public passions and further polarizing the public around these issues, a risk that the public’s scientific ignorance would infect the regulations, a risk that the deliberative process would be captured by special interests, [End Page 23] a risk of irresponsible public enthusiasm for all innovative technologies, and a risk of antiliberal religious enthusiasm inappropriately constraining basic political liberties or limiting basic scientific research. Instead of democratic deliberation, then, we might rely on administrative rule-making, or presidential commissions, or judicial processes, or congressionally appointed expert committees, or self-policing by the scientific and business communities. All of these have well-known significant deficiencies that Fukuyama and Furger have conveniently rehearsed.1
Why is rational democratic deliberation desirable and necessary for addressing these ethically and politically controversial questions? The short answer is that we cannot afford to let the social corrosiveness and polarizing effects of the abortion issue further fray the bonds of trust and respect essential to the peaceful functioning of a liberal, pluralistic society. The abortion issue directly touches relatively few lives in our society, and this limits to a large extent the expression...