Fabienne Peter

There is consistent and strong empirical evidence for social inequalities in health, as a vast and fast growing literature shows. In recent years, these findings have helped to move health equity high on international research and policy agendas. This paper examines how the empirical identification of social inequalities in health relates to a normative judgment about health inequities and puts forward an approach which embeds the pursuit of health equity within the general pursuit of social justice. It defends an indirect approach to health equity, which views social inequalities in health as unjust in so far as they are the result of an unjust basic structure of society in Rawls’ sense.

Does political decision-making require experts or can a democracy be trusted to make correct decisions? This question has a long-standing tradition in political philosophy, going back at least to Plato’s Republic. Critics of democracy tend to argue that democracy cannot be trusted in this way while advocates tend to argue that it can. Both camps agree that it is the epistemic quality of the outcomes of political decision-making processes that underpins the legitimacy of political institutions. In recent political philosophy, epistemic democrats have embraced this instrumentalist way of thinking about democracy. In this chapter, I argue that the attempt to defend democracy on epistemic instrumentalist grounds is self-undermining. I also develop an alternative – procedural – epistemic defence of democracy. I show that there is a prima facie epistemic case for democracy when there is no procedure-independent epistemic authority on the issue to be decided.

In this paper I defend a pure proceduralist conception of legitimacy that applies to epistemic democracy. This conception, which I call pure epistemic proceduralism, does not depend on procedure-independent standards for good outcomes and relies on a proceduralist epistemology. It identifies a democratic decision as legitimate if it is the outcome of a process that satisfies certain conditions of political and epistemic fairness. My argument starts with a rejection of instrumentalism–the view that political equality is only instrumentally valuable. I reject instrumentalism on two grounds: (i) because it fails to respect reasonable value pluralism and to recognize the constitutive role of democratic procedures for legitimacy in pluralist societies, and (ii) because it neglects the constructive function of democratic decision-making. I then consider two alternatives to pure epistemic proceduralism: David Estlund's version of epistemic proceduralism and a Deweyan account of epistemic democracy. I argue that only pure epistemic proceduralism can make good on both shortcomings of instrumentalism, whereas each of the other two approaches only makes good on one and neglects the other.

A conception of legitimacy is at the core of normative theories of democracy. Many different conceptions of legitimacy have been put forward, either explicitly or implicitly. In this article, I shall first provide a taxonomy of conceptions of legitimacy that can be identified in contemporary democratic theory. The taxonomy covers both aggregative and deliberative democracy. I then argue for a conception of democratic legitimacy that takes the epistemic dimension of public deliberation seriously. In contrast to standard interpretations of epistemic democracy, however, the conception I put forward avoids procedure-independent standards of correctness. Instead, it relies on a procedural social epistemology and defines legitimacy entirely in terms of the fairness of procedures. I call this conception of democratic legitimacy `Pure Epistemic Proceduralism'. I shall argue that it should be preferred over `Rational Epistemic Proceduralism', the conception of legitimacy that underlies the standard interpretation of epistemic democracy. Key Words: legitimacy • deliberative democracy • epistemic democracy • social epistemology.

Political egalitarianism is at the core of most normative conceptions of democratic legitimacy. It finds its minimal expression in the “one person one vote” formula. In the literature on deliberative democracy, political equality is typically interpreted in a more demanding sense, but different interpretations of what political equality requires can be identified. In this paper I shall argue that the attempt to specify political equality in deliberative democracy is affected by a dilemma. I shall illustrate the political egalitarian’s dilemma by a hypothetical choice between two informational bases for political equality: Rawlsian primary goods and Amartya Sen’s capability approach. The political egalitarian’s dilemma reveals a clash between the requirement of ensuring equal possibilities to participate in the democratic process and the requirement of subjecting substantive judgments to deliberative evaluation. As such, the dilemma is a variant of the procedure vs. substance dilemma that is well-known in democratic theory. While it has sometimes been argued that deliberative democracy solves the tension between procedure and substance, the political egalitarian’s dilemma shows that this tension continues within deliberative democracy.

Critics and defenders of Rawls' idea of public reason have tended to neglect the relationship between this idea and his conception of democratic legitimacy. I shall argue that Rawls' idea of public reason can be interpreted in two different ways, and that the two interpretations support two different conceptions of legitimacy. What I call the substantive interpretation of Rawls' idea of public reason demands that it applies not just to the process of democratic decision-making, but that it extends to the substantive justification of democratic decisions. I shall argue against this interpretation and suggest a procedural interpretation instead. On this view, public reason is invoked when it comes to the political justification of the principles that should govern the process of democratic decision-making, but not – at least not directly – in relation to the content of public deliberation.