Correspondence to Ms Heather Patton Griffin, Theology, Medicine, and Culture Initiative, Duke Divinity School, Durham, NC 27708, USA; heather.griffin@duke.edu Greenblum and Hubbard argue that physicians are duty-bound by the constraints of Rawlsian ‘public reason’ to avoid engaging their patients’ religious considerations in medical decision-making.1 This position offers a number of appealing benefits to physicians. Physicians whose minds have already been formed to resonate with Rawlsian arguments can take this harmony as confirmation of their membership in the group of ‘all reasonable persons’ who know ‘public reason’ when they see it.5 6 This reinforces the ethical echo chamber, protecting the cooperative activities of medicine from the threat of pluralistic conflict that might stall work while wasting energy that could be used in caring for patients.2 7 But Rawls himself stands in a substantive philosophical tradition, one that is founded on two primary dogmas: first, that some ethical judgments can be affirmed as reasonable by all reasonable persons regardless of their plural substantive visions of the good life. ...that ‘religious’ judgments are the quintessential example of sectarian reasoning which must be banished from the authoritative space of ‘public reason’.2–4 6 7 Critics of Rawls have long pointed out that his foundational concept of ‘public reason’ is empty, which is also why it is useful.3 6 7 Anointed with prestige, ‘public reason’s’ hollowness hallows whatever substantive commitments are smuggled inside its shiny shell.6 7 Labelled as ‘public reason’, these weighty substantive commitments are loaded onto the scale in a putative effort to balance the plural concerns of patients, family members, physicians and medical institutions.