Findings 34Issues emerging from public participation activities include the role of the universal 35 right to health in Brazil, the balance between innovation and budget impact in 37England, the effect of unethical medical practices on public perception in South 38 39Korea, and the legitimacy of priority-setting processes in the USA. Providing 40 policymakers are receptive to these issues, public participation activities may be re-42 conceptualized as processes that illuminate policy problems relevant to a particular 43 44 context, thereby promoting an agenda-setting role for the public. The article offers an empirical analysis of public involvement in the case of 50 sofosbuvir, where the relevant considerations that bear on priority-setting decisions 52 have been particularly stark. The perspectives that emerge suggest that public 53 54 participation contributes to raising attention to issues that need to be addressed by 55 policy-makers. Public participation activities can thus contribute to setting policy 1 2 3 agendas, even if that is not their explicit purpose. However, the actualization of this 4 5 contribution is contingent on the receptiveness of policymakers. Hepatitis C, direct-acting antivirals (DAAs), sofosbuvir, public and patient 11 involvement (PPI), priority-setting, agenda-setting 12 13 14 15 Article Classification 16Case Study 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 59 attached to the disease (Vietri et al, 2013; Younossi and Henry, 2015). as much as $84,000 in the USA (McCarthy, 2015 Clinical and Economic Review (ICER). 8The article draws on country data on PPI and health priority-setting that was for PPI is also omitted for the purpose of this paper. 18In recent years a rapid development in treatments for chronic hepatitis C has administration were mostly through injections. 55However, at an estimated price of $84,000 for a 12-week treatment in the 56 USA, sofosbuvir has been labeled the $1,000 pill (McCarthy, 2015 Brazil's tradition of public involvement is also reflected in the way the public is 31In the case of sofosbuvir, the National Commission on Technology 33Incorporation in the National Health System (CONITEC), the HTA body in Brazil, contributions were made through submissions to the CONITEC website. 41During the process of assessing sofosbuvir, CONITEC also presented revised 42 43
Public reason liberalism is defined by the idea that laws and policies should be justifiable to each person who is subject to them. But what does it mean for reasons to be public or, in other words, suitable for this process of justification? In response to this question, Kevin Vallier has recently developed the traditional distinction between consensus and convergence public reason into a classification distinguishing three main approaches: shareability, accessibility and intelligibility. The goal of this paper is to defend the accessibility approach by demonstrating its ability to strike an appealing middle course in terms of inclusivity between shareability (which is over-exclusive) and intelligibility (which is under-exclusive). We first argue against Vallier that accessibility can exclude religious reasons from public justification. Second, we use scientific reasons as a case study to show that accessibility excludes considerably fewer reasons than shareability. Throughout the paper, we connect our discussion of accessibility to John Rawls's model of public reason, so as to give substance to the accessibility approach and to further our understanding of Rawls's influential model.
William Smith's recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith's argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act (ACA) was created. This reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy.
Originally proposed by John Rawls, the idea of reasoning from conjecture is popular among the proponents of political liberalism in normative political theory. Reasoning from conjecture consists in discussing with fellow citizens who are attracted to illiberal and antidemocratic ideas by focusing on their religious or otherwise comprehensive doctrines, attempting to convince them that such doctrines actually call for loyalty to liberal democracy. Our goal is to criticise reasoning from conjecture as a tool aimed at persuasion and, in turn, at improving the stability of liberal democratic institutions. To pursue this goal, we use as case study real-world efforts to counter-radicalise at-risk Muslim citizens, which, at first glance, reasoning from conjecture seems well-placed to contribute to. This case study helps us to argue that the supporters of reasoning from conjecture over-intellectualise opposition to liberal democracy and what societies can do to counter it. Specifically, they (i) underestimate how few members of society can effectively perform reasoning from conjecture; (ii) overlook that the burdens of judgement, a key notion for political liberals, highlight how dim the prospects of reasoning from conjecture are and (iii) do not pay attention to the causes of religious persons’ opposition to liberal democracy. However, not everything is lost for political liberals, provided that they redirect attention to different and under-researched resources contained in Rawls’s theory. In closing, we briefly explain how such resources are much better placed than reasoning from conjecture to provide guidance relative to counter-radicalisation in societies (i) populated by persons who do not generally hold anything close to a fully worked out and internally consistent comprehensive doctrine and (ii) where political institutions should take responsibility for at least part of the existing alienation from liberal democratic values.
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