How can collective decisions be made among individuals with conflicting preferences or judgments? Arrow’s impossibility theorem and other social-choice-theoretic results suggest that, for many collective decision problems, there are no attractive democratic solutions. In response, deliberative democrats argue that group deliberation makes collective decisions more tractable. How can deliberation accomplish this? In this paper, I explore the distinction between two different types of agreement and discuss how they can facilitate collective decision making. Deliberative democrats have traditionally defended the (...) hypothesis that group deliberation generates consensus on what decision option should be chosen: "substantive agreement". But substantive agreement is not only empirically unrealistic, but also logically unnecessary for meaningful collective decision making. An alternative, less demanding hypothesis is that, under certain conditions, group deliberation generates consensus on how a decision problem should be conceptualized: "meta-agreement". I assess the latter hypothesis, explain how it can be empirically tested, and cite some evidence consistent with it. My discussion addresses two contexts of democratic decision making: preference aggregation and judgment aggregation. (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)

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)

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)

In this paper, I defend teleological theories of belief against the exclusivity objection. I argue that despite the exclusive influence of truth in doxastic deliberation, multiple epistemic aims interact when we consider what to believe. This is apparent when we focus on the processes involved in specific instances (or concrete cases) of doxastic deliberation, such that the propositions under consideration are specified. First, I out- line a general schema for weighing aims. Second, I discuss recent attempts to defend (...) the teleological position in relation to this schema. And third, I develop and defend my proposal that multiple epistemic aims interact in doxastic deliberation—a possibility which, as of yet, has received no serious attention in the literature. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation (...) instrument. The aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (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 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)

In moral case deliberation (MCD), healthcare professionals meet to reflect upon their moral questions supported by a structured conversation method and non-directive conversation facilitator. An increasing number of Dutch healthcare institutions work with MCD to (1) deal with moral questions, (2) improve reflection skills, interdisciplinary cooperation and decision-making, and (3) develop policy. Despite positive evaluations of MCD, organization and implementation of MCD appears difficult, depending on individuals or external experts. Studies on MCD implementation processes have not yet been published. (...) The aim of this study is to describe MCD implementation processes from the perspective of nurses who co-organize MCD meetings, so called ‘ local coordinators ’. Various qualitative methods were used within the framework of a responsive evaluation research design. The results demonstrate that local coordinators work hard on the pragmatic implementation of MCD. They do not emphasize the ethical and normative underpinnings of MCD, but create organizational conditions to foster a learning process, engagement and continuity. Local coordinators indicate MCD needs firm back-up from management regulations. These pragmatic action-oriented implementation strategies are as important as ideological reasons for MCD implementation. Advocates of clinical ethics support should pro-actively facilitate these strategies for both practical and ethical reasons. (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-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)

Majority cycling and related social choice paradoxes are often thought to threaten the meaningfulness of democracy. But deliberation can prevent majority cycles – not by inducing unanimity, which is unrealistic, but by bringing preferences closer to single-peakedness. We present the first empirical test of this hypothesis, using data from Deliberative Polls. Comparing preferences before and after deliberation, we find increases in proximity to single-peakedness. The increases are greater for lower versus higher salience issues and for individuals who seem (...) to have deliberated more versus less effectively. They are not merely a byproduct of increased substantive agreement . Our results both refine and support the idea that deliberation, by increasing proximity to single-peakedness, provides an escape from the problem of majority cycling. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers (...) are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers (...) are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

Can an agent deliberating about an action A hold a meaningful credence that she will do A? 'No', say some authors, for 'Deliberation Crowds Out Prediction' (DCOP). Others disagree, but we argue here that such disagreements are often terminological. We explain why DCOP holds in a Ramseyian operationalist model of credence, but show that it is trivial to extend this model so that DCOP fails. We then discuss a model due to Joyce, and show that Joyce's rejection of DCOP (...) rests on terminological choices about terms such as 'intention', 'prediction', and 'belief'. Once these choices are in view, they reveal underlying agreement between Joyce and the DCOP-favouring tradition that descends from Ramsey. Joyce's Evidential Autonomy Thesis (EAT) is effectively DCOP, in different terminological clothing. Both principles rest on the so-called 'transparency' of first-person present-tensed reflection on one's own mental states. (shrink)

Moral case deliberation (MCD) is a form of clinical ethics support in which the ethicist as facilitator aims at supporting professionals with a structured moral inquiry into their moral issues from practice. Cases often affect clients, however, their inclusion in MCD is not common. Client participation often raises questions concerning conditions for equal collaboration and good dialogue. Despite these questions, there is little empirical research regarding client participation in clinical ethics support in general and in MCD in particular. This (...) article aims at describing the experiences and processes of two MCD groups with client participation in a mental healthcare institution. A responsive evaluation was conducted examining stakeholders’ issues concerning client participation. Findings demonstrate that participation initially creates uneasiness. As routine builds up and client participants meet certain criteria, both clients and professionals start thinking beyond ‘us-them’ distinctions, and become more equal partners in dialogue. Still, sentiments of distrust and feelings of not being safe may reoccur. Client participation in MCD thus requires continuous reflection and alertness on relational dynamics and the quality of and conditions for dialogue. Participation puts the essentials of MCD (i.e., dialogue) to the test. Yet, the methodology and features of MCD offer an appropriate platform to introduce client participation in healthcare institutions. (shrink)

A traditional concern for determinists is that the epistemic conditions an agent must satisfy to deliberate about which of a number of distinct actions to perform threaten to conflict with a belief in determinism and its evident consequences. I develop an account of the sort that specifies two epistemic requirements, an epistemic openness condition and a belief in the efficacy of deliberation, whose upshot is that someone who believes in determinism and its evident consequences can deliberate without inconsistent beliefs. (...) I argue that conditions of both types are indispensable, and that they can be formulated so as to withstand the relevant objections. (shrink)

To what extent do our beliefs, and how strongly we hold them, depend upon how they matter to us, on what we take to be at stake on them? The idea that beliefs are sometimes stake-sensitive (Armendt 2008, 2013) is further explored here, with a focus on whether beliefs may be stake-sensitive and rational. In contexts of extended deliberation about what to do, beliefs and assessments of options interact. In some deliberations, a belief about what you will do may (...) rationally influence your estimate of the value of doing it; deliberation dynamics provides a framework for modeling such interactions. A distinction is drawn between sensitivity to the magnitude of the stakes, and sensitivity to the shape of the stakes. Contexts of extended deliberation are settings in which some beliefs that p rationally depend on the shape of the stakes on p. The dependence is either rational stake-sensitivity or an outcome of rational learning; empirical evidence concerning contexts of deliberation may lead us to model rational beliefs in one way or the other. (shrink)

There is a puzzle about the very possibility of foreseen but unintended side effects, and solving this puzzle requires us to revise our basic picture of the structure of practical deliberation. The puzzle is that, while it seems that we can rationally foresee, but not intend, bringing about foreseen side effects, it also seems that we rationally must decide to bring about foreseen side effects and that we intend to do whatever we decide to do. I propose solving this (...) puzzle by rejecting the idea that we intend to do whatever we decide to do. My solution involves taking account of the underappreciated role that qualified intentions play in deliberation. I also argue that this solution fares better than those that instead reject the idea that we rationally must decide to bring about foreseen side effects, for these solutions are committed to rejecting the even more compelling idea that decisions rationally serve as the conclusions of practical deliberation. (shrink)

A recent skeptical challenge denies deliberation is essential to virtuous agency: what looks like genuine deliberation is just a post hoc rationalization of a decision already made by automatic mechanisms (Haidt 2001; Doris 2015). Annas’s account of virtue seems well-equipped to respond: by modeling virtue on skills, she can agree that virtuous actions are deliberation-free while insisting that their development requires significant thought. But Annas’s proposal is flawed: it over-intellectualizes deliberation’s developmental role and under-intellectualizes its significance (...) once virtue is acquired. Doing better requires paying attention to a distinctive form of anxiety—one that functions to engage deliberation in the face of decisions that automatic mechanisms alone cannot resolve. (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)

It is widely accepted in psychology and cognitive science that there are two “systems” in the mind: one system is characterized as quick, intuitive, perceptive, and perhaps more primitive, while the other is described as slower, more deliberative, and responsible for our higher-order cognition. I use the term “reflectivism” to capture the view that conscious reflection—in the “System 2” sense—is a necessary feature of good moral judgment and decision-making. This is not to suggest that System 2 must operate alone in (...) forming our moral decisions, but that it plays a normatively ineliminable role. In this paper, I discuss arguments that have been offered in defense of reflectivism. These arguments fit into two broad categories; let us think of them as two sides of a coin. On the first side are arguments about the efficaciousness of conscious reasoning—for example, without conscious deliberation we will make bad moral judgments and decisions. On the other side of the coin are arguments about the centrality of conscious deliberation to normative actions—for example, without conscious deliberation we are no more agential than animals or automatons. Despite their attractiveness, I argue that these arguments do not successfully establish that reflection is a necessary component of good moral judgment and decision-making. If I am right, the idea that good moral judgment and decision-making can result from entirely automatic and subconscious processes gains traction. My goal in this paper is to show that reflectivism fails to include the full range of cases of moral decision-making and that a theory of automaticity may do a better job. I briefly discuss at the end of the paper how an account of successful automatic moral judgment and decision-making might begin to take shape. (shrink)

How should we understand the epistemic role of perception? According to epistemological disjunctivism (ED), a subject’s perceptual knowledge that p is to be explained in terms of the subject believing that p for a factive and reflectively accessible reason. I argue that ED raises far-reaching questions for rationality and deliberation; I illustrate those questions by setting up a puzzle about belief-suspension, and I argue that ED does not have the resources to make sense of the rationality of belief-suspension in (...) cases in which suspending is clearly rational. The conclusion that I draw from the puzzle is mainly negative: the epistemic contribution of perception cannot be explained in terms of a warrant-conferring relation between perception and belief. However, toward the end, I sketch a positive picture of the epistemic role of perception in terms of a direct explanatory relation between perception and knowledge. (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)

Ethical oversight of clinical research is one of the primary means of ensuring that human subjects are protected from the natural bias of researchers and research institutions in favor of experimentation. At a minimum, effective oversight should ensure that risks are minimized and reasonable in relation to anticipated benefits, protect vulnerable subjects from potential coercion or undue influence, ensure full and informed consent, and promote the equitable distribution of the risks and benefits of research. Because these assessments often involve value (...) judgments for which there are no agreed-upon objective standards, we rely on deliberative procedures thought to have the greatest likelihood of producing the right or best outcomes. Concerns about the potential for improperly functioning IRBs to waste scarce human and institutional resources and impede biomedical progress have motivated a surge in empirical research assessing their procedures and outcomes. Yet within this literature, there has been minimal attention paid to the social scientific evidence regarding how individuals and deliberating groups make decisions, nor how those data might inform IRB practice. This essay seeks to fill that gap, locating recent empirical data on IRB composition and process within the context of data regarding what I call “deliberative pathologies,” or instances when deliberation fails to live up to one or more aspect of the deliberative ideal because of systematic biases in the ways participants interact. The paper goes on to make evidence-based recommendations to reduce the vulnerability of IRB deliberations to the kinds of pathologies discussed and indicate directions for future research. (shrink)

Alan Hájek launches a formidable attack on the idea that deliberation crowds out prediction – that when we are deliberating about what to do, we cannot rationally accommodate evidence about what we are likely to do. Although Hájek rightly diagnoses the problems with some of the arguments for the view, his treatment falls short in crucial ways. In particular, he fails to consider the most plausible version of the view, the best argument for it, and why anyone would ever (...) believe it in the first place. In doing so, he misses a deep puzzle about deliberation and prediction – a puzzle which all of us, as agents, face, and which we may be able to resolve by recognizing the complicated relationship between deliberation and prediction. (shrink)

Moral Case Deliberation is an up and coming form of ethics support wherein clinical professionals deliberate about moral questions they face in their work. So far, it has been unclear what quality of deliberation in MCD is entailed and how to evaluate this quality. This article proposes a coding scheme that fits the theoretical background of MCD and allows researchers to evaluate the quality of the deliberation in MCDs. We consider deliberation in MCD to be of (...) good quality when participants enrich their own understanding of a case by being exposed to the viewpoints of others. In order to have such an enriching effect, the deliberation in an MCD ought to involve different kinds of arguments from the perspectives of different stakeholders and in favour of different resolutions to the case; and the process of deliberation ought to be critical but constructive. (shrink)

Using data from a randomized field experiment within a Deliberative Poll, this paper examines deliberation’s effects on both policy attitudes and the extent to which ordinal rankings of policy options approach single-peakedness (a help in avoiding cyclical majorities). The setting was New Haven, Connecticut, and its surrounding towns; the issues were airport expansion and revenue sharing – the former highly salient, the latter not at all. Half the participants deliberated revenue sharing, then the airport; the other half the reverse. (...) This split-half design helps distinguish the effects of the formal on-site deliberations from those of other aspects of the treatment. As expected, the highly salient airport issue saw only a slight effect, while much less salient revenue-sharing issue saw a much larger one. (shrink)

Cet article poursuit la réflexion de Dilhac (2014) touchant la relation entre politique et vérité. Au terme d’une analyse de la tolérance chez Mill et Popper, Dilhac conclut qu’une conception épistémique de la tolérance manque sa dimension politique, et qu’il est préférable d’opter pour le concept rawlsien de consensus raisonnable. Discutant ces résultats, le premier objectif est ici de montrer qu’une notion de « raisonnabilité » peut facilement trouver ses racines dans la neutralité scientifique wébérienne, et donc être porteuse d’une (...) dimension épistémique minimale. Le second objectif est de clarifier l’impact de cet argument particulier sur le débat général entourant la démocratie épistémique. Il sera défendu que l’opposition traditionnelle entre les conceptions épistémique et politique de la délibération est à trouver dans un certain perfectionnisme épistémique, mais qu’il existe au moins une conception minimale du potentiel épistémique tout à fait compatible avec les valeurs fondamentales du libéralisme, comme l’inclusion, l’égalité ou la diversité. En d’autres termes, les exigences épistémiques minimales de la neutralité scientifique peuvent être indépendantes du perfectionnisme épistémique. (shrink)

Although both codes of practice and virtue ethics are integral to the ethos and history of “medical professionalism”, the two trends appear mutually incompatible. Hence, in the first part of the paper we explore and explicate this apparent conflict and seek a direction for medical education. The theoretical and empirical literature indicates that moral deliberation may transcend the incompatibilities between the formal and the virtuous, may enhance moral and other aspects of personal sensitivity, may help design and improve other (...) parts of the curricula, and may foster self-awareness and clarification of the professional role. Not only are these goals essential for good and conscientious doctoring, but they may also reduce physicians’ “burn-out”. We argue that medical education should focus on the ubiquitous practice of deliberation in contemporary medicine, and especially the practice of moral deliberation. (shrink)

The article elaborates an original intertwined reading of republican theory, deliberative democracy and political equality. It argues that republicans, deliberative democrats and egalitarian scholars have not paid sufficient attention to a number of features present in these bodies of scholarships that relate them in mutually beneficial ways. It shows that republicanism and deliberative democracy are related in mutually beneficial ways, it makes those relations explicit, and it deals with potential objections against them. Additionally, it elaborates an egalitarian principle underpinning the (...) resulting model that I label Equality of Access and Deliberation. The upshot of these considerations is a novel and mutually reinforcing interrelated three-tiered theoretical and institutional proposal. (shrink)

This paper argues that promises are proposals in joint practical deliberation, the activity of deciding together what to do. More precisely: to promise to ϕ is to propose (in a particular way) to decide together with your addressee(s) that you will ϕ. I defend this deliberative theory by showing that the activity of joint practical deliberation naturally gives rise to a speech act with exactly the same properties as promises. A certain kind of proposal to make a joint (...) decision regarding one's own actions turns out to have the very same normative effects, under the very same conditions, as a promise. I submit that this cannot be a coincidence: we should conclude that promises and the relevant kind of proposals in joint practical deliberation are one and the same. (shrink)

A standard thesis of contemporary Aristotelian virtue ethics and some recent Heideggerian scholarship is that virtuous behavior can be performed immediately and spontaneously without engaging conscious processes of deliberative thought. It is also claimed that phronēsis either enables or is consistent with this possibility. In the Nicomachean Ethics, however, Aristotle identifies phronesis as the excellence of the calculative part of the intellect, claims that calculation and deliberation are the same and that it is the mark of the phronimos to (...) be able to deliberate well. He also insists that for an action to count as virtuous it must issue from rational choice, which he characterizes as determined by deliberation. It thus seems that any exegetically respectable attempt to explain virtuous action within an Aristotelian framework would need to integrate with some account of deliberative choice. This creates a tension in Aristotelian scholarship. In this paper, I shall formalize this tension in terms of an apparently inconsistent triad of claims and shall examine the merits of at least one prominent interpretation of phronesis with respect to its reconciliation. (shrink)

By deliberation we understand practical reasoning with an end in view of choosing some course of action. Integral to it is the agent's sense of alternative possibilities, that is, of two or more courses of action he presumes are open for him to undertake or not. Such acts may not actually be open in the sense that the deliberator would do them were he to so intend, but it is evident that he assumes each to be so. One deliberates (...) only by taking it for granted that both performing and refraining from any of the acts under consideration are possible for one, and that which is to be selected is something entirely up to oneself. What is it for a course of action to be presumed as open, or for several courses of action to present themselves as a range of open alternatives? Answering these questions is essential for an understanding of deliberation and choice and, indeed, for the entire issue of free will and responsibility. According to one common view, a deliberator takes the considered options to be open only by assuming he is free to undertake any of them and, consequently, that whichever he does undertake is, as yet, a wholly undetermined matter. Built into the structure of deliberation, on this theory, is an indeterministic bias relative to which any deliberator with deterministic beliefs is either inconsistent or condemned to a fatalistic limbo. An unmistakable challenge is thereby posed: is there an alternative conception of the presuppositions underlying deliberation more congenial to a deterministic perspective yet adequate to the data? Convinced that there is, I develop a partial account of deliberation that, though highly similar to the aforementioned view, diverges at a critical juncture. (shrink)

Negotiation and deliberation are two context types or genres of discourse widely studied in the argumentation literature. Within the pragma-dialectical framework, they have been characterised in terms of the conventions constraining the use of argumentative discourse in each of them. Thanks to these descriptions, it has become possible to analyse the arguers’ strategic manoeuvres and carry out more systematic, context-sensitive evaluations of argumentative discussions. However, one issue that still must be addressed in the pragma-dialectical theory—and other contextual approaches to (...) argumentation—is how to distinguish negotiation and deliberation in practice. In this paper, I seek to develop criteria that can help the analyst identify them in discourse. To this end, I characterise the felicity conditions of the superordinate speech acts defining and structuring deliberation and negotiation encounters. (shrink)

Call the claim, common to many in the Christian intellectual tradition, that Christ, in virtue of his created human intellect, had certain, infallible exhaustive foreknowledge the Foreknowledge Thesis. Now consider what I will call the Conditional: If the Foreknowledge Thesis is true, then Christ’s created human will lacked an important sort of freedom that we mere humans have. Insofar as many, perhaps all, of the people who affirm the Foreknowledge Thesis also wish to affirm the robust freedom of Christ’s human (...) will, the truth of the Conditional would be most unwelcome to them. I consider an argument in support of the Conditional from the necessary conditions for deliberation, arguing that the argument fails. (shrink)

Traditional views about God and about deliberation seem to imply that we need a deliberation restriction on the concept of divine omniscience. I will argue, however, that this deliberation restriction is both irrelevant and unnecessary. It is irrelevant because there is no time at which God needs to deliberate; and it is unnecessary because even if God does deliberate, it’s possible for him to do so while knowing what the results of that deliberation will be. And (...) because this possibility of deliberating despite knowing the results holds for deliberation in general, my argument provides useful (and perhaps surprising) results not only for discussions of the divine attributes, but also for broader discussions of deliberation itself. (shrink)

In this commentary, I suggest expanding the deliberative aspects of critical care policy development in two ways. First, critical-care policy development should expand the scope of deliberation by leaving fewer issues up to expertise or private choice. For instance. it should allow deliberation about the relevance of age, disability, social position, and psychological well-being to allocation decisions. Second, it should broaden both the set of costs considered and the set of stakeholders represented in the deliberative process. In particular, (...) it should consider efforts to reduce the cost of end-of-life care and to redirect resources away from the provision of costly interventions, and should expand the set of individuals included in deliberation to include stakeholders outside the health-care system. (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)

This chapter reviews empirical evidence bearing on the design of online forums for deliberative civic engagement. Dimensions of design are defined for different aspects of the deliberation: its purpose, the target population, the spatiotemporal distance separating participants, the communication medium, and the deliberative process to be followed. After a brief overview of criteria for evaluating different design options, empirical findings are organized around design choices. Research has evolved away from treating technology for online deliberation dichotomously (either present or (...) not) toward nuanced findings that differentiate between technological features, ways of using them, and cultural settings. The effectiveness of online deliberation depends on how well the communicative environment is matched to the deliberative task. Tradeoffs, e.g. between rich and lean media and between anonymous and identifiable participation, suggest different designs depending on the purpose and participants. Findings are limited by existing technologies, and may change as technologies and users co-evolve. (shrink)

According to Aristotle, character (êthos) and emotion (pathos) are constitutive features of the process of phronetic practical deliberation: in order to render a determinate action-specific judgement, practical reasoning cannot be simply reduced to logical demonstration (apodeixis). This can be seen by uncovering an important structural parallel between the virtue of phronêsis and the art of rhetoric. This structural parallel helps to show how Aristotle's account of practical reason and deliberation, which constructively incorporates the emotions, illuminates key issues in (...) contemporary democratic theory concerning deliberation at the political level. (shrink)

How are we to distinguish between appropriate emotional responses that reveal morally salient reasons and inappropriate emotional responses that reflect our prejudices? It is often assumed that reason – considered as distinct from emotion – will make the distinction. I argue that this view is false, and that the process by which emotional responses are vetted involves ‘emotional self-awareness’. By this, I mean feeling an emotion, being aware of so doing, and feeling some usually subtle emotional response, often of calm (...) or anxiety, to it, together with a general readiness to feel and acknowledge what emotions one has. Registering and exploring feelings of anxiety that arise in emotional self-awareness helps enable us to detect when emotions and thoughts are inappropriate. Deliberation that is not emotionally open in this way is therefore at an epistemic disadvantage. Furthermore, the attempt to remain unemotional when evaluating one’s emotions can be produced or co-opted by anxiety about one’s feelings of precisely the kind that indicates one’s emotional responses and thoughts are being distorted. (shrink)

Most philosophers and psychologists assume that habitual acts do not ensue from deliberation, but are direct responses to the circumstances: habit essentially involves a variety of automaticity. My objective in this paper is to show that this view is unduly restrictive. A habit can explain an act in various ways. Pointing to the operation of automaticity is only one of them. I draw attention to the fact that acquired automaticity is one outgrowth of habituation that is relevant to explanation, (...) but not the only one. Habituation shapes our emotional and motivational make up in ways that affect deliberation itself. Hence mentioning a habit might be indispensable in explaining an act which nevertheless ensues from deliberation. The view that habitual acts are direct responses to the circumstances implies an impoverished conception of habit, which fails to do justice to its rich explanatory potential in theoretical and pre-theoretical contexts, as well as to its role in the history of philosophy. (shrink)

In this issue of the Report, James L. Bernat proposes an innovative and sophisticated distinction to justify the introduction of permanent cessation as a valid substitute standard for irreversible cessation in death determination. He differentiates two approaches to conceptualizing and determining death: the biological concept and the prevailing medical practice standard. While irreversibility is required by the biological concept, the weaker criterion of permanence, he claims, has always sufficed in the accepted standard medical practice to declare death. Bernat argues that (...) the medical practice standard may be acceptable on the ground that proving circulatory or brain permanence is sufficient to assure complete accuracy for death diagnosis. -/- The topic requires public deliberation: processes to survey people's opinions and mechanisms to channel their opinions into policy-making. What is at stake is the nature of our society. Do we want an expertocracy, in which an enlightened few design policies for the greater good of the majority and exploit the lack of public knowledge to achieve compliance? (shrink)

The experience of the last thirty years has shown that whether the different methodologies used in clinical ethics work well or not depends on certain external factors, such as the mentality with which they are used. This article aims to analyze two of these mentalities: the “dilemmatic” and the “problematic.” The former uses preferably the decision-making theory, whilst the latter emphasizes above all the role of deliberation. The author considers that Clinical Ethics must be deliberationist, and that only in (...) this context the different methodologies can be used correctly. (shrink)

Why should we deliberate? I discuss a Kantian response to this query and argue that we cannot as rational beings avoid deliberation in principle; and that we have good reasons to consider the value and strength of Kant's philosophical investigations concerning fundamental moral issues and their relevance for the question of why we ought to deliberate. I also argue that deliberation is a wide duty. This means that it has to be set as an end, that it is (...) meritorious, and that we cannot specify exactly what acts can be identified with it or are required for its realization. I begin by discussing why we cannot avoid deliberation in principle, that deliberation is a wide duty and why we ought to set it as an end. In the second part I argue how deliberation can be acknowledged in cosmopolitan education, and how we can inquire into the quality of communication in terms of deliberation in such an education or elsewhere. (shrink)

In group discussions of any kind there tends to be an up and down in the level of deliberation. To capture this dynamic we coined the concept of Deliberative Transformative Moments (DTM). In deeply divided societies deliberation is particularly important in order to arrive at peace and stability, but deliberation is also very difficult to be attained. Therefore, we wanted to learn about the conditions that in group discussions across the deep divisions of such societies help (...) class='Hi'>deliberation. We organized such group discussions between ex-guerrillas and ex-paramilitaries in Colombia, Serbs and Bosnjaks in Srebrenica, and poor residents and local police officers in the favelas (slums) of Brazil. We could identify factors that help to transform discussions from low to high deliberation and risk transformations in the opposite direction. We could also identify factors that help to keep a discussion at a high level of deliberation, and, in a next step, we could determine to what extent long sequences of deliberation had a positive impact on the outcomes of the discussions. Finally, we show how our research results can have a long term effect if it is used in schools of such deeply divided societies. (shrink)

In response to those who see rational deliberation as a source of epistemic norms and a model for well-functioning scientific inquiry, Solomon cites evidence that aggregative techniques often yield better results; deliberative processes are vulnerable to biasing mechanisms that impoverish the epistemic resources on which group judgments are based. I argue that aggregative techniques are similarly vulnerable and illustrate this in terms of the impact of gender schemas on both individual and collective judgment. A consistently externalist and socially naturalized (...) approach calls for symmetrical treatment of these strategies for capitalizing on what groups know. (shrink)

Can new technology enhance purpose-driven, democratic dialogue in groups, governments, and societies? Online Deliberation: Design, Research, and Practice is the first book that attempts to sample the full range of work on online deliberation, forging new connections between academic research, technology designers, and practitioners. Since some of the most exciting innovations have occurred outside of traditional institutions, and those involved have often worked in relative isolation from each other, work in this growing field has often failed to reflect (...) the full set of perspectives on online deliberation. This volume is aimed at those working at the crossroads of information/communication technology and social science, and documents early findings in, and perspectives on, this new field by many of its pioneers. -/- CONTENTS: -/- Introduction: The Blossoming Field of Online Deliberation (Todd Davies, pp. 1-19) -/- Part I - Prospects for Online Civic Engagement -/- Chapter 1: Virtual Public Consultation: Prospects for Internet Deliberative Democracy (James S. Fishkin, pp. 23-35) -/- Chapter 2: Citizens Deliberating Online: Theory and Some Evidence (Vincent Price, pp. 37-58) -/- Chapter 3: Can Online Deliberation Improve Politics? Scientific Foundations for Success (Arthur Lupia, pp. 59-69) -/- Chapter 4: Deliberative Democracy, Online Discussion, and Project PICOLA (Public Informed Citizen Online Assembly) (Robert Cavalier with Miso Kim and Zachary Sam Zaiss, pp. 71-79) -/- Part II - Online Dialogue in the Wild -/- Chapter 5: Friends, Foes, and Fringe: Norms and Structure in Political Discussion Networks (John Kelly, Danyel Fisher, and Marc Smith, pp. 83-93) -/- Chapter 6: Searching the Net for Differences of Opinion (Warren Sack, John Kelly, and Michael Dale, pp. 95-104) -/- Chapter 7: Happy Accidents: Deliberation and Online Exposure to Opposing Views (Azi Lev-On and Bernard Manin, pp. 105-122) -/- Chapter 8: Rethinking Local Conversations on the Web (Sameer Ahuja, Manuel Pérez-Quiñones, and Andrea Kavanaugh, pp. 123-129) -/- Part III - Online Public Consultation -/- Chapter 9: Deliberation in E-Rulemaking? The Problem of Mass Participation (David Schlosberg, Steve Zavestoski, and Stuart Shulman, pp. 133-148) -/- Chapter 10: Turning GOLD into EPG: Lessons from Low-Tech Democratic Experimentalism for Electronic Rulemaking and Other Ventures in Cyberdemocracy (Peter M. Shane, pp. 149-162) -/- Chapter 11: Baudrillard and the Virtual Cow: Simulation Games and Citizen Participation (Hélène Michel and Dominique Kreziak, pp. 163-166) -/- Chapter 12: Using Web-Based Group Support Systems to Enhance Procedural Fairness in Administrative Decision Making in South Africa (Hossana Twinomurinzi and Jackie Phahlamohlaka, pp. 167-169) -/- Chapter 13: Citizen Participation Is Critical: An Example from Sweden (Tomas Ohlin, pp. 171-173) -/- Part IV - Online Deliberation in Organizations -/- Chapter 14: Online Deliberation in the Government of Canada: Organizing the Back Office (Elisabeth Richard, pp. 177-191) -/- Chapter 15: Political Action and Organization Building: An Internet-Based Engagement Model (Mark Cooper, pp. 193-202) -/- Chapter 16: Wiki Collaboration Within Political Parties: Benefits and Challenges (Kate Raynes-Goldie and David Fono, pp. 203-205) -/- Chapter 17: Debian’s Democracy (Gunnar Ristroph, pp. 207-211) -/- Chapter 18: Software Support for Face-to-Face Parliamentary Procedure (Dana Dahlstrom and Bayle Shanks, pp. 213-220) -/- Part V - Online Facilitation -/- Chapter 19: Deliberation on the Net: Lessons from a Field Experiment (June Woong Rhee and Eun-mee Kim, pp. 223-232) -/- Chapter 20: The Role of the Moderator: Problems and Possibilities for Government-Run Online Discussion Forums (Scott Wright, pp. 233-242) -/- Chapter 21: Silencing the Clatter: Removing Anonymity from a Corporate Online Community (Gilly Leshed, pp. 243-251) -/- Chapter 22: Facilitation and Inclusive Deliberation (Matthias Trénel, pp. 253-257) -/- Chapter 23: Rethinking the ‘Informed’ Participant: Precautions and Recommendations for the Design of Online Deliberation (Kevin S. Ramsey and Matthew W. Wilson, pp. 259-267) -/- Chapter 24: PerlNomic: Rule Making and Enforcement in Digital Shared Spaces (Mark E. Phair and Adam Bliss, pp. 269-271) -/- Part VI - Design of Deliberation Tools -/- Chapter 25: An Online Environment for Democratic Deliberation: Motivations, Principles, and Design (Todd Davies, Brendan O’Connor, Alex Cochran, Jonathan J. Effrat, Andrew Parker, Benjamin Newman, and Aaron Tam, pp. 275-292) -/- Chapter 26: Online Civic Deliberation with E-Liberate (Douglas Schuler, pp. 293-302) -/- Chapter 27: Parliament: A Module for Parliamentary Procedure Software (Bayle Shanks and Dana Dahlstrom, pp. 303-307) -/- Chapter 28: Decision Structure: A New Approach to Three Problems in Deliberation (Raymond J. Pingree, pp. 309-316) -/- Chapter 29: Design Requirements of Argument Mapping Software for Teaching Deliberation (Matthew W. Easterday, Jordan S. Kanarek, and Maralee Harrell, pp. 317-323) -/- Chapter 30: Email-Embedded Voting with eVote/Clerk (Marilyn Davis, pp. 325-327) -/- Epilogue: Understanding Diversity in the Field of Online Deliberation (Seeta Peña Gangadharan, pp. 329-358). -/- For individual chapter downloads, go to odbook.stanford.edu. (shrink)

The Millennium Development Goals (MDGs), an unprecedented set of global commitments to reduce various forms of human deprivation and promote human development, are set to expire in 2015. Despite their promise, the MDGs are flawed in a variety of ways. The development community is already discussing what improved development framework should replace the MDGs. I argue that global justice advocates should focus first on the procedure for developing the post-2015 development framework. Specifically, they should create spaces for citizens, especially the (...) most marginalized and oppressed, to actively deliberate about the form and content of a future global development framework, and ensure that this deliberation receives political uptake in formal intergovernmental processes for deciding the post-2015 framework. (shrink)