'Big picture' manifesto: Democratic policy making in contested domains

Abstract

This essay articulates the overall approach utilized in this book for examining contentious policy questions associated with controversial and emerging issues in bioethics, which we term ‘Big Picture Bioethics.’ We explore conventional and more novel methodological tools that bioethics can use to evaluate and critique policy processes in these domains. We argue that more traditional bioethics has been limited in its capacity to provide answers to these sorts of questions, even though bioethicists are often consulted about such matters. We contend that there must be more adequate consideration of the range of structural, institutional, political, and cultural factors that shape both how a particular ethical challenge will be understood in a particular jurisdiction and the policy frameworks available for addressing the perceived need for policy. This chapter outlines a novel framework within which we can evaluate public policy making processes on the basis of their informed, democratic legitimacy, with particular attention to the considerations that must be in play when attempting to develop public participation and engagement that meet the requirements of deliberative democracy. It draws on both empirical information about opinions and values of a variety of publics, and the problematization of that empirical evidence as informed by debates in political theory. This approach is preferable because it allows us to avoid assumptions about the need for consensus, which are endemic to most of what is said about policymaking processes within liberal democracies that seek to attend to diversity. In addition, the approach advocated is non-substantive in the sense that it does not prescribe a particular moral framework, beyond a commitment to democratic legitimacy, and hence allows recognition of a range of moral views.