Often, a health resource distribution (or, more generally, a health policy) ranks higher than another on one value, say, on promoting total population health; and lower on another, say, on promoting that of the worst off. Then, some opine, there need not be a rational determination as to which of the multiple distributions that partially fulfill both one ought to choose. Sometimes, reason determines only partially, intransitively, or contentiously which of the many “compromises” between these two values is best or most choiceworthy. Norman Daniels, Ruth Chang, Martijn Boot, and Anders Herlitz affirm this opinion, which I shall call “value incommensurability,” “rational underdeterminacy,” or “reasonable disagreement.” To decide between the multiple reasonable compromises on health resource distribution, these philosophers recommend a deliberative democratic process, on two main grounds. First, in such situations, deliberation can produce the determinacy needed for decisionmaking. Second, by treating respectfully and justly even those patients or communities for whom the distributive compromise selected is bad, deliberation shields the legitimacy of that policy. Increasingly, practically-oriented bioethics recommends democratic deliberation even more expansively than these philosophers do—for nearly every decision on health resource distribution and not only when values are incommensurate—on these two grounds and on others. And one could propose a more modest variant on this expansive move as the justification of democratic deliberation. I argue that none of these moves warrants democratic deliberation on health policy.

通常，一项卫生资源分配（或更一般地说，一项卫生政策）在一个价值上高于另一个，例如，在促进总体人口健康方面;而另一个则低于另一个，比如说，在促进最贫困者的情绪上。那么，一些人认为，不需要理性地确定应该选择部分满足两者的多个分配中的哪一个。有时，理性只能部分地、不及物地或有争议地决定这两个价值之间的许多“妥协”中哪一个是最好的或最值得选择的。诺曼·丹尼尔斯（Norman Daniels）、露丝·张（Ruth Chang）、马丁·布特（Martijn Boot）和安德斯·赫利茨（Anders Herlitz）肯定了这一观点，我将其称为“价值不可比性”、“理性不确定性”或“合理分歧”。为了在卫生资源分配的多种合理妥协之间做出决定，这些哲学家基于两个主要理由建议采用审议民主过程。首先，在这种情况下，深思熟虑可以产生决策所需的确定性。其次，通过尊重和公正地对待那些选择分配妥协是坏的病人或社区，深思熟虑保护了该政策的合法性。越来越，以实践为导向的生物伦理学比这些哲学家更广泛地建议进行民主审议——对于几乎所有关于健康资源分配的决定——不仅仅是在价值观不相称时——基于这两个理由和其他理由。人们可以对这一广泛的举措提出一个更温和的变体，作为民主审议的正当理由。我认为，这些举措都不值得对卫生政策进行民主审议。