John Rawls’s Public Reason and Health Care Justice
The purpose of this paper is to search for a decision-making method for health care justice that is both morally justifiable and practically feasible, in John Rawls’s theory of public reason. For this purpose, I first analyze the circumstances of health care justice in order to confirm whether health care can be a matter of distributive justice, and break these circumstances down into three conditions: the moderate scarcity of medical resources, the demand of equality in health care, and the fact of reasonable pluralism. Then, I deal with Ezekiel Emanuel’s critique of Rawls’ concept of neutrality because, if Emanuel’s critique were valid, this inquiry would have been meaningless from the start. I demonstrate Emanuel’s critique is a straw man fallacy because I interpret Rawls’s theory as justificatory neutrality, but not the consequential neutrality Emanuel criticizes. Finally, I attempt a construction of a justifiable method of decision making using Rawls’s concept of public reason. Rawls’s public reason is effective in resolving medical issues in the sense that it is relevant as a response to the reality of modern society or the fact of reasonable pluralism. Moreover, it guarantees democratic values such as openness of information and discussion, autonomy, etc. I demonstrate that deliberation with public reason could break down into external deliberation between citizens and internal deliberation within each citizen. In addition, I examine how decision-making concerning medical issues can be justified and legitimated with the cooperation and interaction between external and internal deliberations. Through this inquiry, I show that Rawls’s public reason could be effective and stable enough in order to resolve controversial moral issues in health care.