This chapter contains sections titled: Deductive Rules and Fulfilling Commitments Rules as Programs for Routine Expansion Rules in Deliberate or Inferential Expansion What Recommends Scientific Method over Other Methods of Fixing Belief? Deliberation and Inconsistency.

The objective of this article is to analyse and compare four methods of ethical case deliberation. These include Clinical Pragmatism, The Nijmegen Method of ethical case deliberation, Hermeneutic dialogue, and Socratic dialogue. The origin of each method will be briefly sketched. Furthermore, the methods as well as the related protocols will be presented. Each method will then be evaluated against the background of those situations in which it is being used. The article aims to show that (...) there is not one ideal method of ethical case deliberation, which fits to all possible kinds of moral problems. Rather, as each of the methods highlights a limited number of morally relevant aspects, each method has its strengths and weaknesses as well. These strengths and weaknesses should be evaluated in relation to different types of situations, for instance moral problems in treatment decisions, moral uneasiness and residue, and the like. The suggestion arrived at on the basis of the findings of this paper is a reasonable methodological plurality. This means that a method can be chosen depending on the type of moral problem to be deliberated upon. At the same time it means, that by means of a method, deliberation should be facilitated. (shrink)

As one of the most influential comparative philosophers of our time, Henry Rosemont, Jr. is known for his unrelenting criticisms against Western libertarian ideas, and for advocating ideas derived from classic Confucian thought. One of the criticisms against him is that his views are one-sided, and hence unfair to Western libertarian ideas. In this paper, I argue that Rosemont’s one-sidedness is deliberate. His theory is not intended to be a balanced account. I will illustrate that Rosemont’s way of conceiving the (...) human self is not peculiar to him, but characteristic of those who take philosophy as a way of life, such as Mencius and Sartre. I shall argue that their practices suggest a gong-fu perspective, with which we evaluate philosophical theories according to their functions in shaping people’s behaviors and with consideration of the context of their uses. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is (...) the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is (...) the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

Following a discussion of some historical roots of conscience, we offer a systematized version of reflective equilibrium. Aiming at a comprehensive methodology for bioethical deliberation, we develop an expanded variant of reflective equilibrium, which we call ‘triangular reflective equilibrium’ and which incorporates insights from hermeneutics, critical theory and narrative ethics.We focus on a few distinctions, mainly between methods of justification in ethics and the social practice of bioethical deliberation, between coherence in ethical reasoning, personal integrity and consensus (...) formation, and between political and moral deliberation.The ideal of deliberation is explicated as a sharing of conscience within a special commitment to sincerity and openness to persuasion. Personal growth in wisdom is an indirect by-product of the continuous practice of moral deliberation. This is explicated in the light of Sternberg's balance theory of wisdom and in the context of medicine as a profession embodying altruistic responsibilities of care in democratic and pluralistic societies. (shrink)

BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral (...) Case Deliberation with the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method.ResultsThe didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case.DiscussionThe reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue.ConclusionThe specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice. (shrink)

Philosophical Deliberations continues Rescher s longstanding practice of publishing groups of philosophical essays. Notwithstanding their thematic diversity, these discussions exhibit a uniformity of method in addressing philosophical issues and a commonality of objective: the elucidation of philosophically pivotal ideas.".

There is an increased focus on fostering integrity in research by through creating an open culture where research integrity dilemmas can be discussed. We describe a pilot intervention study that used Moral Case Deliberation (MCD), a method that originated in clinical ethics support, to discuss research integrity dilemmas with researchers. Our research question was: can moral case deliberation in research groups help to navigate research integrity dilemmas? We performed 10 MCDs with 19 researchers who worked in three different (...) research groups from three different disciplinary fields at a university in the Netherlands. We analyzed the dilemmas and values discussed, sent out a survey questionnaire to assess self-perceived moral competencies, and conducted in-depth interviews. We found research integrity dilemmas pertained to authorship disputes, supervision of junior co-workers, and questionable handling of data. Participants perceived the majority of moral competencies to a higher degree during the MCD when compared to perceiving them in daily practice afterward. Interviewees told us that they felt most comfortable discussing dilemmas among peers with whom they were not closely affiliated. We conclude that MCD sessions could be relevant in navigating research integrity dilemmas, but that revisions to ensure commitment and safety are required. (shrink)

In this paper, we examine two methods of public participation, namely consensus conference and public hearing. While both methods are used in order to involve the public in decision making about science and technology policy, they differ in a number of aspects. Consensus conference seeks the active participation of a selected group of citizens who are expected to elaborate cooperatively a text of recommendations. Public hearing seeks to inform the public and to collect as many reactions by it (...) as possible. In our analysis, we consider the characteristics of these two methods described in the social and political sciences literature as institutional constraints that can play a role in the production of argumentative discourse. We focus our study on the discourse produced in two concrete instances of the application of these participatory methods on the deliberation over the development of nanotechnology in France. More specifically, we study the expression of counter discourse and seek to describe how the participants in the two deliberation processes end up managing the institutional constraints in order to have their criticisms expressed. In this way, we propose a bottom-up approach to the theorization of the role that institutional context plays in the practice of argumentation, and discuss the descriptive adequacy of existing definitions of the deliberative genre within argumentation studies. (shrink)

The question of how democracy can deal with cultural diversity has become more central than ever. The increasing flow of people to many Western democratic countries indicates that our societies will become more and more multicultural. But what is the best way for democracy to deal with cultural diversity? It has been argued that, given its communicative core, the Habermasian model of deliberative democracy provides a platform where cultural groups can concur on peaceful agreements. In this paper, I show the (...) limits of this model of democracy in relation to diverse cultural traditions to public interactions. I will discuss the case of societies and ethnic groups of a Confucian heritage and show that Habermas’ account of public deliberation is not a neutral method for facilitating political decision making, but is culturally biased. (shrink)

Background This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.Methods We adapted democratic deliberation, an approach to stakeholder engagement, (...) for use with three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.Results A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.Conclusion The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described. (shrink)

BackgroundCase consultation performed by clinical ethics committees (CECs) is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical (...) problems intertwined. Clinicians rated the average CEC consult highly, being both satisfied with the process and perceiving it to be useful across a number of aspects. CEC evaluations corresponded well with those of clinicians in a large majority of cases. Having next of kin/patients present was experienced as predominantly positive, though practised by only half of the CECs. The educational function of the consult was evaluated more positively when the CEC used a systematic deliberation method.ConclusionsCEC case consultation was found to be a useful service. The study is also a favourable evaluation of the Norwegian CEC system, implying that it is feasible to implement well-functioning CECs on a large scale. There are good reasons to involve the stakeholders in the consultations as a main rule. (shrink)

Background. Since the nineties, policymakers and theorists working across several disciplines started to entertain the notion of directly engaging the public in matters of public concern. Accompanying this was the attempt to resort to deliberative democracy in order to make such an involvement effective. Seizing on its intrinsic dialogic nature, some scholars proposed the application of public deliberation to the realm of public bioethics. Drawing upon the theory and practice of deliberative public bioethics, the purpose of this paper is (...) to shed light onto the figure of the bioethical expert and its role in public bioethics, and relatedly, to investigate how deliberation may be implemented in a public bioethics context. Methods. We set up a large-scale experiment to investigate whether, and to what extent, different moderation styles impact on participants’ moral preferences. The study combines a survey of a representative sample of the general population with a laboratory experiment based on a random sample of students that ex-ante has identical attitudes to the general population.Results. Findings show that: i) different moderation styles can significantly influence deliberative outcomes; iii) the effects of deliberation are not necessarily immediate, but may be revealed after the end of deliberative session; iii) participants tend to better appreciate a bioethical expert acting as “passive moderator”, namely as someone who acts in order to ensure non-domination and non-interference, thus allowing the creation of basic conditions for equality within the deliberative setting.Conclusions. Our experiment represents an example of how deliberation can be employed in public bioethics. (shrink)

Standard methods for teaching Deliberative Democratic Theory (DDT) in the philosophy classroom include presenting theories in the historical order in which they originated, by theorist (or groups of theorists) or in various thematic categories, including criticisms of the theories. However, if Simone Chambers is correct and DDT has truly entered “a working theory stage,” whereby the theory and practice of deliberation receive equal consideration, then such approaches may no longer be appropriate for teaching DDT. I propose that DDT (...) be taught using the Critical Friends (CF) discussion protocol. This protocol enables high quality deliberation in the context of a supportive intellectual community. The key advantage of my proposal is that the CF pedagogical framework empowers students to conceive DDT through the lens of their own and others’ deliberative practices. By referring to a rather than the strategy, this proposal does not specify the single right way to teach DDT, but suggests one among a field of possibilities. (shrink)

Public participation is increasingly an aspect of policy development in many areas, and the governance of biomedical research is no exception. There are good reasons for this: biomedical research relies on public funding; it relies on biological samples and information from large numbers of patients and healthy individuals; and the outcomes of biomedical research are dramatically and irrevocably changing our society. There is thus arguably a democratic imperative for including public values in strategic decisions about the governance of biomedical research. (...) However, it is not immediately clear how this might best be achieved. While different approaches have been proposed and trialled, we focus here on the use of public deliberation as a mechanism to develop input for policy on biomedical research. We begin by explaining the rationale for conducting public deliberation in biomedical research. We focus, in particular, on the ELS (ethical, legal, social) aspects of human tissue biobanking. The last few years have seen the development of methods for conducting public deliberation on these issues in several jurisdictions, for the purpose of incorporating lay public voices in biobanking policy. We explain the theoretical foundation underlying the notion of deliberation, and outline the main lessons and capacities that have been developed in the area of conducting public deliberation on biobanks. We next provide an analysis of the theoretical and practical challenges that we feel still need to be addressed for the use of public deliberation to guide ethical norms and governance of biomedical research. We examine the issues of: (i) linking the outcomes of deliberation to tangible action; (ii) the mandate under which a deliberation is conducted; (iii) the relative weight that should be accorded to a public deliberative forum vs other relevant voices; (iv) evaluating the quality of deliberation; and (5) the problem of scalability of minipublics. (shrink)

Background Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input.Methods We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of (...) childhood vaccination.Results 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children.Conclusions We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination. (shrink)

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

Brian Skyrms constructs a theory of "dynamic deliberation" and uses it to investigate rational decision-making in cases of strategic interaction. This illuminating book will be of great interest to all those in many disciplines who use decision theory and game theory to study human behavior and thought. Skyrms begins by discussing the Bayesian theory of individual rational decision and the classical theory of games, which at first glance seem antithetical in the criteria used for determining action. In his effort (...) to show how methods for dealing with information feedback can be productively combined, the author skillfully leads us through the mazes of equilibrium selection, the Nash equilibria for normal and extensive forms, structural stability, causal decision theory, dynamic probability, the revision of beliefs, and, finally, good habits for decision. The author provides many clarifying illustrations and a handy appendix called "Deliberational Dynamics on Your Personal Computer." His powerful model has important implications for understanding the rational origins of convention and the social contract, the logic of nuclear deterrence, the theory of good habits, and the varied strategies of political and economic behavior. (shrink)

During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and (...) ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics. (shrink)

Crombie's acceptance of the deliberate commission of a category mistake in his defense of the meaningfulness of theological statements raises a pointed challenge to the philosophy of Ryle which seems not to have been specifically addressed in subsequent literature. We review the analysis which leads Crombie into it, including concepts of anomaly, deficiency, affinity, and inadequate notion, noting basic differences in method and attitude from Ryle. We express our own agreements and disagreements in keeping with an overall concern for the (...) preservation of rationality in this sphere of language, finding acceptable distinct contributions to that end from both. (shrink)

Building on an illustrative case of a systemic environmental threat and its multi‐stakeholder response, this paper draws attention to the changing political impacts of corporations in the digital age. Political Corporate Social Responsibility (PCSR) theory suggests an expanded sense of politics and corporations, including impacts that may range from voluntary initiatives to overcome governance gaps, to avoiding state regulation via corporate political activity. Considering digitalization as a stimulus, we explore potential responsibilities of corporations toward public goods in contexts with functioning (...) governments. We show that digitalization—in the form of transparency, surveillance, and data‐sharing—offers corporations’ scope for deliberative public participation. The starry sky beetle infestation endangering public and private goods is thereby used to illustrate the possibility of expanding the political role of corporations in the digital sphere. We offer a contribution by conceptualizing data‐deliberation as a Habermasian variation of PCSR, defined as the (a) voluntary disclosure of corporate data and its transparent, open sharing with the public sector (b) along with the cooperation with governmental institutions on data analytics methods for examining large‐scale datasets (c) thereby complying with existing national and international regulations on data protection, in particular with respect to privacy and personal data. (shrink)

Background Clinical moral case deliberation consists of the systematic reflection on a concrete moral case␣by health care professionals. This paper presents the study of a 4-year moral deliberation project.Objectives The objectives of this paper are to: (a) describe the practice and the theoretical background of moral deliberation, (b) describe the moral deliberation project, (c) present the outcomes of␣the evaluation of the moral case deliberation sessions, and (d) present the implementation process.Methods The implementation process is (...) both monitored and supported by an interactive responsive evaluation design with: (a) in-depth interviews, (b) Maastricht evaluation questionnaires, (c) evaluation survey, and (d) ethnographic participant observation. In accordance with the theory of responsive evaluation, researchers acted both as evaluators and moderators (i.e. ethicists).Results Both qualitative and quantitative results showed that the moral case deliberations, the role of the ethics facilitator, and the train-the-facilitator program were regarded as useful and were evaluated as (very) positive. Health care professionals reported that they improved their moral competencies (i.e. knowledge, attitude and skills). However, the new trained facilitators lacked a clear organisational structure and felt overburdened with the implementation process. The paper ends with both practical and research suggestions for future moral deliberation projects. (shrink)

In this chapter, I consider the claim for pluralism commonly advanced in political philosophy as a claim concerning the standards, methods, and norms for forming belief and judgment about certain kinds of facts, rather than concerning the nature of facts themselves. After distinguishing between descriptive and normative epistemic pluralism, I contend that, in this context, pluralism needs to rest on grounds that are stronger than fallibilism yet weaker than relativism in order to enjoy a distinct standing. The idea of (...) reasonable pluralism seems to devise a variety of normative pluralism designed to meet this demand. I argue, however, that this is an unstable position and suggest that an epistemic view of deliberation may be better suited to making sense of political justification. The latter view, though, is bound to dispense with normative pluralism. (shrink)

This article investigates the prospects of deliberative democracy through the analysis of small-scale deliberative events, or mini-publics, using empirical methods to understand the process of preference transformation. Evidence from two case studies suggests that deliberation corrects preexisting distortions of public will caused by either active manipulation or passive overemphasis on symbolically potent issues. Deliberation corrected these distortions by reconnecting participants’ expressed preferences to their underlying “will” as well as shaping a shared understanding of the issue.The article concludes (...) by using these insights to suggest ways that mini-public deliberation might be articulated to the broader public sphere so that the benefits might be scaled up. That mini-public deliberation does not so much change individual subjectivity as reconnect it to the expression of will suggests that scaling up the transformative effects should be possible so long as this involves communicating in the form of reasons rather than preferred outcome alone. (shrink)

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and (...) methodologies have emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

Global fatalities related to COVID-19 are expected to be high in 2020–2021. Developing and delivering a vaccine may be the most likely way to end the pandemic. If it were possible to shorten this development time by weeks or months, this may have a significant effect on reducing deaths. Phase II and phase III trials could take less long to conduct if they used human challenge methods—that is, deliberately infecting participants with COVID-19 following inoculation. This article analyses arguments for (...) and against such methods and provides suggested broad guidelines for regulators, researchers and ethics committees when considering these matters. It concludes that it may be possible to maintain current ethical standards yet still permit human challenge trials in a context where delay is critical. The implications are that regulators and researchers need to work together now to design robust but short trials and streamline ethics approval processes so that they are in place when applications for trials are made. (shrink)

Trial by jury is a fundamental feature of democratic governance. But what form should jury decision-making take? I argue against the status quo system in which juries are encouraged and even required to engage in group deliberation as a means to reaching a decision. Jury deliberation is problematic for both theoretical and empirical reasons. On the theoretical front, deliberation destroys the independence of jurors’ judgments that is needed for certain attractive theoretical results. On the empirical front, we (...) have evidence from both legal and non-legal contexts that group deliberation often leads to group judgments that are worse in a number of respects than judgments generated by non-interactional methods of judgment aggregation. Finally, I examine some possible alternatives to free-wheeling jury deliberation, including the constrained and structured deliberation embodied in the DELPHI method, voting, and averaging of probabilistic judgments. (shrink)

Joint practical deliberation is the activity of deciding together what to do. In this dissertation, I argue that several speech acts that we can use to alter our moral obligations – promises, offers, requests, demands, commands, and agreements – are moves within joint practical deliberation. -/- The dissertation begins by investigating joint practical deliberation. The resulting account implies that joint deliberation is more flexible than we usually recognize, in two ways. First, we can make joint decisions (...) not only about what we will do together, but also about what you or I will do alone. Second, we can deliberate by means of two distinct methods: propose-and-ratify, in which a proposed joint decision must be explicitly accepted to come into effect, and propose-and-challenge, in which a proposed joint decision comes into force unless it is explicitly challenged. -/- Varying these parameters generates a botany of different kinds of proposals we can make within joint deliberation. When we look at these proposals more closely, we make a surprising discovery: for each kind of proposal we can make in joint practical deliberation, there is an everyday speech act with the very same properties. A certain kind of proposal to make a joint decision regarding one’s own actions has the same normative effects, under the same conditions, as a promise. One kind of proposal to make a joint decision regarding one’s addressee’s actions has all the essential features of a command; another kind of deliberative proposal – with the same content but a different method of evaluation – looks exactly like a request. And so on. -/- These similarities are too systematic to be coincidental. The only explanation, I argue, is that these ordinary speech acts are identical to their doppelgängers within joint practical deliberation. Promises and offers are proposals to make joint decisions about what I will do. Commands, demands, and requests are proposals to make joint decisions about what you will do. And agreements are joint decisions about what we will do. Call this the deliberative theory of these speech acts. -/- Considering each speech act in turn, I defend the deliberative theory by arguing that it provides a uniquely powerful explanation of its targets’ social and moral significance. Once we see how naturally these speech acts fall out of our practice of joint deliberation, theories that treat them as sui generis – as many moral philosophers now do – will come to seem redundant and nonexplanatory. Conversely, thinking of promises, offers, commands, demands, requests, and agreements as moves within joint practical deliberation allows us to give an elegant and generative theory of these phenomena that have confounded moral philosophers for so long. (shrink)

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for (...) an ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

This essay argues that a black radical Kantianism proposes a Kantian theory of justice in the circumstances of injustice. First, I describe BRK’s method of political critique and explain how it builds on Kant’s republicanism. Second, I argue that Kant’s original account of public right is incomplete because it neglects that a situated citizenry’s adoption of an ideal contributes to its refinement. Lastly, with the aid of W.E.B. Du Bois’s analysis of American Reconstruction and his proposal of an “abolition democracy,” (...) I offer my refined universalizable standard for political critique. Du Bois reconceptualizes the requirements of justice to protect the political liberties and productive powers of black freedmen and the working poor. While originating with the political demands of black freedmen during the Reconstruction era, the universal protection of political liberties and productive powers offers a novel public standard for political judgment that should still anchor deliberation today. (shrink)

Background There has been little attention paid to research on the outcomes of clinical ethics support or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. Objective To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation, prior to MCD participation, and to compare results between respondents. Methods This mixed- (...) class='Hi'>methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. Results 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were ‘more open communication’, ‘better mutual understanding’, ‘concrete actions’, ‘see the situation from different perspectives’, ‘consensus on how to manage the situation’ and ‘find more courses of action’. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. Conclusions Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD. (shrink)

It has been argued that the precautionary principle is incoherent and thus useless as a guide for regulatory policy. In a recent paper in Bioethics, Wareham and Nardini propose a response to the ‘precautionary paradox’ according to which the precautionary principle's usefulness for decision making in policy and regulation contexts can be justified by appeal to a probability threshold discriminating between negligible and non‐negligible risks. It would be of great significance to debates about risk and precaution if there were a (...) sound method for determining a minimum probability threshold of negligible risk. This is what Wareham and Nardini aim to do. The novelty of their approach is that they suggest that such a threshold should be determined by a method of public deliberation. In this article I discuss the merits of Wareham and Nardini’s public deliberation method for determining thresholds. I raise an epistemic worry about the public deliberation method they suggest, and argue that their proposal is inadequate due to a hidden assumption that the acceptability of a risk can be completely analysed in terms of its probability. (shrink)

Moral case deliberation is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to (...) acquire expertise in dealing with moral questions independent of the expertise of an ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: ‘learning by doing’, ‘reflection instead of ready made knowledge’, and ‘dialogue on dialogue’. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions. (shrink)

The philosophy of mechanisms has developed rapidly during the last 30 years. As mechanisms-based explanations are often seen as an alternative to nomological, law-based explanations, MBEs could be relevant in IS. We begin by offering a short history of mechanistic philosophy and set out to clarify the contemporary landscape. We then suggest that mechanistic models provide an alternative to variance and process models in IS. Finally, we highlight how MBEs typically contain deliberate misrepresentations. Although MBEs have recently been advocated as (...) critical realist accounts in IS, idealizations seem to violate some fundamental tenets of CR and research method principles for CR. Idealizations in MBEs, therefore, may risk being regarded as flawed in IS. If it turns out that CR cannot account for idealizations, naturalism can, and it does so without extra-philosophical baggage. (shrink)

Coordination problems, problems in which each agent's expected utility depends upon what other agents do, pose a problem for act utilitarianism. When the agents are act utilitarians and know of each other that they are so, they seem unable to achieve optimal outcomes in certain coordination problems. I examine various ways the act utilitarian might attempt to solve this problem, where act utilitarianism is interpreted within the framework of subjective expected utility theory. In particular, a new method for computing expected (...) utility,dynamic deliberation, deserves examination as a possible act utilitarian solution to coordination problems. I argue that even dynamic deliberation fails to give the act utilitarian what he needs in coordination problems, and that the failure of act utilitarianism for such problems suggests the need for an alternative theory of moral choice along rule utilitarian lines. (shrink)

Approaches to clinical ethics dilemmas that rely on basic principles or rules are difficult to apply because of vagueness and conflict among basic values. In response, casuistry rejects the use of basic values, and specification produces a large set of specified rules that are presumably easily applicable. Balancing is a method employed to weigh the relative importance of different and conflicting values in application. We argue against casuistry and specification, claiming that balancing is superior partly because it most clearly exhibits (...) the reasoning behind moral decision-making. Hence, balancing may be most effective in teaching bioethics to medical professionals. (shrink)

A traditional approach to teaching medical ethics aims to provide knowledge about ethics. This is in line with an epistemological view on ethics in which moral expertise is assumed to be located in theoretical knowledge and not in the moral experience of healthcare professionals. The aim of this paper is to present an alternative, contextual approach to teaching ethics, which is grounded in a pragmatic-hermeneutical and dialogical ethics. This approach is called moral case deliberation. Within moral case deliberation, (...) healthcare professionals bring in their actual moral questions during a structured dialogue. The ethicist facilitates the learning process by using various conversation methods in order to find answers to the case and to develop moral competencies. The case deliberations are not unique events, but are a structural part of the professional training on the work floor within healthcare institutions. This article presents the underlying theory on ethics and illustrates this approach with an example of a moral case deliberation project in a Dutch psychiatric hospital. The project was evaluated using the method of responsive evaluation. This method provided us with rich information about the implementation process and effects the research process itself also lent support to the process of implementation. (shrink)

Background Although methods proposed for the conduct of ethics consultation tend to be viewed as competing approaches, they may in fact function in a complementary manner. Methods We describe the experience of ethics consultation in two ethics committees at the University Hospitals of Geneva, Switzerland. Results Both committees provide case consultation by a multi-disciplinary team of committee members, but with different processes. These differences in process do not necessarily lead to differences in outcome. Discussion Different methods of (...) ethics consultation are not mutually exclusive, and can co-exist within the same institution. The practical application of one method of ethics consultation can lead to substantial variations in process between different groups of consultants. Conclusion Despite the importance of clarifying theoretical groundings, and consultation and deliberation processes, in ethics consultation, choosing between different processes may not be pressing. To assist these choices, exploration of the practical strengths and weaknesses of different methods will be necessary to assist clinical ethicists, and clinical ethics committees, in acquiring a flexible and evidence-based set of approaches to their work. (shrink)

In clinical moral decision making, emotions often play an important role. However, many clinical ethicists are ignorant, suspicious or even critical of the role of emotions in making moral decisions and in reflecting on them. This raises practical and theoretical questions about the understanding and use of emotions in clinical ethics support services. This paper presents an Aristotelian view on emotions and describes its application in the practice of moral case deliberation.According to Aristotle, emotions are an original and integral (...) part of (virtue) ethics. Emotions are an inherent part of our moral reasoning and being, and therefore they should be an inherent part of any moral deliberation. Based on Aristotle's view, we examine five specific aspects of emotions: the description of emotions, the attitude towards emotions, the thoughts present in emotions, the reliability of emotions, and the reasonable principle that guides an emotion. We then discuss three ways of dealing with emotions in the process of moral case deliberation. Finally, we present an Aristotelian conversation method, and present practical experiences using this method. (shrink)

The domain of “procedural ethics” is the set of reflective and deliberative methods that maximize the reliability of moral judgment. While no general algorithmic method exists that will guarantee the validity of ethical deliberation, non‐algorithmic “heuristic” methods can guide and inform the process, making it significantly more robust and dependable. This essay examines various representative heuristic procedures commonly recommended for use in applied ethics, maps them into a uniform set of twelve stages, identifies common faults, then shows (...) how the resulting stage‐by‐stage decision‐making model could be adapted for general use and for use in computer ethics. (shrink)

While the philosophical literature has extensively studied how decisions relate to arguments, reasons and justifications, decision theory almost entirely ignores the latter notions. In this article, we elaborate a formal framework to introduce in decision theory the stance that decision-makers take towards arguments and counter-arguments. We start from a decision situation, where an individual requests decision support. We formally define, as a commendable basis for decision-aid, this individual’s deliberated judgment, a notion inspired by Rawls’ contributions to the philosophical literature, and (...) embodying the requirement that the decision-maker should carefully examine arguments and counter-arguments. We explain how models of deliberated judgment can be validated empirically. We then identify conditions upon which the existence of a valid model can be taken for granted, and analyze how these conditions can be relaxed. We then explore the significance of our framework for the practice of decision analysis. Our framework opens avenues for future research involving both philosophy and decision theory, as well as empirical implementations. (shrink)

Purpose:The pandemic of coronavirus disease 2019 (COVID-19), which has had a significant impact on people’s lives, has apparently increased the incidence of depression. Although the topic of how depression affects creativity is contested, previous research has revealed a significant relationship between the two. The purpose of this study is to further investigate the relationship and the mechanisms that operate between depression and creativity.Methods:A total of 881 students at an independent college in China completed a questionnaire consisting of the Self-Reported (...) Depression Scale, Runco Ideational Behavior Scale, Psychological Resilience Scale, Deliberate Rumination Scale and demographic information. Among the respondents, 317 (36.0%) were male and 564 (64.0%) were female, all of whom were from the same grade. Correlation analyses were conducted, and then the researchers carried out mediation analysis and developed a moderated mediation model.Results:The results indicated that (a) depression was positively related to creativity (r= 0.085,p< 0.05); (b) psychological resilience mediated the relationship between depression and creativity; specifically, psychological resilience was negatively related to depression (r= −0.462,p< 0.01), which in turn was positively related to creativity (r= 0.198,p< 0.01); and (c) deliberate rumination moderated the relationship between depression and psychological resilience, showing a significant negative correlation with depression (r= 0.138,p< 0.01), psychological resilience (r= 0.078,p< 0.05), and creativity (r= 0.288,p< 0.05); specifically, higher levels of deliberate rumination strengthened the negative correlation between psychological resilience and depression.Conclusion:The results suggest that depression is a positive predictor of creativity and may promote creativity to some extent. Further, individuals with greater psychological resilience are more creative than those with less psychological resilience, as it is a question of whether they can and to what extent they can effectively use depression as an emotional resource. Last, an individual’s level of deliberate rumination moderates the mediating process, especially at the stage where depression is associated with psychological resilience. These findings advance understanding of the mechanisms that operate between depression and creativity. (shrink)

Abstract The use of photo research methods is influenced by underlying ontological and epistemological assumptions. Variant assumptions about reality and knowledge converge to conceive a relationship between the knower and what can be known. These assumptions provide the rationale for decided ways of engaging participants in the process of scientific inquiry. In this paper, we examine how perspectives of realism and relativism may shape epistemological understandings and influence type and use of photo methods in qualitative research. Based on (...) deliberations about underlying ontological and epistemological assumptions and related strengths and challenges of photo methods, we assert that photo methods contribute to the development of knowledge that both matters to participants and informs nursing practice. (shrink)

Committee protocols typically involve a deliberation stage in which members try to influence and convince other regarding the “right” decision. Beyond information exchange, such deliberations also aim to affect the preferences and the votes of other members. Using a model of social influence, we demonstrate how deliberation procedures affect the voting outcome and how different protocols of consultation by committees’ chairs may affect their decisions. We then analyze the ability of a “designer” to control the deliberation protocol (...) and to manipulate the deliberation procedure to increase the probability that the outcome he favors will be selected. (shrink)