A NORMATIVE FRAMEWORK OF PUBLIC BIOETHICAL DISCOURSE TEOH CHIN LEONG (M.A.), NUS A THESIS SUBMITTED FOR THE DEGREE OF DOCTOR OF PHILOSOPHY SCHOOL OF MEDICINE NATIONAL UNIVERSITY OF SINGAPORE 2012 DECLARATION I hereby declare that this thesis is my original work and it has been written by me in its entirety. I have duly acknowledged all the sources of information which have been used in the thesis. This thesis has also not been submitted for any degree in any university previously. Teoh Chin Leong May 2012 i Acknowledgements My greatest debt of gratitude is to my supervisor, Prof Alastair Campbell, who pored through several draft versions of my thesis, often at short notice, and gave invaluable and timely feedback on both matters of detail and in terms of the overall flow and coherence of my ideas. His encouraging words and steady guidance provided me with the confidence to believe I actually had something worthwhile to say. Always thorough, compassionate and fair-minded, Prof Campbell would gently critique what needed critiquing, commend what he felt was worth commending, whilst ensuring that I never lost sight of the bigger picture. The present work began with the opportunity to write a chapter for a book edited by Prof Benjamin Capps. It was then that I realized that the initial ideas in that chapter could be developed more fully and substantially into my current thesis. Prof Capps tirelessly read through drafts of my work, and provided detailed written comments from which I have greatly benefitted. His advice, encouragement, knowledge of the field and suggestions for further reading, helped me contextualize, situate and connect my own ideas about the local bioethics landscape with ongoing debates in the wider literature. My only regret is that I could not take on board more of his ideas, or the thesis would have been double the length. Prof Ten Chin Liew read an earlier draft of Chapter Three, and discussed Rawls at great length and depth with me, helping me understand the historical and intellectual traditions that influenced Rawls. Prof Ten’s insightful and penetrating comments, both written and verbal, at my discussion sessions with him, and also at my PhD Qualifying Examination, and as a member of my Thesis Advisory Committee, have enriched my understanding of the relevant issues immeasurably. ii My thesis was written while I was a Research Fellow at the Centre for Biomedical Ethics (CBmE), NUS. The Centre has provided an excellent environment for research, reflection and professional collaboration, and the opportunities for teaching, training and public outreach helped not only in my general bioethics education, but also shaped the ideas that now find expression in my thesis. For this, I am deeply appreciative, and truly grateful. Teoh Chin Leong 12 January 2012 iii Table of Contents Declaration i Acknowledgements ii Table of Contents iv Summary vii 1. Setting the Context: Public Policy Debates in Singapore Overview of Thesis Religious Discourse and Public Debate Consensus Position in Singapore Moving the Public Debate Forward 10 The Context and Possibility of Rational Morality 13 Conclusion 34 Audi on Religion and Civic Virtue in Public Discourse 36 Introduction 36 Setting the Context: Substantive and Procedural Ethics 37 The Cultivation of an Ethic of Citizenship 40 Three Principles of Civic Virtue 42 An Institutional Ethics of Citizenship 51 Five Objections 53 Procedural Virtues in Public Ethical Discourse 64 Religion and the Cultivation of Exploratory Openness 68 Civic Virtue and the Stem Cell Debate 71 Conclusion 103 Rawls on Public Reasons 105 Background to Rawls’ Conception of Public Reasons 105 Assessing Rawls’ Conception of Public Reasons 108 Is it Reasonable to Privilege the Political over the Moral? 111 2. 3. Is the Distinction between Political and Moral Values needed for Public 117 iv Reasons? Assessing Rawls’ Criterion of Reciprocity 133 Principled Accommodation as a Specification of the Principle of 141 Reciprocity 4. 5. How the Principle of Reciprocity Limits Public Deliberation 145 Conclusion 156 The Significance of Habermasian Discourse Ethics for Bioethics 158 Deliberation Background 159 Habermas’ Discourse Ethics 166 Objections to (U) and Proposals for Improvement 171 The Educative Effects of Public Moral Discourse 188 Conclusion 206 The Possibility of Rationality in Bioethics 208 Assessing Häyry’s Nonconfrontational Approach to Bioethics 211 Why We Should Reject Häyry’s Account of Nonconfrontational Moral 228 Rationality 6. Two Examples of Better Moral Argumentation 229 Is the Agree-to-Disagree Model of Rationality a Superior Approach? 259 Conclusion 265 A Normative Framework of Public Bioethical Discourse 267 Elements in a Normative Framework of Public Bioethical Discourse 268 The Meaning of Moral Justification 276 A Note on the Concept of Legitimacy 282 Applications of the Revised Normative Framework of Public Bioethical 285 Discourse Beyond Consequentialism 294 The Moral Limits of Pragmatism in Public Bioethical Discourse 297 Looking to the Future 311 Conclusion 316 v Bibliography 318 vi Summary Public debate shows that the twin aspirations of appropriate public justification and better argumentation ought to guide policy-making and formulation in Singapore. These consensus goals arose from attempts at answering the question of how complex matters of morality ought to be debated in the public sphere. The more heated debates reported in the Singapore press have involved the legalization of homosexual acts, whether to allow casinos to be built in Singapore and the role of religious groups in civic society, as reflected in the take-over of women’s group AWARE by a group of Christians in 2009. However, there has also been debate over the ethics of organ donation, end of life care (including euthanasia), stem cell research, abortion and research on human-animal combinations, amongst other bioethics topics, though at varying degrees of intensity. These debates show that citizens, aided and abetted by the various arguments and positions forwarded by journalists, academics, doctors, politicians and other stakeholders, have been increasingly forced to grapple with the idea and complexities of the public justification of laws and policies. Given the diversity of voices and opinions in the public sphere, the public justification of policies is needed because there are different ways of arriving at moral decisions, based on different conceptions of “the good life”. Pluralistic societies like Singapore thus have to decide on a model of public deliberation and decision-making that can be deemed acceptable, and which can lead to legitimate policy outcomes. In the context of multireligious, multicultural but secular Singapore, advances have been made in the public understanding of the place of religion in public discourse, where such understanding was previously unclear. The outlines of a consensus position on such vii discourse have emerged, although challenges remain, and these will be described in my thesis. However, beyond this initial understanding, much needs to be done in elaborating on and evaluating the nature and content of public justification acceptable to Singaporeans. The thesis takes up a philosophical analysis of public justification in the work of Robert Audi, John Rawls and Jürgen Habermas, and shows their relevance and significance for bioethical debate. My critique of these authors will lead to a revised normative conception of public ethical discourse, which also underscores the importance of cultivating appropriate character-based discourse virtues central to ethical literacy, rationality and reflective equilibrium. In addition, there have been appeals for policy-making to be based on better argumentation. I analyse the possibility of such an endeavour, examine its normative presuppositions, and provide guidelines and criteria for civically-oriented bioethics practice. In summary, the twin aspirations of public justification and better deliberation undergird public policy debates in Singapore, and set the context of my thesis. The significance of my thesis lies in the various recommendations for moving public bioethical deliberation forward, including an emphasis on critical elements of moral argumentation. The result is a conception of virtue epistemic democratic legitimacy in bioethical discourse and practice. This has important implications for civic engagement and education in any pluralistic, deliberative democracy. viii . in a Normative Framework of Public Bioethical Discourse 268 The Meaning of Moral Justification 276 A Note on the Concept of Legitimacy 282 Applications of the Revised Normative. content of public justification acceptable to Singaporeans. The thesis takes up a philosophical analysis of public justification in the work of Robert Audi, John Rawls and Jürgen Habermas, and. Moral Argumentation 229 Is the Agree-to-Disagree Model of Rationality a Superior Approach? 259 Conclusion 265 6. A Normative Framework of Public Bioethical Discourse 267