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Published online by Cambridge University Press: 06 March 2018
Appeals to social justice that argue medicine and healthcare should have certain priorities and not others are common. It is an obvious question to ask: What does social justice demand of the new genetic technologies? However, it is important to note that there are many theories and sub-theories of justice. There are utilitarian theories, libertarian theories, and egalitarian theories. There are so-called luck egalitarians, equality-as-fairness thinkers, and capability theorists, with each having his or her own distinctive approach to the distribution of medical goods and technologies, and to healthcare priorities. This article argues that the discussion surrounding this question is potentially hampered by an implicit assumption that if one theory of justice is applicable in one context, then it must also be applicable in others. Instead, it is proposed that one adopt the stance, influenced by Michael Waltzer, that different theories with their opposing principles may be applicable to different questions regarding justice and genetics. The specific view advanced is that to answer questions about what justice requires regarding the therapeutic and enhancement use of genetic techniques, a method of reflective equilibrium can show how intuitions, in context, may support different theories of justice. When particular pre-theoretic ethical judgments are balanced against the theories that might explain or justify them, and are in accord with what seems emotionally acceptable, then it can be seen how different general theories may be applicable in the different contexts in which questions of justice and genetics arise.
1. For example, Colin Farrelly thinks that we should all be “prioritarians.” Farelly C. Justice in the genetically transformed society. Kennedy Institute of Ethics Journal 2005;15(1):91–9.
2. Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics. New York: Oxford University Press; 1979.Google Scholar
3. Jinek, M, Chylinski, K, Fonfara, I, Hauer, M, Doudna, JA, Charpentier, E. A programmable dual-RNA–guided DNA endonuclease in adaptive bacterial immunity. Science 2012;337(6096):816–21.CrossRefGoogle ScholarPubMed
4. Rawls, J. A Theory of Justice, 2nd ed. Cambridge, MA: Harvard University Press; 1999, at 79.Google Scholar
5. See note 4, Rawls 1999, at 54.
6. Utilitarianism has undergone many refinements since the early statements of the doctrine from J.S. Mill, Bentham, and Sidgewick. What remains is the basic idea that we should do that which maximizes utility for as many as possible.
7. The classic statement of libertarian justice is to be found. In: Nozick R. Anarchy, State and Utopia. New York: Basic; 1974.
8. See note 4, Rawls 1999. Rawls’s A Theory of Justice. is considered to be the modern initiator of discussions of justice-as-fairness, as well as offering a refinements to the role of equality in the theory of justice. Other statements of his views can be found in Rawls J. Political Liberalism. New York: Columbia University Press; 1993, and in Rawls J. Justice as Fairness: A Restatement. Cambridge: Harvard University Press; 2001.
9. Farrelly’s Genetic Difference Principle, as a modification of Rawls’s framework, develops this idea. See Farrelly C. The genetic difference principle. American Journal of Bioethics 2004;4:21–8.
10. For example see, Hare, RM. Rawls’ Theory of Justice. Philosophical Quarterly 1973;23:144–55;241–5.CrossRefGoogle Scholar
11. The idea of different principles of justice being applicable in different contexts, without contradiction, can be found in Michael Waltzer’s book: Waltzer, M. Spheres of Justice: A Defence of Pluralism and Equality. Oxford: Robertson; 1983.Google Scholar
12. If the scenario had been different, then intuitions might be different, perhaps activating prioritarian views.
13. I am aware that none of these are actually possible now, and arguably, a general intelligence procedure never will be, but this license with the scientific reality is taken to make the point regarding what the theories should say. See, for example, Chan, S, Harris, J. Cognitive regeneration or enhancement: The ethical issues. Regenerative Medicine, 2006;1(3):361–6,CrossRefGoogle ScholarPubMed for a discussion of some of the ethical issues here.