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The Journal of Political Philosophy: Volume 10, Number 2, 2002, pp. 153±174 THEORIES of deliberative democracy consist of a set of principles that are intended to establish fair terms of political cooperation in a democratic society. Some theorists believe that the principles should refer only to the process of making political decisions in government or civil society.1The principles of deliberative democracy, they argue, should not prescribe the content of the laws, but only the procedures (such as equal suffrage) by which laws are made and the conditions (such as free political speech) necessary forthe procedures to work fairly. These theorists, whom we call pure proceduralists, insist that democratic theory should not incorporatesubstantive principles such as individual liberty or equal opportunity beyond what is necessary for a fair democratic process. They do not deny thatsubstantive principles such as freedom of religion, nondiscrimination or basic health care are important, but they wish to keep these principles out of theirdemocratic theories.
We argue that thiseffort to keep democratic theory procedurally pure fails, and that any adequate theory must include substantive as well as procedural principles. Our own theory, presented in Democracy and Disagreement, offers one such approach: it includes substantive principles (such as basic liberty andfair opportunity) that extend fairness to persons (for the sake of reciprocity, mutual respect, or fairness itself). Principles of basic liberty and fair opportunitycan be defended on many substantive grounds; in that book we argue from a 1AsJuÈrgen Habermas writes, ``All contents, no matter how fundamental the action norm involved may be, must be made to depend on real discourses (or advocatory discourses conducted as substitutes for them)''. ``Discourse ethics,'' Moral Consciousness and Communicative Action, trans. Christian Lenhardt and Shierry Weber Nicholsen (Cambridge, Mass.: M.I.T. Press, 1993), p. 94. For comments and other citations, see our discussion in Amy Gutmann and Dennis Thompson, Democracy and Disagreement (Cambridge, Mass.: Harvard University Press, 1996), pp. 17±18. Other theorists who would also be more inclined to limit deliberative democracy to process considerations and are therefore critical of including substantive principles in its theory include: Jack Knight, ``Constitutionalism and deliberative democracy'' Deliberative Politics, ed. Stephen Macedo (New York: Oxford University Press, 1999), pp. 159±69; Cass Sunstein, ``Agreement without theory,'' ibid., pp. 147±8; and Iris Marion Young, ``Justice, inclusion, and deliberative democracy,'' ibid., pp. 151±8.
For our reply, see Gutmann and Thompson, ``Democratic disagreement,'' ibid., pp. 261±8.
# Blackwell Publishers, 2002, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, widely recognized principle of reciprocity or mutual justi®cation among persons who are bound by the lawsof a democracy.
But our argument here doesnot depend on accepting the whole theory in that book, or even the speci®c grounds of reciprocity on which we base the principles.
We wish to maintain here that, on a wide range of available grounds, democraticprinciples must be substantive as well as procedural. A democratic theory that shuns substantive principles for the sake of remaining purely procedural sacri®cesan essential value of democracy itself: its principles cannot claim to treat citizens in the way that free and equal persons should be treatedÐwhether fairly, reciprocally,or with mutual respectÐin a democratic society in which laws bind all equally.
Pure proceduralists make two kinds of arguments against including substantive principlesÐone from moral authority and the other from political authority. The argument from moral authority holdsthat the moral judgment of democratic citizens, not democratic theorists, should determine the content oflaws. A theory that contains substantive principles improperly pre-empts the moral authority of citizens. The argument from political authority maintains thatsubstantive principles similarly pre-empt the political sovereignty of citizens, which should be exercised not through hypothetical theoretical reasoning butthrough actual democratic decision-making. A theory that contains substantive principles unduly constrains the democratic decision-making process, includingthe process of deliberation itself.
We dispute both of these arguments and defend the inclusion of substantive principles in a theory of deliberative democracy. We agree with those theoristswho point out that mere procedures such as majority rule cannot justify outcomes that are unjust according to substantive principles. But these theoristsusually neglect the substantive value in the procedures, and assume that an outcome is justi®ed if it is just according to their substantive principles.
In any case, our main argument against pure proceduralism is not the same as the standard objection that procedures can produce unjust outcomes, though weaccept this objection. We also argue for including substantive principles in a democratic theory for another, generally neglected reason. Such principles shouldbe included so that the theory can explicitly recognize that both substantive and procedural principles are subject to contestation in similar ways. A critical claim in our defense of a deliberative democratic theory that is both procedural andsubstantive is that the principles are to be treated as morally and politically provisional. This provisionality gives deliberation part of its point. Bothprocedural and substantive principles are systematically open to revision in an ongoing process of moral and political deliberation. If the principles areunderstood in this way, the usual objections against including substantive principles lose their force. The provisional status of all its principles thusconstitutes a distinctive strength of deliberative democratic theory, and at the same time offers deliberative democrats an effective response to those who would exclude substantive principles from democratic theory.
Although we concentrate here on showing the problems with the form of pure proceduralism that justi®es political outcomes by procedural criteria only, our general criticisms also apply against any attempt to segregate procedural andsubstantive principles in separate theories. Theorists who judge outcomes partly by substantive principles of justice are still pure proceduralists (with respect totheir democratic theories) if they assume that the democratic procedures can be justi®ed without reference to some of the same substantive values expressed bytheir principles of justice. Our argument is intended to show that this kind of sharp separation between procedural and substantive principles and theories isnot sustainable.
To illustrate some of the major points in the argument for including both procedural and substantive principles in a deliberative democratic theory, we use a case involving deliberation about health care in the United Kingdom. In 1999, the British Government created a new body, the National Institute for ClinicalExcellence (NICE), which is to provide assessments of treatments and clinical guidelinesfor use by the National Health Service (NHS).2 The impetusfor thenew Institute came from the widespread recognition that the NHS could not fund care for all health needs, and needed to ®nd a way to make its dif®cult decisionsin a more public and deliberative manner. By creating a deliberative decision- making body, which includes both expert and lay members, the BritishGovernment may also have hoped that it could defuse some of the controversy about the hard choices that had to be made. But not surprisingly, shortly after its creation, NICE itself came under criticism in another deliberative forumÐtheHouse of Commons. Together these moments of deliberationÐthe proceedings of NICE and the Commonsdebate about NICEÐare more appropriate for ourpurposes than cases from the US. They involve an attempt to institutionalize nationwide deliberation about health care prioritiesin a way that the US hastriedonly in certain states. Also, the deliberation takes place in a nation in which principles of justice in health care come closer to being satis®ed than in the US,and therefore poses a greater challenge to our claim that such principles are necessary in any adequate theory of deliberative democracy. If a theory needssubstantive principles when applied to health care in the UK, then a fortiori it should need them when applied to similar issues in the US.
To determine what kind of principlesbelong in a deliberative democratic theory, we need ®rst to consider the meaning and implications of the fundamentalprinciple of reciprocity. Reciprocity iswidely recognized asa core principle of 2See statements by NICE's newly appointed director Michael Rawlins: Richard Horton, ``NICE: a step forward in the quality of NHS care,'' The Lancet, 353 (March 27, 1999), 1028±9, and Gavin Yamey, ``Chairman of NICE admitsthat itsjudgmentsare hard to defend,'' British Medical Journal, democracy in its many moral variationsÐliberal, constitutional, procedural, and deliberativeÐbut most theories do not give it the central role that deliberative democracy does. Reciprocity holds that citizens owe one another justi®cationsfor the mutually binding lawsand public policiesthey collectively enact. The aim of a theory that takes reciprocity seriously is to help people seek politicalagreement on the basis of principles that can be justi®ed to others who share the Mutual justi®cation means not merely offering reasons to other people, or even offering reasons that they happen to accept (for example, because they are ina weak bargaining position). It means providing reasons that constitute a justi®cation for imposing binding laws on them. What reasons count as such ajusti®cation is inescapably a substantive question. Merely formal standards for mutual justi®cationÐsuch as a requirement that the maxims implied by laws be generalizeableÐare not suf®cient. If the maxim happens to be ``maximize self- orgroup-interest,'' generalizing it does not ensure that justi®cation is mutual.
Something similar could be said about all other conceivable candidates for formalstandards. Mutual justi®cation requires reference to substantive values.
We can see more clearly why mutual justi®cation cannot proceed without relying on substantive values by imagining any set of reasons that would deny persons basic opportunities, such as equal suffrage and essential health care. Evenif the reasons satis®ed formal standards, they could not constitute a mutual justi®cation because those deprived of the basic opportunities could reasonably reject them. Denying some persons suffrage is a procedural deprivation that isinconsistent with reciprocity: we cannot justify coercive laws to persons who had no share in making them. Similarly, denying persons essential health care is asubstantive deprivation that cannot be justi®ed to the individuals who need it.
That such denials are unacceptable shows that the mutual justi®cation is neitherpurely formal nor purely procedural.
Because such denials of basic opportunities cannot be mutually justi®able, the principles of a democratic theory must be both procedural and substantive. A democratic theory whose principles would permit some persons to beunnecessarily deprived of a basic opportunity like health care does not take seriously the value of mutual justi®cation implied by the principle of reciprocity.
Furthermore, it does not treat persons as free and equal beings. While we arguefrom the fundamental principle of reciprocity, thisprinciple convergesin its implications with the ideal of free and equal personhood, which is the basis ofmany democratic theories, not only deliberative ones.
The principlesof our deliberative democratic theory s cooperation that satisfy reciprocity. Such terms are similar to what John Rawls calls ``fair terms of social cooperation.'' But the procedural and substantivecontent of fair termsof social cooperation will vary with different interpretations of what reciprocity requires. A theory is ``deliberative'' if the fair terms of social cooperation include the requirement that citizensor their representativesactually seek to give one another mutually acceptable reasons to justify the laws they adopt. The reasons, as we have seen, refer to substantive values no less than to Although reciprocity isa foundational value in deliberative democracy, it does not play the same role that ®rst principles, such as utility or liberty, play intheories such as utilitarianism or libertarianism. These theories derive all of their other principles from their ®rst principles. Reciprocity is not a ®rst principlefrom which the rest of justice is derived, but rather a regulatory principle that serves two different roles. First, it guides thinking in the ongoing process inwhich citizens as well as theorists consider what justice requires in the case of particular laws in speci®c contexts. Second, it shows the need for otherprinciplesto ®ll out the content of a deliberative democratic theory. Reciprocity points to the need to develop such principles as publicity, accountability, basic liberty, basic opportunity, and fair opportunity, which are necessary for themutual justi®cation of laws. As the ®rst role of reciprocity suggests, such principles should be developed in an actual ongoing process of mutualjusti®cation.
An important implication of reciprocity isthat democratic deliberationÐ the processof mutual reason-givingÐisnot equivalent to the hypothetical justi®cations proposed by some social contract theories. Such justi®cations mayconstitute part of the moral reasoning to which some citizens appeal, but the reasoning must survive the test of actual deliberation if it is to ground laws that actually bind all citizens. This deliberation should take place not only in theprivate homes of citizens or the studies of philosophers but in public political forums. In this respect, deliberative theory proposes a political ideal that isprocess-dependent, even if its content is not exclusively process-oriented.
The requirement that actual deliberation take place isnot simply a matter of trying to ensure that citizens feel that their views were taken into account even when they disagree with the outcome. Actual political deliberation at some timeisrequired to justify the law for thissociety at thistime. The reason-giving process is necessary for declaring a law to be not only legitimate but also just.
The process is necessary to give assurance that (substantive or procedural) principlesthat may be right in general are right in the particular case or rightly applied to this particular case. No amount of hypothetical reasoning is likely tobring out all the complexitiesthat are relevant to determining whether a law is justi®ed at a particular time in any given society. It would be dif®cult to decide onthe basis of any general principle of basic opportunity whether, for example, NICE wasjusti®ed in denying coverage for a new anti-¯u drug (zanamivir)marketed asRelenza by the pharmaceutical company Glaxo±Wellcome.3 What would be missing is not simply factual information but the weighing of facts and 3See ``NICE appraisal of Zanamivir (Relenza)'' posted at www.nice.org.uk. For some of the reaction, see Stephen D. Moore, ``U.K. rebuffs Glaxo on new ¯u drug,'' Wall Street Journal (October the balancing of valuesin the context of other health care and related decisions that of®cialsaswell ascitizensneed to make.
It may be helpful to think of the requirement of actual deliberation as analogous to a feature of scienti®c inquiry. Reciprocity is to justice in political ethics what replication is to truth in scienti®c ethics. A ®nding of truth in sciencerequiresreplicability, which callsfor public demonstration. A ®nding of justice in political ethicsrequiresreciprocity, which callsfor public deliberation.
Deliberation is not suf®cient to establish justice, but deliberation at some point in history is necessary. Just as repeated replication is unnecessary once the truthof a ®nding (such as the law of gravity) has been amply con®rmed, so repeated deliberation is unnecessary once a precept of justice (such as equal protectionunder the laws) has been extensively deliberated. Deliberation may still be desirable, of course, even when justice does not demand it.
The practice of actual deliberationÐgiving justifying reasons for mutually binding lawsto one'sfellow citizensÐitself both exempli®esand promotesthe value of reciprocity. Citizenswho have effective opportunitiesto deliberate treatone another not merely asobjectswho are to be judged by theoretical principles but also as subjects who can accept or reject the reasons given for the laws thatmutually bind them. The reasons are not to be regarded as binding unless they are presented to citizens who have the chance to consider and reject them eitherdirectly or indirectly through their accountable representatives in a public forum.
In this respect, the creation of NICE supported the value of reciprocity by providing citizenswith an example of deliberation in action in which they couldassess the justi®cations their representatives give for policies that will affect their wellbeing in important ways. The possibility of continuing debate in Parliamentabout the deliberative practicesaswell asthe decisionsof NICE further helpsto The processof deliberation also hasepistemic value. Decisionsare more likely to be morally justi®able if decision-makers are required to offer justi®cations forpoliciesto other people, including those who are both well informed and representative of the citizens who will be most affected by the decisions. Theepistemic value of deliberation is especially great when the justi®cation for a decision must combine factual and evaluative matters, as is the case with most health care decisions, including the kind that NICE makes. While experts may bethe best judges of scienti®c evidence, they have no special claim to ®nding the right answer about priorities when degrees of risk and trade-offs of costs andbene®tsare involved.
II. WHY RECIPROCITY REQUIRES SUBSTANTIVE PRINCIPLES The practice of deliberation isan ongoing activity of reciprocal reason-giving,punctuated by collectively binding decisions. It is a process of reaching mutually binding decisions on the basis of mutually justi®able reasons. Because the reasons have to be mutually justi®able, the process presupposes some principles with substantive content. It is possible, and sometimes desirable, to distinguish procedural and substantive aspects of principles and theories, but to turn thesedistinctions into separate principles or distinct theories is to distort both the theory and practice of (deliberative) democracy. Although for convenience werefer to principles and theories as procedural and substantive, strictly speaking democratic principles and theories have both procedural and substantivedimensions, and approaches that force a sharp division are misleading.
The principle of reciprocity itself expresses neither purely procedural nor purely substantive values. A reciprocal perspective is both procedural and substantive because mutual justi®cation cannot proceed without appealing toreasons that refer to both procedures of government and substance of laws, often at the same time. Even philosophers like Stuart Hampshire who seek to exclude substantive justice completely from their procedural political theoriesacknowledge the need for some substantive valuesÐsuch as ``common decency''Ðin the very concept of justice.4 Hampshire says justice is ``primarilyprocedural''Ðnot entirely so.5 Like other philosophers who want to be pure proceduralists, he never says what constitutes the correct set of proceduralprinciples, and why people who remain subject to tyrannical rule should settle for only procedural principlesif they permit tyranny.
At a minimum, no one would seriously dispute that justi®cations should recognize some values expressed by substantive principles such as liberty and opportunity. It would hardly be suf®cient for NICE to justify a decision to denyprescription drugs to West Indian immigrants on the grounds that they are not white. EvenÐor especiallyÐif a large majority of British citizens would acceptsuch reasoning, the justi®cation would not satisfy any adequate standard of reciprocity. Nor would it be any more acceptable to deny prescription drugs to adisadvantaged minority on the grounds that they agreed with the conclusion.
They might have agreed simply because they had less power than the groups thatprevailed and had no better alternative in a bargaining situation.
To see more clearly why reciprocity requires substantive principles, we might further imagine a situation in which the process of decision-making itself was fair in the sense that the bargaining power of the parties was equitable, but in which the reasoning of the decision-makers was prejudiced (or could only be reasonablyinterpreted as based on prejudice) against West Indian immigrants or another disadvantaged minority group. The prejudiced reasoning then yields anoutcomeÐsupported by the vast majorityÐthat denies critical health care to the disadvantaged minority. This outcome could not be justi®ed on grounds ofreciprocity, even if the proceduresby which it wasreached were otherwise completely fair. The justi®cation for the outcome does not treat members of the 4Stuart Hampshire, Innocence and Experience (Cambridge, Mass.: Harvard University Press, minority group as worthy of a justi®cation that they could reasonably accept.
Alternatively, one might say that the prejudiced reasoning denies members of the minority group the status of free and equal persons. Given the nature of thereasoning, this would be so no matter how fair the process of decision-making We can see the principle of reciprocity in action, and the mixture of procedural and substantive values it implies, in the debate about NICE in the House ofCommons. The debate had hardly begun when an MP (who is also a physician) challenged the idea that NICE or anyone else has the moral or political authorityto ration health care. Another MP responded, saying that rationing was necessary and therefore justi®able: ``sometimes some treatments are not available whenthey would bene®t patients or populations, because there simply are not the resources to provide all those treatments on the NHS.'' Although the debate at ®rst seemed to turn on issues about the legitimacy of the process (who has theauthority to decide), most critics (as well as most defenders of the Government) agreed that NICE represented an improvement asfar asprocesswasconcerned.
Most recognized that the new decision-making process is preferable to the old, and much superior to the less deliberative process that prevails in the US.
The challenge instead was directed against the substance of NICE's decision in its ®rst review of a drug. NICE had recommended against the NHS's funding thenew anti-¯u drug Relenza.6 The criticsworried that thisdecision would be a precedent that would justify NICE's recommending against funding of other more expensive and effective new drugs, such as beta interferon (which treats thesymptoms of multiple sclerosis). The critics argued that decisions denying coverage are likely to deprive less advantaged patients of life-enhancing and life-saving treatments that more advantaged patients receive, and that this unequal opportunity cannot be justi®ed. It leaves the less fortunate without the healthcare and the life chancesthat, if any citizensenjoy, then all should be entitled to.7 They appealed to substantive principles, not simply to a claim that the processwasunfair, or even that it wasnot deliberative.
Defenders of NICE's decision rightly realized that they needed to justify the substance of the decision because the deliberative process in which NICE had engaged (and in which they were engaging in the Commonsdebate) could not in itself be a suf®cient justi®cation of the decision. They explicitly invokedsubstantive standards to defend NICE's decision. They argued, for example, 6See ``NICE appraisal of Zanamivir (Relenza).'' For some of the reaction, see Moore, ``U.K.
rebuffs Glaxo on new ¯u drug.'' The Food and Drug Administration approved Relenza for use in the US despite a 13±4 vote of an outside panel of experts recommending against approval. Some critics believe that the drug has been overprescribed during the current ¯u season. See Sheryl Gay Stolberg, ``F.D.A. warns of overuse of 2 new drugs against ¯u,'' New York Times (Jan. 13, 2000), 7Asone MP put it in the Commonsdebate: ``When we talk about rationing of NHS treatments, we aren't saying no one in the UK has them. What we are saying is that they aren't available to poor people. The rich and those who can afford it can get these treatments privately'' (House of Commons that the decision not to fund Relenza would not adversely affect the basic life chancesof any citizen, not even patientswho are at high risk of complications from in¯uenza. They called for more research on the effects of Relenza on high-risk patients, and suggested that if there were evidence of Relenza's bene®t in reducing the serious secondary complications of in¯uenza in such patients, thenthey would support NHS funding. Their arguments, whether correct on the merits, were entirely in order, and if correct they were also necessary to justifytheir conclusion. That they were necessary cannot readily be accommodated in a democratic theory that limits itself to procedural considerations only.
An obvious but no less important virtue of a theory that does not limit itself to procedural principles is that it has no problem with asserting that what themajority decides, even after full deliberation, is wrong. Within a deliberative theory, one should be able to condemn majority tyranny on substantive grounds: one should be able to say that a majority acts wrongly if it violates basic libertyby denying health care on grounds of race, gender, or poverty. Or suppose that the majority, following perfectly deliberative procedures, decides to institute apractice of compulsory organ donation. On a purely procedural conception of deliberative democracy, thislaw would be justi®ed. If a deliberative theoryincludes substantive principles such as basic liberty which protect bodily integrity, democratswould be able to object to s abandoning their commitment to deliberative democracy.
Democrats of course may be mistaken when they assert claims based on substantive principles either because they draw incorrect implications from acorrect principle or because they rely on an indefensible principle. Perhaps compulsory organ donation does not violate basic liberty, or perhaps thisparticular principle of basic liberty is ¯awed. Our argument for including substantive principlesÐbased on reciprocityÐnot only allows for both kinds ofmistakes; it also incorporates into the theory itself the insight that democratic theorists and citizens may be mistaken about both procedural and substantiveprinciples. Deliberation explicitly deals with the likelihood of mistaken views about principlesand their implicationsby considering the principlesof a theoryto be provisional, and therefore subject to ongoing deliberation. To point out the possibility of being mistaken about substantive principles is therefore not an argument against including such principles within a deliberative democratictheory.
The conclusions of purely procedural theories sometimes converge with the claims of the substantive standards that reciprocity requires. For example, a procedural theory of democracy may say that racial discrimination in voting isnot justi®ed because it excludes a class of human beings from citizenship, and this violatesthe procedural requirementsof democracy, which demand theenfranchisement of all adult persons. This procedural reason is ®ne as far as it goes. But it does not go far enough in establishing why such discrimination is not justi®ed. Democratic theorists should be able to object that racial discrimination (for example, in the provision of health care by a for-pro®t Health Maintenance Organization) is not justi®ed even if democratic citizenship or no other process values are at stake. Majority tyranny is objectionable on substantive, not onlyprocedural, grounds.
Moreover, thiskind of objection should be capable of being made from within a deliberative democratic theory. After all, democracy hasnever meant merely majority rule. Denying basic liberties and opportunities by raciallydiscriminatory policies is either the result of state action or can be remedied by state action, and any such action or inaction requires a justi®cation that couldreasonably be accepted by those whose liberties and opportunities are denied.
requirement to give such a justi®cationÐto invoke substantive principles in the public forum to justify a mutually binding law or policyÐis therefore not an incidental feature of deliberative democracy. The substantive principles areintegral to the deliberative process itself.
To say that the principles are integral to the process is not to deny that they may be justi®able outside of that process. Like any theorist of justice (or citizen making a claim about justice), deliberative democrats may put forward principlesfor consideration which they regard as justi®ableÐand which indeed may be correct, but simply not yet justi®ed as laws. Deliberative theorists try to justifytheir substantive principles in a number of familiar ways, some just like those used by any theorist. We justify the substantive principles such as basic liberty in Democracy and Disagreement, ®rst and foremost, on their own termsÐbyidentifying core values, convictions, and paradigmatic cases where no one would reasonably deny that they were violated (for example, discrimination on groundsof race). Then by analogy and other formsof reasoning, we try to thicken and extend the principles to apply to more controversial cases. This is also how muchof actual political deliberation proceeds.
Certainly, these substantive principles might be rejected, and perhaps even reasonably rejected, in a deliberative process that satis®es the procedural conditionsof deliberative democracy. But a precisely parallel argument can bemade about procedural principles. Procedural principles may also be rejected by a deliberative democracy (and so may a purely procedural conception of deliberative democracy). Pure proceduralists do not have access to some moralbasis, which our conception lacks, on which to claim that the procedural constraints that they recommend for a constitutional deliberative democracy arecorrect or authoritative.
Some critics who object to including substantive principles in a deliberative democratic theory are themselves not pure proceduralists with respect to justice.
They agree that justice requires the protection of basic liberties andopportunities, including perhaps even access to adequate health care. But they still insist that the subject matter of democratic theories should be kept distinct from questions of distributive justice. They are pure proceduralists with respect to democracy, but not justice. Democracy, they imply, is supposed to tell us how to decide when we do not agree on what is just; we should not confuse matters by combining principles of justice with the procedures for deciding disputes aboutthose principles.
This argument is not so much substantive as it is de®nitional: democracy (including deliberative democracy) means fair procedures, not right outcomes.
The critics cannot rely on ordinary usage or the history of modern democratictheory, because representative democracy has rarely been characterized as exclusively procedural. Ordinary usage of a concept as complex as democracy isenormously varied, as are the conceptions of democracy found in modern democratic theory. And democratic practice itself is full of debates aboutsubstantive principles. Why then strain so hard to exclude them from the The reason cannot be that democratic theory is somehow internally inconsistent if it contains substantive as well as procedural principles. To be sure, the more principles a theory contains, the more likely there are to becon¯icts among them. And including both substantive and procedural principles certainly increases the potential for con¯ict. But democratic politics itself is rifewith con¯ict among principles, and a democratic theory that tries to insulate itself from that con¯ict by limiting the range of principles it includes is likely to beless relevant for recognizing and resolving the disagreements that democracies typically confront. When the disagreements mix substantive and procedural values as so many do in actual democratic practice, theorists who arti®ciallysegregate substance and procedure in separate theories of justice and democracy are prone to distort the role of both.
Some pure proceduralists may wish to keep out substantive principles because they are contestable, and democracy is supposed to be a means of resolvingdisagreement among contestable principles such as basic liberty. But the content accountability, are also contestable. A purely procedural theory does not avoid fundamental disagreement: con¯icts among procedural principles are no lesssevere than among substantive principles. For example, in the debate in Commonsabout NICE'sdecision to deny coverage for beta interferon, the MP from North Wilshire implicitly raised a basic procedural questionÐto whatextent doesdemocratic control require local autonomyÐwhen he argued that his constituents should have access to the drug. He objected thatÐbecause of therelative autonomy of regionsÐsome citizens in other parts of the country could get beta interferon from the NHS while hisconstituentscould not. Thisis``aterrible tragedy for constituents such as mine, who could be prescribed beta interferon if they lived in Bath or Oxford, but not in Wiltshire.''8 8House of Commons Debate, November 10, 1999. Also see Jo Lenaghan, ``The rationing debate: Central government should have a greater role in rationing decisions,'' British Medical Journal, 314 The political debatesover health care rationing that are occurring not only in the UK but also in almost every contemporary democracy clearly reveal the need to consider both procedures and outcomes in judging democratic justice. At stakeare both the conditions under which these decisions are made and their content.
Do the decision-making bodies bring together representatives of all the peoplewho are most affected by the decisions? Are the representatives accountable to all their constituents? These procedural questions cannot be answered in the contextof these debates without also asking: to what extent is the substance of the decisions justi®able to all the people who are bound by them? To excludesubstantive criteriaÐsuch as liberty and opportunityÐthat judge the justice of decisions would be morally arbitrary and incomplete according to deliberativedemocracy's own premise of reciprocity. (To exclude substantive criteria would also be morally arbitrary and incomplete according to other premises that are often identi®ed asfundamental to deliberative democracy, such asfree and equalpersonhood or mutual respect.) To af®rm that a democratic theory should include substantive principles does not of course commit one to any particular set of principles. In Democracy and Disagreement, we propose a set of principles that are both substantive andprocedural, and present arguments for their inclusion as part of the constitution of a deliberative democracy.9 The argumentswe present are intended to be partof a deliberative process itself, and in fact include fragments from actual deliberations. For example, we argue that laws or policies that deprive individuals of the basic opportunities necessary for making choices amonggood lives cannot be mutually justi®ed as a principle of reciprocity requires. The basic opportunities typically include adequate health care, education, security,work, and income, and are necessary for living a decent life and having the ability to make choicesamong good lives. We therefore would include aprinciple of basic opportunity as part of any adequate theory of deliberative Criticswho object that thisprinciple isnot mutually justi®able or that other principlesof equality are more mutually justi®able are effectively accepting theidea that democratic theory should include substantive principles. Even while challenging the content of the principles, they are nevertheless accepting that the termsof the argument should be reciprocal. Such challengesare welcomeby the terms of the theory itself, which asks for reasons that can be publicly assessed by all those who will be bound by them.10 Thiskind of challenge canthen become part of the continuing deliberative process. The reason that such 9Gutmann and Thompson, Democracy and Disagreement, pp. 199±229.
10Not so welcome are other criticsÐthose who reject the aim of giving substantive content to the claimsof reciprocity or who reject the very standard of reciprocity. But neither are their claims cogent. Having rejected the idea of mutual justi®cation, they are hard-pressed to explain how they can justify at all imposing coercive laws and policies on citizens who morally disagree with them. See section III below, and Gutmann and Thompson, Democracy and Disagreement, a challenge ®tswithin the termsof a deliberative theory itself isthat the principles of the theory per se have a morally and politically provisional III. WHY THE PRINCIPLES SHOULD BE MORALLY PROVISIONAL How is it possible for a theory to propose substantive principles to assess laws while regarding citizensasthe ®nal moral judgesof the lawsthey make? The keyto deliberative democracy's answer lies in the provisional status of its principles.11 The principlesof deliberative democracy have a different statusin deliberative democracy than they do in most moral and political theories. Theyare morally and politically provisional in ways that leave them more open to challenge and therefore more amenable to democratic discretion. The moral basisof the provisional status of deliberative principles comes from the value of reciprocity. Giving reasonsthat otherscould reasonably accept impliesacceptingreasons that others give in this same spirit. At least for a certain range of views they oppose, citizens should acknowledge the possibility that the rejected viewmay be shown to be correct in the future.12 Thisacknowledgement has implications not only for the way citizens should treat their opponents but also for the way they regard their own views.
The process of mutual reason-giving further implies that each participant involved take seriously new evidence and arguments, new interpretations of oldevidence and arguments, including moral reasons offered by those who oppose their decisions, and reasons they may have rejected in the past. ``Takingseriously'' means not only cultivating personal dispositions (such as open- mindedness and mutual respect) but also promoting institutional changes (suchas open forums and sunset provisions) that encourage reconsideration of laws and their justi®cations. One implication is that citizens and their accountablerepresentatives should continue to test their own political views, seeking forums in which their views can be challenged, and keeping open the possibility of their Deliberative democracy thusexpressesa dynamic conception of political justi®cation, in which provisionalityÐopenness to change over timeÐis anessential feature of any justi®able principles. Provisionality takes two general forms. The principles are morally provisional in the sense that they are subject to 11The discussion here of moral and political provisionality draws on our analysis in ``Why deliberative democracy isdifferent,'' Democracy, ed. Ellen Frankel Paul et al. (Cambridge: Cambridge University Press, 2000), pp. 161±80.
12The range is determined by what we call ``deliberative disagreements,'' which are those in which citizens continue to differ about basic moral principles even though they seek a resolution that is mutually justi®able. The dispute over abortion is an example of a deliberative disagreement because both sides can justify their views within a reciprocal perspective. A dispute about racial segregation is an example of a nondeliberative disagreement because one side can be reasonably rejected within a reciprocal perspective. See Gutmann and Thompson, Democracy and change through further moral argument; and they are politically provisional in the sense that they are subject to change through further political argument.
Morally provisional principles are presented as claims that can be challenged and changed over time in response to new philosophical insights, empirical evidence, or interpretations of both the insights and evidence. They are justi®edonly when they are so presented. Many theories endorse something like this general outlookÐfor example, by adopting some form of fallabilism, or moresimply by expressing general approval of moral and intellectual open- mindedness. But the provisional stance that deliberative democracy takestoward itsown claimsisdistinctive in being integral to the theory. Deliberative democracy supports the means for fundamental change in the content of thetheory itself. Deliberative democracy subjects its own principles, as well as other moral principles, to critical scrutiny over time. If as a consequence of such scrutiny, its fundamental principles substantially changeÐsay, from a moreegalitarian to a more libertarian orientation (or vice versa)Ðthe theory is appropriately seen as undergoing revision rather than rejection.
Not all principlescan be challenged at the s deliberative democratic theory, but any single principle (or even severalprinciples) may be challenged at a particular time by other principles in the theory. Citizens and accountable of®cials can revise one principle in a sequentialprocess in which the other principles are held constant. They can alter their understanding of all the principles by applying them in a different context or at a different time. For example, when the NICE Board decided against fundingRelenza, it implicitly made the provisional status of its decision clear by limiting its decision to one in¯uenza season only. NICE also recommended thatadditional trials be conducted and further data be obtained so that its decision could be reassessed in the next in¯uenza season. Particular attention should bepaid, the Board said, to ®nding out whether Relenza has positive effects on reducing serious secondary complications of in¯uenza in high-risk patients. Themoral basis for a decision against funding RelenzaÐthe claim that the use of Relenza does not signi®cantly affect anyone's basic opportunity in lifeÐwouldno longer be defensible if evidence came to light showing that Relenza could signi®cantly reduce serious complications of in¯uenza in high-risk patients. In this way, both the process and the substance of the decision kept open thepossibility of revising the recommendation in the future.
The possibility of revision applies not only to substantive principles but also to a principled defense of the practice of deliberation itself. This is why it is misleading to claim that substantive principles should have no place in the theorybecause they are merely philosophical proposals. Substantive principles are no more or less provisionalÐand no more or less philosophical proposalsÐthan thecase for deliberation itself. It is as possible to question, from within deliberative theory, whether deliberation is justi®ableÐand what it entailsÐas it is to question whether basic liberty is justi®ableÐand what it entails.
Consider the deliberation in Commons about whether NICE itselfÐalso a deliberative forumÐis the justi®able way to make health care decisions. This part of the debate began when several MPs objected that letting NICE makerecommendations is ``to shield the Government from the very dif®cult decisions that have to be taken.'' Should NICE recommend beta interferon, which costsabout £10,000 per patient per year and hasbeen judged ``marginally effective''? (It treats incurable multiple sclerosis ``by reducing the exacerbation rate inpatients who have relapsing±remitting disease without important disability.''13) Should NICE recommend the new taxane drugsfor chemotherapy, which do notcure but, asone MP put it, ``can add yearsto life at a cost of about £10,000 per year''? If NICE recommends against prescribing expensive new drugs that canprovide some health care bene®ts to patients, will it thereby be shielding the Government from pressure to increase the total NHS budget? If NICE recommends in favor of the NHS prescribing these drugs, will it thereby beforcing the NHS not to fund some other existing and highly valuable treatments (or pressuring the Government to increase funding for the NHS)? The answer tothese substantive questions thus depends on taking a position on what the process Not even the deliberative principle that callsfor giving moral reasonsin politics is beyond reasonable disagreement. Some critics of deliberation arguethat bargaining isnot only more common but also preferable asa way of resolving moral disagreements in politics. The claim that self-interested (or group-interested) bargaining processes are better than deliberative ones relies onthe premise that interest-based politics is more morally desirable and mutually justi®able than a deliberative politics. Whether political bargaining satis®esreciprocity (or any other moral standards) depends in part on the actual consequences of political bargaining in a particular social context. If thoseconsequences can be shown to be mutually justi®able to the people who are bound by them, or more mutually justi®able than the consequences ofdeliberative processes, then to this extent substituting bargaining for deliberation would satisfy the fundamental aim of deliberative democracy. Atleast one claim that deliberative democrats often make about the general superiority of deliberation over bargaining would need to be revisedÐbut revised in order to satisfy the demands of deliberative theory itself.
In any actual political context, a general defense of bargaining is not likely to be plausible. The main problem with bargaining as a general substitute fordeliberation is that it accepts the current distribution of resources and power as a baseline, the place to begin the negotiations. On the face of it this is not the bestsite for a moral defense of democratic procedures or outcomes.14 It issigni®cant that no one defending NICE'srejection of Relenza attempted to justify the 13E. Rous et al., ``A purchase experience of managing new expensive drugs: interferon beta,'' British Medical Journal, 313 (November 9, 1996), 1195±6.) 14Gutmann and Thompson, Democracy and Disagreement, pp. 57±8.
decision as the outcome of bargaining. Nor did anyone in Commons suggest that bargaining should play any role in the process, as they might propose for a labor± management dispute, or a controversy about tax policy.
Isthere no limit to what deliberative democratscan treat asprovisional? They can encourage reinterpretationsof the meaning and implicationsof deliberativeprinciples, even the guiding principle of reciprocity, but they cannot accommodate the wholesale rejection of the moral justi®cation required notonly by reciprocity but many other morally based democratic theories.
Deliberative democrats can welcome criticism of any of their principles,including reciprocity, but they cannot accept a general rejection of the requirement that binding political decisions must be justi®ed by moral reasons.
The refusal to give up that requirement is not peculiar to deliberative democracy.
To reject the idea of moral reasoning in politics tout court isto abandon not only deliberative democracy, but also any form of democracy that would claim that itslawsare justi®ed to the citizenswho are bound by them. Although criticsof deliberative democracy sometimes write as if they reject moral reasoning inpolitics, they rarely face up to what such a rejection would entail either in What such rejection would meanÐeven in a partial form in a particular caseÐ can be illustrated by imagining what would have happened if NICE had made itsdecision about Relenza on the basis of considerations of bargaining power. The single most powerful agent in this case, the one who stood to gain the most from NICE's decision, was Relenza's manufacturer and distributor, the Glaxo±Wellcome pharmaceutical company. When Glaxo executiveslearned of the possibility that NICE might recommend against NHS funding of Relenza, theythreatened to abandon Glaxo's operations in the UK. They also said they would encourage other pharmaceutical companiesto boycott the British economy. Asitturned out, NICE stood its ground and Glaxo backed down from its threat.
Deliberation and justice coincided in this case, and both prevailed. That wouldhave not been the outcome, given the baseline distribution of power, had NICE Deliberative democrats thus rejectÐand not just provisionallyÐany theory that denies the need for moral justi®cation, and therefore also any theory that bases politics only on power. Deliberative democrats are committedÐand notjust provisionallyÐto mutually justi®able ways of judging the distribution of power. Deliberative democracy acceptsthe provisionality of itsprinciplesbutrejects the provisionality of moral reasoning itself as a way of assessing politics.
Theorists who claim that politics is only about power must reject far more thanthe moral termsand the adjudicative meansof deliberative democracy. They must also reject criticism of any current distribution of power, however unjust itmay be. Or if they criticize it, they must do so in terms thatÐon their own viewÐ the persons who would be constrained by the power have no moral reason to accept. If they decline to search for political principles and practices that can be mutually justi®ed, who should listen to them? Certainly no one who is motivated to ®nd fair termsof social cooperation. Their audience can be only people who have themselves already given up on ®nding mutually defensible reasons. Thosewho would renounce reciprocal reasons are therefore trying either to persuade the already converted or to reach the unreasonable. In the ®rst case their audiencehas no need and in the second case no reason to listen.15 IV. WHY THE PRINCIPLES SHOULD BE POLITICALLY PROVISIONAL We are now in a better position to address the second objection against includingsubstantive principles in deliberative democratic theoryÐthat their inclusion usurps the political authority of democratic citizens. A democratic theory thatincludes substantive principles can declare that a law citizens make is unjust, however correct the proceduresby which they make it. It isno comfort to thedefender of the authority of citizens to be told that the substantive principles are morally provisional. Even morally provisional principlesÐif they are the most theoretically justi®able at the timeÐcarry the implication that they should bepolitically enacted. Acting on thisimplication deniesdemocratic citizensthe authority to determine through a deliberative process what should be politicallyenacted and why. To respond to this objection, deliberative democracy relies on the second kind of conditional statusÐpolitical provisionality.
Political provisionality means that deliberative principles and the laws they justify must not only be subject to actual deliberation at some time, but also thatthey be open to actual reconsideration and revision at a future time. Like the rationale for treating principles as morally provisional, the justi®cation for regarding principles as politically provisional rests on the value of reciprocity.
From the perspective of reciprocity, persons should be treated not merely as objects of legislation or as passive subjects to be ruled. They should be treated aspolitical agentswho take part in governance, directly or through their accountable representatives, by presenting and responding to reasons thatwould justify the laws under which they must live together. We showed earlier (in Section I) why reciprocity requiresactual not merely hypothetical deliberation.
Because deliberative principles must be justi®ed in an actual deliberative process in which citizensor their accountable representativestake part, the politicalauthority of democratic citizens is to a signi®cant degree respected.
But it still may be objected that once a principle or law is justi®ed in this process, it acts as a constraint on other new laws that citizens may wish to make.
Because the body of citizens and their representatives who deliberate about the new laws are never exactly the same as those who enacted the old laws, thedemocratic authority of citizensat any particular time isheld hostage to principles justi®ed at a previous time. Providing such constraints is of course what constitutions are supposed to do, and that may be why some deliberative democratsare wary about regarding their principlesaspart of a constitution. But if all the principles of deliberative democracy are seen as provisional in the senseof being open to revision over time, these constitutional constraints that embody substantive principles such as basic liberty and opportunity are not so threateningto the political authority of citizens.
Deliberative democratsdo not favor continual deliberation, but they are committed not only to deliberation about laws at some time but also to the possibility of actually reconsidering them in the future. The extent to which anylaw is subject to actual reconsideration should depend on the strength of the available moral reasons and empirical evidence (and any other morally relevantconsiderations) supporting it, which often change over time. In the case of Relenza, part of the reason that NICE's decision was justi®ed is that it called for review after a year'stime, an appropriate interval in light of the signi®cantchanges that may occur over the course of even a single ¯u season. A decision by any of®cial body not to fund Relenza even if otherwise well supported would notbe justi®ed without its providing for the possibility of continuing deliberation in the future. To be sure, at some point a decision is reached, as it was in this case,and it is justi®ably enforced. But deliberative theory emphasizes, more than other democratic theories, what happens before the decision andÐeven more to thepoint of provisionalityÐwhat happens after.
Political provisionality thus goes further than its moral counterpart. It implies that principlesshould be open to challenge over time in an actual politicalprocess that not only permits but encourages revision. Even when a law is rightly enacted today, the practices and institutions of deliberative democracy shouldensure that it is subject to the regular reconsideration that is necessary to its justi®cation over time. Deliberative democrats should therefore be especiallysuspicious of practices that routinely defer to the ``intent of the framers'' or that make constitutional amendments almost impossible even when the inheritedreasons for supporting the laws in question are not compelling. Deliberative democrats should be favorably disposed toward practices that attach sunsetprovisions to everyday laws and procedures, and require administrators to issue periodic ``impact statements'' describing the effects of these laws and the regulationsthat enforce them. We noted earlier that the moral justi®cation forNICE's decision against funding RelenzaÐthe claim that the use of Relenza does not signi®cantly affect anyone's basic opportunity in lifeÐdepends in part onevidence that the drug does not signi®cantly reduce complications in high-risk patients. In its deliberations, NICE demonstrated its respect for politicalprovisionality by taking speci®c institutional measures: limiting their decision to one ¯u season, providing for continuing review, and recommending furtherresearch.
The objection that the presence of substantive principles in a deliberative theory pre-emptsdemocratic authority, it should now be clear, either provestoo much or too little. It proves too much if the mere inclusion of substantive principles is taken to imply that these principles must therefore be politically binding on citizens. This objection would apply equally to the inclusion ofprocedural principles, which may be no less reasonably contestable than substantive principles. If the objection were accepted, it would requiredemocratic theory to exclude all reasonably contestable principles, procedural aswell assubstantive. The objection provestoo little if the complaint isonlyagainst making provisional judgments (however substantive) that challenge laws enacted by proper procedural methods. Even the critics of deliberativedemocratic theory could hardly fault it for rendering provisional judgments of this kind. If political theory were disbarred from offering such judgments, itwould have little relevance to the democratic politicsit purportsto criticize.
V. WHEN MORAL AND POLITICAL JUDGMENTS CONFLICT Ideally, the moral and political judgmentsthat deliberative democracy renders coincide. What deliberative politics decides will satisfy deliberative morality.
Indeed, this happy conjunction occurs more often than is usually assumed. In the case of NICE, the decision against funding Relenza, made in a process that wasmore deliberative than that in which such decisions were made in the past, seems to be morally justi®ed (at least provisionally). The most reliable studies, asreported by NICE, show that the only bene®t of Relenza is a one-day reduction of in¯uenza symptoms in the median patient at a direct ®nancial cost to the public of as much as 10 million pounds annually. NICE also took into account the costof the expected increase in visits to doctors by typical in¯uenza patients (most of whom are otherwise healthy), and the risk that the increase would overload thehealth care system for a very minor health bene®t. Furthermore, NICE found no evidence that Relenza reduces any of the serious, life-threatening effects ofin¯uenza on high-risk patients.
Nevertheless, there were some critics who raised reasonable moral objections to NICE's decision. In the Commons debate, the physician±MP mentioned earlier complained that the decision not to cover Relenza discriminated against poor people. ``When we talk about rationing of NHS treatments, we aren't saying noone in the UK hasthem. What we are saying isthat they aren't available to poor people. The rich and those who can afford it can get these treatments privately.''The money saved for all patients would be at the expense of the poor because more af¯uent citizens could obtain Relenza by means of postcode prescribing.
The decision by NICE against funding Relenza would therefore at least appear to be sacri®cing the welfare of some poorer citizens in order to save taxpayermoney.
Whatever the meritsof thisMP'scriticism, all partiesto the dispute over Relenza should be able to agree that he has raised a serious moral question about a decision that was reached by politically justi®able (deliberative) process. Even if, under current conditions, the NHS cannot do anything about this differential access to drugs such as Relenza, defenders of the decision (and other similarly hard choices) should be prepared to acknowledge the moral costs inherent in asituation in which rich people tend to live in richer districts that provide better health care and they also can buy any health care treatment on the market whilepoor people are completely dependent on the NHS for funding those treatments that may be cost-effective for society as a whole.
In this case there was some reasonable disagreement about whether the political judgment conformed to the moral judgment, but in many other casesthere may be no doubt that the (procedurally correct) political judgment con¯icts with the (carefully considered) moral judgment. A deliberative process thatdeliberative democratsrecommend may yield an outcome that runscontrary to one or more of the substantive principles of justice that deliberative democrats also wish to defend. This kind of con¯ict does not seem to be a serious problemfor a purely substantive theory, which simply declares the outcome of the process unjust. Similarly, a purely procedural theory faces no serious problem here either;it declaresthe outcome just, aslong asthe procedureswere proper. But, aswe have seen, a deliberative democratic theory should include both procedural andsubstantive principles because the pure approaches at best neglect and at worst deny the moral complexity of democratic politics. A democratic theory thatrecognizes what is morally at stake in political decision-making must contain principles that are both substantive and procedural. Moreover, as we have also seen, the basic premise of deliberative democratic theoryÐreciprocity that callsfor mutual justi®cation among free and equal personsÐsupports both substantive Thus, compared to the purer theories, deliberative democracy more fully faces up to the potential con¯ictsbetween moral and political deliberation. It doesnotprovide a simple resolution, but instead relies on deliberation itself to deal with the con¯icts as they arise. But then the question persists: how can deliberativedemocrats af®rm substantive conclusions about politics and still support the value of actual deliberation, which may or may not produce those sameconclusions? Political philosophers, including deliberative democrats like us, reach substantive conclusions (including conclusions about what procedures are most justi®able) without engaging in any actual political deliberation. This seemsto ¯y in the face of the commitment to actual rather than hypothetical adjudication of political disagreements.
Some criticsof deliberative democracy pose thisproblem asa paradox of deliberative democracy.16 The criticsargue that if, on the one hand, they acceptthe arguments and conclusions of a substantive deliberative theory (such as the one we present in Democracy and Disagreement), they need not bother calling 16Frederick Schauer, ``Talking asa decision procedure,'' Deliberative Politics, ed. Macedo, for actual political deliberation. The substantive theory provides all the reasons anyone who accepts it needs for making sound political judgments, and without the aid of any actual deliberation. If, on the other hand, criticsreject thearguments and conclusions of the substantive theory, then they should also reject the deliberation that it recommends. Either way, deliberative theory that includessubstantive principles seems to eliminate the need for the practice of deliberation.
As our earlier discussion of moral and political provisionality should indicate, substantive principles (even the political conclusions) that deliberativedemocratsdefend do not pre-empt actual deliberation. According to the very terms of the theory, the (substantive and procedural) principles and conclusionsneed to be subjected to the rigors of actual deliberation over time; that is part of what it means to treat them as politically provisional. (Moral provisionality also bene®ts indirectly from political provisionality, because individuals thinking inthe privacy of their own homes or of®ces often draw on ideas, arguments, and perspectivesÐor respond to challengesÐthat public deliberations bring to theirattention.) Deliberative democratsoffer their principlesand conclusionsnot as authoritative philosophical constraints on democratic politics but as provisionalcontributionsto democratic deliberation.
The conclusions that deliberative democrats reach about substantive and procedural principles should be understood as normative hypotheses about political morality. Given certain assumptions about reciprocity, for example, certain principles are the most mutually justi®able. The hypotheses are normativebecause simply showing that some people, even a majority, in fact reject the principlesor their policy implicationsdoesnot refute them. Restricting coveragefor experimental drugsto only those who are willing to participate in random clinical trials, for example, may be the best policy even if a majority of citizensreject it.
But the principles and policies recommended by deliberative theorists are still hypotheses because they may be refuted or re®ned by showing that there are better arguments for competing principles or conclusions in the same context.
And they are hypotheses about political moralityÐnot morality in generalÐ because their con®rmation, refutation, or revision calls for public deliberation in the democratic process. Whether a normative hypothesis is con®rmed, refuted, orre®ned, this kind of criticism can succeed only by subjecting rival arguments to the rigors of actual deliberation. Deliberative theorists should of course take intoaccount the imperfections from which any such process suffers in practice. But so should they take account of the imperfections in their own process of reasoning,less obvious though these imperfections may be (to them if not to other theorists).
The problem of the con¯ict between moral and political judgment is misconceived if it is understood as requiring a choice in general or in advance between substantive and procedural principles. Both kinds of principles are subject to deliberation and are equally provisional in the way we have described.
The choice between substantive and procedural principlesÐwhen they con¯ictÐ is similarly subject to deliberation and should accordingly be regarded as provisional. Neither substantive nor procedural principles have priority eventhough citizens sometimes justi®ably choose one over the other at some In the debate about NICE in Commons, both the critics and the defenders appealed to both substantive and procedural principles. They addressed thejustice of the decision (does it violate equal opportunity by hurting poor people?), and the process (does it insulate the government from demands to increaseexpendituresfor health care?). Even while agreeing that the processwasbetter than in the past, some critics challenged the substance of the decision. And evenwhile agreeing that the substance of the decision was correct, some critics questioned the process. Some criticized and some defended both substance and process. But no one tried to argue that as a general rule one had priority over theother, or that the disagreement should be resolved by deciding once and for all whether substantive or procedural principles should prevail. In this respect thedebate in Commonsillustrated the nature of public deliberation in many of the best democratic forums. The debate also captured the moral complexity ofdemocratic politics far better than do theories that seek to resolve the con¯ict of substance and procedure by excluding one or the other, or declaring one ratherthan the other trump.
Deliberative democratic theory can and should go beyond process. It can consistently incorporate both substantive and procedural principles. It should gobeyond process for many reasons that we have suggested, but above all because its core principleÐreciprocityÐrequires substantive as well as proceduralprinciples. Reciprocity is widely accepted as a core principle of democracy, but even those democrats who do not emphasize this principle argue from ideals suchas free and equal personhood, mutual respect or avoidance of majority tyranny, which like reciprocity require both substantive and procedural principles tojustify the laws that democracies adopt.
Deliberative democratic theory isbetter prepared to deal with the range of moral and political challengesof a robust democratic politicsif it includesboth substantive and procedural principles. It is well equipped to cope with the con¯ict between substantive and procedural principles because its principles are tovarying degreesmorally and politically provisional. Deliberative democratic theory can avoid usurping the moral or political authority of democraticcitizensÐand yet still make substantive judgments about the laws they enactÐ because it claims neither more, nor less, than provisional status for the principlesit defends.

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