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)

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)

A central task for clinical ethics consultants and committees (CEC) is providing analysis of, and advice on, prospective or retrospective clinical cases. However, several kinds of biases may threaten the integrity, relevance or quality of the CEC's deliberation. Bias should be identified and, if possible, reduced or counteracted. This paper provides a systematic classification of kinds of bias that may be present in a CEC's case deliberation. Six kinds of bias are discussed, with examples, as to their significance (...) and risk factors. Possible remedies are suggested. The potential for bias is greater when the case deliberation is performed by an individual ethics consultant than when an entire clinical ethics committee is involved. (shrink)

Dialectical approaches traditionally conceptualize argumentation as a discussion in which two parties debate on “two sides of an issue”. However, many political issues engender multiple positions. This is clear in multi-party online deliberations in which often an array of competing positions is debated in one and the same discussion. A proponent of a given position thus addresses a number of possible opponents, who in turn may hold incompatible opinions. The goal of this paper is to shed extra light on such (...) “polylogical” clash of opinions in online deliberation, by examining the multi-layered participation in actual online debates. The examples are drawn from the readers’ discussions on Osama bin Laden’s killing in online versions of two British newspapers: The Guardian and The Telegraph. As a result of the analysis, a distinction between sides, positions, and cases in argumentative deliberation is proposed. (shrink)

Trust in the practice of rational deliberation is widespread and largely unquestioned. This paper uses recent work from business contexts to challenge the view that rational deliberation in a group improves decisions. Pressure to reach consensus can, in fact, lead to phenomena such as groupthink and to suppression of relevant data. Aggregation of individual decisions, rather than deliberation to a consensus, surprisingly, can produce better decisions than those of either group deliberation or individual expert judgment. I (...) argue that dissent is epistemically valuable, not because of the discussion it can provoke (Mill's and Longino's view about the benefit of dissent), but because dissenting positions often are associated with particular data or insights that would be lost in consensus formation. Social epistemologists can usefully pay attention to various methods of aggregation of individual opinion for their effectiveness at realizing epistemic goals. (shrink)

This paper defends Heidegger's account of resolute self-choice against the ubiquitous Decisionism Critique [DC]. According to DC, Heidegger's discussion of resoluteness commits him to an indefensible position in which resolute Dasein is said to choose who it will be without recourse to any reasons or evaluative standards. In response, I argue that DC is based on a misunderstanding of some of the key arguments of Being and Time . I then offer an alternative portrait of Heidegger's account of resolute self-choice (...) and argue that such choice will involve both 1) the consideration of factical claims as reasons that count in favor of a particular way of life and 2) the evaluation of these reasons in light of at least three deliberative standards. Thus, I argue that DC is misguided and needs to be replaced by an interpretation rooted in a more complete understanding of Heidegger's project. (shrink)

Für die Medizinethik liegt ein großes Potential sozialempirischer Forschung in der Erhöhung der Kontextsensitivität, dem Sichtbarmachen von sozialen und institutionellen Rollen und dem Einbringen von Stimmen, die bislang zu wenig gehört worden sind. Diese Möglichkeiten bergen jedoch auch das Risiko, dass Deliberation und Argumentation durch Umfragen und Meinungserhebungen ersetzt werden. Der in den Sozialwissenschaften einsetzende participatory turn gibt Anlass, Anliegen und Methoden klassischer sozialempirischer Vorgehensweisen aus normativer Sicht zu hinterfragen. Eine Auseinandersetzung mit Konzeptionen von Betroffenheit, Öffentlichkeit und Expertise ist (...) nicht nur aus methodologischen, sondern gerade auch aus normativen Gründen wichtig. Für die ethische Relevanz sind dabei die Idee der Argumentation und demokratietheoretische Überlegungen besonders erörterungswürdig. Wenn Bioethik Teil eines auch öffentlich verankerten Diskurses sein soll, ist die Frage nach der angemessenen Form der Berücksichtigung bestimmter Perspektiven ebenso im Kern bioethischer Reflexion zu verorten wie die Rechtfertigung spezieller ethischer Normen. (shrink)

In this paper it is shown how tools developed in argumentation theory and artificial intelligence can be applied to the development of a new dialectical analysis of the speech act of making a proposal in a deliberation dialogue. These tools are developed, modified and used to formulate dialogue pre-conditions, defining conditions and post-conditions for the speech act of making a proposal in a deliberation dialogue. The defining conditions set out what is required for a move in a dialogue (...) to count as the making of a proposal by one of the parties. What is required are the conditions that (1) the move fit the requirements of the argumentation scheme for practical reasoning, and (2) the premises are propositions describing common goals of both parties or propositions that they reasonably consider means to achieve these goals. The analysis goes beyond the standard speech act approach by specifying not only the normative requirements for making a well-formed proposal, but also the requirements for responding to it by questioning or criticizing it, and the requirements for defending it. (shrink)

Contemporary Anglo-American political thought is witnessing a revival of theories of deliberative democracy. The principle of public argumentation, according to which the legitimation of a general norm is predicated upon a rational and open dialog among all those affected by this norm, constitutes their common underlying assumption. This assumption is itself grounded in the metatheoretical claim that arguing is the defining activity of a demos of free and equal members. Habermas' well-known formulation of communicative or discursive democracy represents one of (...) the earliest, most discussed, and indeed most emblematic versions of the existing models of deliberative democracy. It is here, I believe, that Castoriadis' political theory can prove exceptionally important as it provides a starting point and a solid ground for articulating one of the most incisive and convincing critiques of the limits and flaws of communicative democracy. Although Castoriadis himself never directly discussed deliberative democracy as such, we can try to approximate from various parts of his work what he might have thought about, especially when it comes to Habermas' model. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 40.2 (2007) 216-237MuseSearchJournalsThis JournalContents[Access article in PDF]Who's Afraid of Fear Appeals? Contingency, Courage, and Deliberation in Rhetorical Theory and PracticeMichael William Pfau Department of Communication University of Minnesota—DuluthFear is an influential emotion whose history reveals its impacts not only on individuals, but on entire communities, economies, and political systems. Fear has been particularly important politically, and the history of republics reveals a political discourse rife (...) with appeals to fear. But the discourse of. (shrink)

Present arrangements for the control and administration of schools in Sweden foster freedom of choice and the interests of different value communities more than ideals such as democratic deliberation. I argue that children and young people should be given the opportunity to deliberate in ‘discourse ethics’ terms during their compulsory schooling, and I suggest that their right to engage in such deliberation is contained in the national curriculum. A discourse ethics approach to democratic deliberation pays attention to (...) whether, and to what extent, individuals are free and able to participate in joint democratic deliberation. (shrink)

This paper develops themes addressed in an article by Eric Wiland in the Journal of Medical Ethics 2000;26:466–8, where he aims to contribute to the debate concerning the moral status of abortion, and to emphasise the importance of analogies in moral argument. In the present paper I try to secure more firmly a novel understanding of why analogy is an essential component in the attempt to justify moral beliefs. I seek to show how analogical argument both encapsulates and exercises the (...) notions of rationality and imagination and that the construction, development, and comparison of analogies fundamentally underpins ethical argument. In so doing, it enables us to adopt imaginative and ethically illuminating perspectives but in a manner that does not relinquish any claims to intellectual rigour. I present a critique of a brand of “moral particularism” by showing how it cannot, if construed in a certain way, adequately conceive of how we use analogies and imaginary cases in ethics. Although such a particularism is thus impotent with regard to ethical debate, I show that the wider motivation behind particularism that can be extracted is of clear relevance and importance to medical practitioners. (shrink)

Pragmatism has been understood by bioethicists as yet another rival in the “methods wars,” as yet another theory of moral deliberation. This has led to criticism of pragmatic bioethics as both theoretically and practically inadequate. Pragmatists’ responses to these objections have focused mainly on misunderstandings of pragmatism’s epistemology. These responses are insufficient. Pragmatism’s commitment to radical empiricism gives it theoretical resources unappreciated by critics and defenders alike. Radical empiricism, unlike its more traditional ancestors, undercuts the gaps between theory and (...) practice, and subjective and objective accounts of experience, and in so doing provides the metaphysical and epistemological basis for a thoroughgoing empirical naturalism in ethics. Pragmatism’s strength as an approach to moral problems thus emerges as a result of a much wider array of resources than contemporary interpreters have acknowledged, which makes it a richer, deeper framework for understanding moral deliberation in general and bioethical decision making in particular. (shrink)

Despite the venerable place that "justice" occupies in social scientific theory and research, little effort has been made to see how members of society themselves define and use the concept when confronted with determining "what has happened" in some social arena, theorizing about why it happened, and deciding what should ensue. We take an ethnomethodological approach to justice, attempting to recover it as a feature of practical activity or a "phenomenon of order." Our analysis involves an actual videotaped jury (...) class='Hi'>deliberation. In his classic study of decision making by juries, Garfinkel observed that jurors changed their reliance on commonsense reasoning very little, even though they were instructed to adhere to official and legal criteria for guilt. The vacillation between commonsense reasoning and using official criteria creates a tension; in our data this tension is manifested as the choice between adhering to law and procedural rules and providing "justice." By articulating this tension as a puzzle, several of the jurors prepare the way for using "justice," and then use this concept in formal ways which, along with other discursive patterns and strategies, constitute the deliberation as a structured, concerted activity. We show four stages in the use of the term justice as it is embedded in jurors' practical reasoning. (shrink)

Despite all the attention given to Kant’s universalizability tests, one crucial aspect of Kant’s thought is often overlooked. Attention to this issue, I will argue, helps us resolve two serious problems for Kant’s ethics. Put briefly, the first problem is this: Kant, despite his stated intent to the contrary, doesn’t seem to use universalization in arguing for duties to oneself, and, anyway, it is not at all clear why duties to oneself should be grounded on a procedure that envisions a (...) world in which everyone wills the contrary of those duties. The second, more global problem is that if we follow Barbara Herman in holding that Kantian ethics can provide a structure for moral deliberation, we need an interpretation of the universalization procedure that unproblematically allows it to generate something like prima facie duties to guide that deliberation; but it is not at all clear that we have such an interpretation. I argue here that if we expand our limited way of thinking about universalization, we can solve the first problem and work towards a solution to the second. We can begin by recalling that Kant’s ‘Law of Nature’ formulation (FLN) of the Categorical Imperative obligates us to ‘act as if the maxim of your action were to become by your will a universal law of nature’ (G, 421). (shrink)

The paper has two goals. First, it defends one type of subjectivist account of reasons for actions—deliberative accounts—against the criticism that they commit the conditional fallacy. Second, it attempts to show that another type of subjectivist account of practical reasons that has been gaining popularity—ideal advisor accounts—are liable to commit a closely related error. Further, I argue that ideal advisor accounts can avoid the error only by accepting the fundamental theoretical motivation behind deliberative accounts. I conclude that ideal advisor accounts (...) represent neither a substantial departure from, nor a substantial improvement upon, deliberative accounts. (shrink)

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly (...) hidden rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Keywords: cost containment, democratic deliberation, fairness, justice, rationing CiteULike Connotea Del.icio.us What's this? (shrink)

Presentazione del curatore italiano (C.Corradetti): È possibile conciliare il pluralismo culturale con la dimensione pubblica della deliberazione? Partendo dall’analisi critica di Rawls e Habermas, James Bohman offre una risposta innovativa alla questione dell’accordo democratico. In tale proposta, parallelamente al rigetto di soluzioni meramente strategiche, viene riabilitata la nozione di compromesso morale nel quadro di un accordo normativo. Mantenendo fede ad una prospettiva composta da elementi normativi e fattuali, l’autore si propone di ampliare le opportunità democratiche nella riconciliazione tra conflitti culturali (...) profondi propri delle società contemporanee. L’elemento civico partecipativo risulta essere dunque una componente essenziale per la produzione di una sfera pubblica vibrante. Ne emerge una ricostruzione convincente volta non solo a respingere le critiche degli scettici sulle reali possibilità d’inclusività democratica, ma diretta soprattutto a suggerire un più efficace modello deliberativo per la garanzia della stabilità sociale. Questo testo è diventato ormai un riferimento internazionale classico nella discussione sul tema della deliberazione pubblica. L’autore ha inoltre sviluppato in ambito post-nazionale il suo modello deliberativo senza tuttavia ridiscutere i fondamenti concettuali della sua proposta teorica qui enunciati.Vista la rilevanza del tema e considerata la centralità del testo proposto, sembrerebbe dunque auspicabile rendere il testo disponibile anche al lettore italiano. (shrink)

This article considers the sort of diversity in perspective appropriate for a presidential commission on bioethics, and by implication, high-level governmental commissions on ethics more generally. It takes as its point of comparison the respective reports on human cloning produced by the National Bioethics Advisory Commission, appointed by President Bill Clinton, and George W. Bush's President's Council on Bioethics, under the leadership of its original chair, Leon Kass. I argue that the Clinton Commission Report exemplifies forensic diversity (the type of (...) diversity between contesting parties in a legal case), while the Kass Council Report exemplifies academic diversity (the diversity found in a medieval disputatio). Drawing upon Thomas Aquinas, I argue that the type of diversity most appropriate for such advisory bodies is deliberative diversity, which facilitates the President's process of taking counsel. After considering their respective charges, I suggest that neither the Clinton Commission nor the Kass Council possessed an adequate degree of deliberative diversity for their respective tasks. (shrink)

David Carr; Roughing Out the Ground Rules: reason and experience in practical deliberation, Journal of Philosophy of Education, Volume 29, Issue 1, 30 May 2006.

Theories of rational choice focus on the question of how to choose what to do. They are, that is, concerned with the selection of one among a set of possible actions. Furthermore, they tell us how to make such a choice rationally. They accomplish this aspect of their task by telling us how to choose ‘in order to achieve our aims as well as possible.’Theories of reasonable deliberation, as I describe them in this paper, analyze a different domain of (...) reasoning in the service of action. First, their subject matter is the deliberation that leads to action, rather than the final selection of the action itself. Second, they ask about the intrinsic character of a deliberative path, rather than its likely outcome. That is, they are theories of the reasonableness of deliberation, rather than its rationality. To see the distinctiveness of this theoretical domain, it helps to approach it by backing away from the domain of rational choice theories one step at a time. (shrink)

Much has been written about Bernard Williams' remarks (1981) regarding the (imagined) man faced with the choice of saving either a drowning stranger or his drowning wife. For Williams, the man's justification for saving his wife ought not to be any kind of practical syllogism, but simply, "because she is my wife." Susan Wolf claims (2012) that the standard response to Williams', which she dubs the Standard View, has been inadequate. Wolf then considers and rejects a potential response to the (...) Standard View—what she calls the "virtuous attention" view. Such a view, Wolf argues, is merely a variation of the Standard View. In this paper, I argue that the virtuous attention view is not a variation of the Standard View. While Wolf’s reading of Williams is correct, I argue that a developed version of the virtuous attention view can actually provide support for Wolf's reading of Williams. (shrink)

ABSTRACT The media's attentive vigil over America's most militant and outrageous activists in the abortion wars has obscured a massive but quiet effort on the part of evangelicals to engage their opponents in exemplary deliberative discussions about bioethics. For a variety of reasons, activists in the pro‐life movement are more committed to carving out civic spaces for such dialogue than are their pro‐choice counterparts. This discrepancy invites investigation into the forces that promote and constrain political movements' interest in deliberation, (...) as well as highlighting the undeniable limits to deliberative ideals. (shrink)

The article examines the new discourse on medical professionalism and responsibility through the prism of conflicts among moral values, especially with regard to truth-telling. The discussion is anchored in the renaissance of English-language writing on medical ethics in the 18th century, which paralleled the rise of humanitarianism and the advent of the word “responsibility”. Following an analysis of the meanings of the value of responsibility in general and in medical practice in particular, it is argued that, similarly to the Aristotelian (...) notion of equity, responsibility of care is a second-order value, which corrects virtues, laws and norms in exceptional circumstances. Virtues and practices of the second order, such as responsibility and deliberation, bear especially on professional doctoring, which includes a commitment to give priority to the good of the patient over one’s own good. It is argued that, in situations of conflict, and particularly conflicts between personal moral identity and the good of patients, the fundamental professional commitment is to critical and rational deliberation and to the cultivation of psycho-moral flexibility. This leads indirectly to moral growth and strengthening of professional character. (shrink)

Editors’ Note: We decided that a commentary to the original Aikin essay from the perspective of humanities policy would be beneficial. We then invited Scott Aikin to respond to this commentary. What follows is (a) the Briggle/Frodeman commentary and (b) the Aikin response. We present the discussion in its entirety in the conviction that this transparency will help the reader to critically assess the viability of these arguments and to draw his/her own conclusion as to the efficacy of such reasoning (...) for environmental philosophy as such. (shrink)

This paper is part of a broader argument that seeks to offer a justification for political authority. It aims to investigate the role of truth in political argument and to place the problem of reasonable disagreement. The argument focuses on the possibility of political deliberation, that figures as a stage of political decision‐making. It has to do with a confrontation between incompatible substantive beliefs which, however, all seem to be reasonable. How can citizens holding incompatible beliefs engage in an (...) enterprise of justifying them to one another? That is the question. (shrink)

In this paper, I argue that many recent interpretations of John Dewey's vision of democracy distort that vision by filtering it through the prism of contemporary deliberative democratic theories. An earlier attempt to defend Dewey's theory of moral deliberation is instructive for understanding the nature and function of this filter. In James Gouinlock's essay "Dewey's Theory of Moral Deliberation," he argues that Morton White and Charles L. Stevenson's criticisms of John Dewey's ethical theory are based upon fundamental misinterpretations (...) of Dewey's theory of moral deliberation. In the spirit of Gouinlock's 1978 essay, I show how this historical debate relates to a claim of political philosophers and political theorists that is currently in vogue, namely, that Dewey's writings contain a nascent theory of deliberative democracy. Deliberative democratic theorists contend that deliberation is the group activity that transforms individual preferences and behavior into mutual understanding, agreement, and collective action. Once Dewey's vision of democracy is identified with this theory of deliberative democracy, the strategic question for Deweyans arises: If Deweyan democracy is identified too closely with deliberative democracy, will Dewey scholars risk making Dewey's democratic vision an outmoded approach to theorizing about democracy in the wake of an expired deliberative turn? One way to see our way clear of this strategic question is to remove the deliberative democracy filter and appreciate Dewey's vision of democracy as a unique and free-standing contribution to democratic theory. (shrink)

In this paper, I will try to answer the question: How are we supposed to assess the expert’s opinion in an argument from the position of an outsider to the specialized field? by placing it in the larger context of the political status of epistemic authority. In order to do this I will first sketch the actual debate around the problem of expertise in a democracy and relate this to the issue of the status of science in society. Secondly, I (...) will review how Douglas Walton’s pragma-dialectical approach offers a practical procedure to assess the expert bias from a nonprofessional’s perspective. Thirdly, I will introduce the problem of group bias using insights from Bohman and Fischer and show how Walton’s solution does not address this specific type of bias. Lastly, I will try proposing a revision of Walton’s solution in order to address this problem. In order to make the explanation more easy to follow I will use a case study concerning the medical expertise in the public debate on second-hand smoke. (shrink)

I defend evidential decision theory and the theory of deliberation-probability dynamics from a recent criticism advanced by Jordan Howard Sobel. I argue that his alleged counterexample to the theories, called the Popcorn Problem is not a genuine counterexample.

Cet article est consacré aux relations inter-institutionnelles et à la manière dont elles traduisent des principes généraux. Dans ce type de contexte, la communication et la délibération prennent en charge des tâches interprétatives ainsi que des opérations d’élaboration de compromis. Cela est illustré par l’exemple de l’allocation du pouvoir lorsque des principes généraux d’arrière-plan sont de nature à favoriser des migrations d’autorité. On examine ensuite le concept de marges de manoeuvre institutionnelles.

Even if war, terrorism, and other acts of political violence are inherently wrong, in so radically imperfect a world as our own there remains a need, as Virginia Held suggests, to evaluate such acts so as to distinguish between degrees of their unjustifiability. This essay proposes a notion of deliberative democracy as one criterion for such a comparative evaluation. Expanding on an analysis of the psychologically terrorizing impact of violence borrowed from Hannah Arendt, I suggest that it is principally this (...) that makes for the special wrongness of terrorism, though that by itself does not show that it is never necessary.An effort to distinguish clearly the superiority of states over non-state actors in this regard proves futile, so I conclude that there is no automatic legitimacy to be gained by either sort. It follows that we should weigh an act of political violence on its own demerits irrespective of whether it is done by a state or by a group in opposition to states, and further that we should resist the propagandistic labeling of non-state violence as “evil” or “terroristic,” where such terms beg the question of its relative merits, in context, vis-à-vis state violence. (shrink)