Abstract
AbstractGiven the inadequacies of all theories of justice for addressing the complex wicked problems generated by precision medicine, what is needed instead is a fair and inclusive process of democratic deliberation. To be fair, the deliberative process must be governed by both process constraints and substantive constraints. The process constraints include a commitment to public reason (following Rawls), transparency of reasoning, acceptance of the “burdens of judgment” and value pluralism, mutual respect in deliberation, reasonableness, and inclusion of all who could be affected by the outcomes of the deliberative process. The substantive constraints include constitutional principles of health care justice, respect for medical and scientific facts, respect for well-established considered judgments of health care justice, and the use of wide reflective equilibrium to balance competing perspectives. The deliberative process can be fair and impartial because most people are behind a health care veil of ignorance.
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