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Public Reason
and Bioethics
Three Perspectives
Edited by
Hon-Lam Li
Michael Campbell
Public Reason and Bioethics
Hon-Lam Li • Michael Campbell
Editors
© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature
Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans-
mission or information storage and retrieval, electronic adaptation, computer software, or by similar or
dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or
the editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG.
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Acknowledgments
The editors would like to thank all contributors of this volume, and are
especially grateful to Ruiping Fan, Dominic Farrell, and Joseph Tham,
without whose commitment and support from the start this volume
would not have existed. Special thanks are also owed to Alastair Campbell
and Terence Hua Tai for their commitment and unfailing support from
the start.
Special thanks are due to Dr. Edgar Cheng, Dr. Derrick Au, and the
CUHK Centre for Bioethics for their unwavering support. Thanks are
also due to Lauree Wang for having organized two workshops for this
project. The editors would like to thank the Department of Philosophy
of the Chinese University of Hong Kong for its continuous support.
The editors are grateful to Brendan George of Palgrave Macmillan for
his patient work overseeing this project from the beginning to the end.
Thanks to Rebecca Hinsley for her coordination. For excellent profes-
sional editing, we want to thank Hemalatha Arumugam and her team.
The research project on Public Reason and Bioethics was partially sup-
ported by a grant from the Research Grants Council of the Hong Kong
Special Administrative Region, China (Project No. CUHK No.14660716).
Hon-Lam Li was the principal investigator of this project, and Alastair
Campbell, Michael Campbell, Ruiping Fan, Dominic Farrell, Terence
Hua Tai, and Joseph Tham were the co-investigators.
v
vi Acknowledgments
Bibliography 389
Index 409
Notes on Contributors
xiii
xiv Introduction
1
In this book, different authors prefer different terms, such as medically assisted death, medically
assisted suicide (MAS), physician-assisted suicide (PAS), physician-assisted death (PAD), and med-
ical assistance in dying (MAID). All of these terms refer to the same thing.
2
Rawls attributes the cause of “the fact of reasonable pluralism” to “the burden of judgements”
(John Rawls, Political Liberalism, (New York: Columbia University Press, 1993), 54-58). Reasonable
and rational people disagree over religious, moral, and philosophical matters because these matters
involve evidence that is hard to assess, concepts that are vague, conflicting considerations, and dif-
ficulty in setting our priorities.
3
Comprehensive doctrines also include beliefs about personal virtues, political beliefs about how
society ought to be arranged, and also “what is of value in life, the ideals of personal character, as
well as ideals of friendship and familial and associational relationships, and much else that is to
inform our conduct, and in the limit to our life as a whole” (ibid., 13).
Introduction xv
but other issues that “can be the cause of deep conflict”8 would include
medical assistance in dying and same-sex marriage.
Discourse in terms of public reasons, as Rawls points out, by no means
guarantees consensus. So long as controversial issues are debated in the
public forum in terms of public reasons, Rawls maintains that enactment
of a law according to the majority view in the legislature will be legiti-
mate. Rawls would also think that decisions of the appellant and supreme
courts, typically couched in terms of public reasons, are legitimate.
However, Rawls has never clearly indicated how discussion in public
reason is to be carried out. He says that with respect to a particular issue,
say, abortion, political values relevant to this issue should be ordered and
be reasonably balanced. He claims, without providing any detail, that any
reasonable ordering and balancing of the relevant political values must
allow abortion during the first trimester.9
In Chap. 1, Part I, of this volume, Hon-Lam Li articulates Rawls’
theory of political liberalism and raises pertinent issues. Though sympa-
thetic to Rawls’ view, Li argues that Rawls’ idea of reasonable ordering of
political values is too vague. He contends that self-standing arguments
should be included as public reasons in public discourse. In this regard,
he argues that T. M. Scanlon’s contractualism—especially Scanlonian
principles and reasoning—could be incorporated for three reasons. First,
Scanlon and Rawls have mutually influenced each other’s view over a
fairly long period of time and their terms of reference are similar or con-
genial. Second, Scanlon’s principles are self-standing and do not rely on
any comprehensive doctrine. Finally, his theory is worked out in detail
theoretically and has been applied to practical issues.10
8
Ibid.
9
According to Rawls, the three important political values relevant to abortion are the due respect
of human life, the ordered reproduction of political society over time, and the equality of women
as equal citizens (Political Liberalism, 243n; The Law of Peoples, (Cambridge, MA: Harvard
University Press, 1999), 169).
10
See Corey Brettschneider, “The Rights of the Guilty: Punishment and Political Legitimacy.”
Political Theory 35, no. 2 (2007): 175–99; Hon-Lam Li, “Contractualism and the Death Penalty.”
Criminal Justice Ethics 36, no. 2 (2017): 152-182; Hon-Lam Li, “What We Owe to Terminally Ill
Patients: The Option of Physician-Assisted Suicide.” Asian Bioethics Review 8, no. 3 (2016): 224-43;
Hon-Lam Li, Nancy S. Jecker, Roger Yat-Nork Chung, “Reopening Economies during the
COVID-19 Pandemic: Reasoning about Value Tradeoffs.” The American Journal of Bioethics 20, no.
Introduction xvii
7 (2020), 136-8; Hon-Lam Li, “Contractualism and Punishment.” Criminal Justice Ethics 34, no.
2 (2015): 177-209.
11
Farrell and Tham, as well as Fan, prefer the term “medically assisted suicide.” It refers to the same
thing as “medical assistance in dying” by Li.
xviii Introduction
These are communitarian values, and according to Fan, Rawls would not
regard them as suitable candidates for public reasons. Against this, Fan
argues that whether some consideration is a public or a private reason
should be understood as a matter of degree rather than of kind; public
reasons are just those which are capable of engaging the whole of a popu-
lace. Thus, culturally specific beliefs concerning the nature and impor-
tance of the family may provide public reasons when they express
convictions that are sufficiently deeply embedded with a particular society.
Fan puts forward a theory that comprises (1) Confucian virtues, (2) a
list of basic liberties and rights that are developed from Confucian virtues
or values, and (3) principles of political justice that integrate the elements
at these lower levels into a coherent whole. Fan acknowledges that the
rights to life, to liberty, and to formal equality are important, but argues
that these basic liberties and rights are not intrinsically liberal. Finally,
Fan applies this view to medically assisted suicide. He argues that to
decide on this matter one must balance the following considerations: (1)
the importance of a patient’s autonomy, (2) the requirement to cherish
life, (3) a physician’s role as a healer, and (4) the broader social conse-
quences of legally permitting assisted suicide. He concludes that a reason-
able balancing of these considerations should point to the conclusion
that assisted suicide should not be legalized in any of the Confucian
countries in East Asia.
In Chaps. 4, 5, and 6, Li, Farrell and Tham, and Fan critique each
other’s view. Chapters 7, 8, and 9 are further responses by these authors
to Chaps. 4, 5, and 6. Apart from responding to rival conceptions of
public reason, each group reflects on possible deficiency of their own
theories and whether they are drawn to each other a little bit more during
the course of deliberation and debate. These chapters were written
sequentially, and reflect the results of robust debate between the
participants.
This book comprises two parts. Whereas Part I consists of nine chap-
ters from three different traditions (where the question of which is the
best conception of public reason is debated), Part II contains five essays
that supplement the debate, by situating the debate within its conceptual
and historical background and by reflecting on the ways in which the
concept of public reason might be developed in the future.
xx Introduction
In Chap. 10, Terence Hua Tai interrogates the historical origins of the
concept of public reason by examining in detail Kant’s conception of
public reason. Tai shows that Kant’s conception differs from Rawls’ for-
mulation in several key respects. In particular, whereas Rawls sees the
concept of public reason as a formal demand which governs debate within
a pluralistic society, for Kant public reason is fundamentally connected to
the preconditions for being an autonomous agent within a society of
coercive rules. The public use of reason allows us to convert certain laws
of the state—which are “laws of heteronomy” in the sense of being
imposed on us by an external authority—into “laws of autonomy,” that
is, into freely willed constraints, obedience to which constitutes an act of
genuine self-expression.
Tai contrasts his reading with Onora O’Neill’s account of Kantian
public reason, showing that in order to grasp Kant’s position we must
stress not only the law-like form and universal scope of laws of public
reason but also their connection with our common humanity and their
falling within the “domain of right.” The public use of reason is its uses
by members of the state when they speak as scholars rather than as
engaged in some or other public office. Public reasoning therefore faces
in two directions, being designed both to justify our institutions and to
point citizens the way toward intellectual maturity. Once they have
gained this maturity, they will then be able to stand back from the laws
that they live under and see not only that they must be followed but why
or to what extent. In this way they can convert laws of heteronomy into
laws of autonomy.
At the end, the principles of right upon which our state is based must
be justified by reference to the humanity of the citizens which the laws
serve. But for Kant, the justifiability of our laws must be distinguished
from the act of justifying them. Justification can be undertaken only by
those who have educated themselves in the ways of correct reasoning, and
this education goes on through studying the examples of those who
debate over the justifiability or otherwise of some particular law. By
showing the educative function of public reason, as well as the connec-
tion between the structures of law and the common humanity of the citi-
zens who are governed by it, Tai’s reconstruction shows how the concept
of public reason can play an important role in bioethical deliberation
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KYMMENES LUKU.
— Kuka se on?
— Olen tshekkiläinen.
— Sitä en kiellä.
— Kuinka niin?
— Kuinka minulta voidaan vaatia enemmän kuin itse puolalaisilta?
Missä ovat nyt puolalaiset? Missä ovat tämän kuningaskunnan
senaattorit, ruhtinaat, ylimykset, aateli ja ritarit, jos ei ruotsalaisten
leirissä? Heidänhän on ensi sijassa tiedettävä, mitä he ovat
velvolliset tekemään, mikä on heidän isänmaansa pelastus ja mikä
sen tuho. Minä kuljen heidän mukanaan, ja kenellä heistä on oikeus
sanoa minua kiittämättömäksi? Miksi minun, muukalaisen, pitää olla
uskollisempi Puolan kuninkaalle ja Puolalle kuin he itse? Miksi
karttaisin sitä palvelusta, jota he itse kärkkyvät?
— Miksi niin?
Koko yön hän oli kuumeessa. Oli hetkiä, jolloin hän luuli
auttamattomasti sairastuvansa. Vihdoin alkoi päivä sarastaa. Kmicic
nousi vuoteeltaan ja meni ulos.
Priori otti hänet vastaan heti. Hän oli jo iäkäs mies, elämänsä
iltaan kallistumassa. Hänen kasvoissaan oli harvinaisen rauhallinen
ilme. Tuuhea, musta parta ympäröi kasvoja, sinisissä silmissä oli
läpitunkeva katse. Valkeassa puvussaan hän muistutti pyhimystä.
Kmicic suuteli hänen hihaansa, priori laski kätensä hänen päänsä
päälle ja kysyi, kuka hän oli ja mistä tuli.
— Tulen Samogitiasta, — vastasi Andrzej, palvelemaan Pyhää
Neitsyttä, onnetonta isänmaata ja hylättyä kuningasta, joita jokaista
vastaan olen rikkonut, minkä kaiken tarkemmin selitän pyhässä
ripissä, jonka pyydän saada jo tänään tahi huomenna, sillä katumus
rikosteni johdosta ahdistaa minua. Oikean nimeni sanon teille,
kunnioitettava isä, myös silloin rippisalaisuutena, mutta en muuten,
sillä ihmiset vihaavat minua ja voisivat olla haitaksi parannukselleni.
Ihmisten edessä on nimeni Babinicz omistamani maatilan mukaan,
joka on vihollisen vallassa. Mutta minä tuon tärkeän tiedon, jota
pyydän teitä, kunnioitettava isä, kärsivällisesti kuuntelemaan, sillä se
koskee tätä pyhäkköä ja luostaria.