Amy Gutmann

Democracy and the welfare state

The essays in this volume explore the moral foundations and the political prospects of the welfare state in the United States. Among the questions addressed are the following: Has public support for the welfare state faded? Can a democratic state provide welfare without producing dependency on welfare? Is a capitalist (or socialist) economy consistent with the preservation of equal liberty and equal opportunity for all citizens? Why and in what ways does the welfare state discriminate against women? Can we justify limiting immigration for the sake of safeguarding the welfare of Americans? How can elementary and secondary education be distributed consistently with democratic values? The volume confronts powerful criticisms that have been leveled against the welfare state by conservatives, liberals, and radicals and suggests reforms in welfare state programs that might meet these criticisms. The contributors are Joseph H. Carens, Jon Elster, Robert K. Fullinwider, Amy Gutmann, Jennifer L. Hochschild, Stanley Kelley, Jr., Richard Krouse, Michael McPherson, J. Donald Moon, Carole Pateman, Dennis Thompson, and Michael Walzer.

Moral Conflict and Political Consensus

When citizens reasonably disagree about the morality of a public policy, on what principles can they agree to conduct their public life? The hope of liberal political theory, and the basis of the most common solution to the problem of moral conflict in a pluralist society, is that citizens can still agree on principles that would remove decisions about the policy from the political agenda. Liberals typically invoke higher-order principles (such as neutrality or impartiality) that are intended to transcend disagreement on specific policies: these principles purport to determine which issues are appropriate subjects for public policy and which are not. When there is no reasonable basis for resolving the moral conflict on an issue of policy, the principles preclude state action on the issue and leave each citizen free to act on the basis of his or her own morality (to the extent possible without state action). A consensus on these principles thus insulates the political process from fundamental moral conflict. We want to challenge, at least in part, this familiar liberal way of dealing with moral conflict. The consensus on these higher-order principles that liberals propose is not sufficient to eliminate moral conflict from politics, and a more robust set of principles is necessary to govern the conflict that inevitably and legitimately remains. The higher-order principles that constitute the core of the consensus, we suggest, must permit greater moral disagreement about policy and greater moral agreement on how to disagree about policy. Two kinds of higher-order principles should be distinguished, corresponding to different purposes that the consensus is supposed to serve. First, there are what may be called principles of preclusion, which serve the more familiar purpose of determining which policies deserve a place on the political agenda in the sense of being a legitimate subject for legislation. These principles preclude fundamental moral conflict by denying certain

Why Deliberative Democracy Is Different

In modern pluralist societies, political disagreement often reflects moral disagreement, as citizens with conflicting perspectives on fundamental values debate the laws that govern their public life. Any satisfactory theory of democracy must provide a way of dealing with this moral disagreement. A fundamental problem confronting all democratic theorists is to find a morally justifiable way of making binding collective decisions in the face of continuing moral conflict.

For and against Equal Access to Health Care

There is a fairly widespread consensus among empirical analysts that access to health care in this country has become more equal in the last quarter century. Agreement tends to end here, and debate ensues as to whether this trend will or should persist. But before debating these questions, we ought to have a clear idea of what equal access to health care means. Since we cannot define equality of access to health care in a morally neutral way, we must choose a definition that is morally loaded with a set of values.1 The definition offered here is by no means the only one possible. It has, however, the advantage not only of clarity but also of embedding within it strong and commonly accepted liberal egalitarian values. The debate is better focused upon arguments for and against a strong principle of equal access than on disputes over definitions, which tend to hide fundamental value disagreements instead of making them explicit.

Moral Disagreement in a Democracy

Moral disagreement about public policies—issues such as abortion, affirmative action, and health care—is a prominent feature of contemporary American democracy. Yet it is not a central concern of the leading theories of democracy. The two dominant democratic approaches in our time—procedural democracy and constitutional democracy—fail to offer adequate responses to the problem of moral disagreement. Both suggest some elements that are necessary in any adequate response, but neither one alone nor both together are sufficient. We argue here that an adequate conception of democracy must make moral deliberation an essential part of the political process. What we call “deliberative democracy” adds an important dimension to the theory and practice of politics that the leading conceptions of democracy neglect.

Safeguarding Children — Pediatric Research on Medical Countermeasures

The Presidential Commission for the Study of Bioethical Issues has concluded that before pediatric trials of anthrax vaccine can be considered in the absence of an outbreak or attack, further steps must be taken, including additional research in adults, to reduce risks to participating children.

The Bioethics Commission on Incidental Findings

Shared decision-making allows patients, participants, and consumers to decide what they do and do not want to know. Dr. Sarah Hilgenberg believes that participating in a research study saved her life, although she had no reason to believe this when she enrolled. While examining functional magnetic resonance images collected during a memory study, researchers found an arteriovenous malformation, an abnormal connection between arteries and veins in her brain (see the image). Sarah had the mass surgically removed, and she recovered (1). Consider also a hypothetical case in which a routine computerized tomography angiogram turns up no clinically significant stroke warning signs but shows an unrelated nodule in the lung. During biopsy, the lung collapses, which leads to cardiac arrest and permanent anoxic brain injury. The nodule pathology report reveals benign inflammation.

Rawls on the Relationship between Liberalism and Democracy

Rawls and his critics agree on at least this: his theory is liberal. This essay asks, To what extent is it also democratic? Does Rawlsian liberalism denigrate democracy as some critics charge? Despite the enormous literature on Rawls, remarkably little has been written on the relationship between liberalism and democracy in the theory. Critics over the years have suggested that the theory denigrates democracy in one of three ways, which I consider by posing three critical questions about the theory. First, does it devalue the equal political liberty of adults (at any one of three levels of theory formation)? Second, does it devalue the political process of majority rule? Third, does it devalue the kind of civic discourse that relies on more comprehensive philosophies – both religious and secular – rather than on the free-standing political philosophy that Rawlss theory distinctively defends? In interpreting Rawls’s understanding of democracy, I draw upon both A Theory of Justice ( Justice ) and Political Liberalism ( Liberalism ). The two works diverge at points, which I discuss when the differences bear on Rawls’s understanding of the relationship between liberalism and democracy. But together they have more to say about the relationship than either work alone.

Democracy & democratic education

A profound problem posed by education for any pluralistic society with democratic aspirations is how to reconcile individual freedom and civic virtue. Children cannot be educated to maximize both individual freedom and civic virtue. Yet reasonable people value and intermittently demand both. We value freedom of speech and press, for example, but want (other) people to refrain from false and socially harmful expression. The various tensions between individual freedom and civic virtue pose a challenge that is simultaneously philosophical and political. How can we resolve the tensions philosophically in light of reasonable political disagreements over the relative value of individual freedom and civic virtue? Instead of giving priority to one value or the other, this essay defends a democratic ideal ofconscious social reproduction, which consists of three principles:nonrepression, nondiscrimination, and democratic deliberation.

Found Your DNA on the Web: Reconciling Privacy and Progress

An article by Melissa Gymrek and colleagues, published this January in Science, described how the researchers used surname inferences from commercial genealogy databases and Internet searches to deduce the identity of nearly fifty research participants whose supposedly private data were stored in large, publicly available datasets. This news comes just months after the Presidential Commission for the Study of Bioethical Issues published a report that expressed serious concerns about personal privacy and security in whole genome sequencing. The bioethics commission (on which we serve as chair and vice-chair) highlighted the importance of reconciling the enormous public benefits anticipated from research in this area with the potential risks to individuals’ privacy, and it offered several policy proposals to help balance the potential of scientific progress with privacy and respect for persons. The human subjects research protections laid out in the federal regulations are triggered by the identifiability of data. The participants in the Gymrek et al. study were not “readily identifiable”; however, the data proved far more easily identifiable than expected. With rapidly evolving technology, a precise definition of that notion may be impossible. But if we move the debate from the rhetoric of identifiability to the ethical principles of public beneficence and the centrality of respecting all persons, we find that the real ethical focus must be on promoting generalizable progress while at all times respecting individual privacy.