Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships.

Gerald Gaus was one of the leading liberal theorists of the early twenty-first century. He defended liberal order based on its unique capacity to handle deep disagreement and pressed liberals toward a principled openness to pluralism and diversity. Yet, almost everything written about Gaus's work is evaluative: determining whether his arguments succeed or fail. This essay breaks from the pack by outlining underlying themes in his work. I argue that Gaus explored how to sustain moral relations between persons in light of the institutional threats of social control, evaluative pluralism, and institutional complexity, and the psychological threat of acting solely from what I shall call the mere first-personal point of view. The idea of public justification is the key to sustaining moral relations in the face of such challenges. When a society's moral and political rules are justified to each person, moral relations survive the threats they face.

Kevin Vallier has recently argued that the ideals of public justification and public deliberation should be separated. The link between the two, Vallier suggests, has been assumed without being properly defended. Once examined, the connection falls apart. In this paper, I argue that there is, in fact, a clear and convincing story available for why the two ideals should be treated as mutually reinforcing. Drawing on recent empirical evidence, I argue that the deliberative behaviour of citizens can have a clear and positive impact on the behaviour and policy choices of public officials.

Democratic institutions are appealing means of making publicly justified social choices. By allowing participation by all citizens, democracy can accommodate diversity among citizens, and by considering the perspectives of all, via ballots or debate, democratic results can approximate what the balance of reasons favors. I consider whether, and under what conditions, democratic institutions might reliably make publicly justified social decisions. I argue that conventional accounts of democracy, constituted by voting or deliberation, are unlikely to be effective public justification mechanisms. I conclude that the limitations of conventional mechanisms can be ameliorated through the use of lotteries instead of elections.

In Liberalism without Perfection, Jonathan Quong develops what is perhaps the most comprehensive defense of the consensus model of public reason – a model which incorporates both a public-reasons-only requirement and an accessibility requirement framed in terms of shared evaluative standards. While the consensus model arguably predominates amongst public reason liberals, it is criticized by convergence theorists who reject both the public-reasons-only requirement and the accessibility requirement. In this paper, I argue that while we have good reason to reject Quong’s call for a public-reasons-only requirement, all public reason liberals should endorse at least some shared evaluative standards and, hence, an accessibility requirement.

This paper explores the idea of robust discursive equality on which respect-based conceptions of justificatory reciprocity often draw. I distinguish between formal and substantive discursive equality and argue that if justificatory reciprocity requires that people be accorded formally equal discursive standing, robust discursive equality should not be construed as requiring standing that is equal substantively, or in terms of its discursive purchase. Still, robust discursive equality is purchase sensitive: it does not obtain when discursive standing is impermissibly unequal in purchase. I then showcase different candidate conceptions of purchase justice, and draw conclusions about the substantive commitments of justificatory reciprocity.

The paper challenges the view that public justification sits well with emancipatory and egalitarian intuitions. I engage political liberalism’s view of public justification. A standard objection to this view is that public justification should be more inclusive in scope. This is both plausible and problematic in emancipatory and egalitarian terms. If inclusive public justification allocates discursive standing that has much discursive purchase, as seems desirable in emancipatory terms, it is unable to allocate equal discursive standing within relevant scopes. And, if it must allocate equal discursive standing, discursive equality should be construed in terms that allow for unequal discursive purchase.

Public reason liberalism includes an ideal of political stability where justified institutions reach a kind of self-enforcing equilibrium. Such an order must be stable for the right reasons — where persons comply with the rules of the order for moral reasons, rather than out of fear or self-interest. John Rawls called a society stable in this way well-ordered.

In this essay, I contend that a more sophisticated model of a well-ordered society, specifically an agent-based model, yields a richer and more attractive understanding of political stability. An agent-based model helps us to distinguish between three concepts of political stability — durability, balance, and immunity. A well-ordered society is one that possesses a high degree of social trust and cooperative behavior among its citizens (durability) with low short-run variability (balance). A well-ordered society also resists destabilization caused by noncompliant agents in or entering the system (immunity).

Distinguishing between these three concepts complicates the necessary reformulation of the idea of a well-ordered society. Going forward, public reason theorists must now distinguish between types of assurance, specify heretofore unknown aspects of reasonable behavior, and reconceive of the nonideal preconditions for forming a stable, ideal social order.

The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from appealing to controversial conceptions of the good life, liberals committed to this principle face a significant puzzle.

In A Theory of Justice, John Rawls demands from citizens who decide upon principles of justice and the rules derived from such principles that they abstract from all particularities that constitute their identity as unique individuals. This demand is unrealistic in policy settings where actual policy-makers convene to provide guidance, establish rules regarding public good, and enact legislation. In practice, I argue, policy-makers, legislators, and others involved in developing social rules that pertain to distributive justice formulate such rules as reasonably partial spectators. To illustrate, I show how clinical practice guidelines are established and mediated by a reasonably partial expert panel whose partial action is publicly justifiable, yet whose claims to impartiality are not.