The public's considerations about implementing non-pharmaceutical interventions to manage a novel COVID-19 epidemic.

In the future, new variants of the SARS-CoV-2 virus might emerge and cause outbreaks. If this occurs, the implementation of non-pharmaceutical interventions (NPIs) can be reconsidered. Consideration of the potential benefits and harms of implementing NPIs, and ultimately deciding about implementing NPIs, is currently mainly executed by experts and governments. However, general literature on public engagement suggests that integrating public perspectives into decision-making can enhance the quality of decisions and foster greater public understanding of them. In this study, a deliberative mini-public was conducted to integrate this public perspective. The aim was to elicit public considerations regarding non-pharmaceutical interventions by asking a diverse group of citizens to participate as decision-makers and convene, learn and deliberate about implementing non-pharmaceutical interventions during a hypothetical outbreak of a new SARS-CoV-2 variant. Participants emphasized the importance of early implementation during the outbreak, to prevent exceeding healthcare capacity, long-term mental health issues, educational deficits, and bankruptcies. Additionally, participants stressed taking public support into account, and shared ideas on maintaining support. Furthermore, participants wanted to give citizens personal responsibility and freedom in making their own assessment regarding adherence to interventions and how much risk of infection they would be willing to accept. Participants also expressed the need for the government to adopt a learning attitude towards improvements in pandemic response, and to generate more focus on long-term strategies. The deliberative mini-public, revealed public considerations that reflected public values and needs. These considerations might be helpful in better aligning epidemic management policies with public perspectives. Regarding the deliberative mini-public, uncertainties remain about the design and impact on a bigger scale.

Preferences on Governance Models for Mental Health Data: Qualitative Study With Young People.

BACKGROUND: Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people. OBJECTIVE: In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so. METHODS: Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method. RESULTS: Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers. CONCLUSIONS: Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people's preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank.

Neuroscience and Society: Supporting and Unsettling Public Engagement.

Advancing neuroscience is one of many topics that pose a challenge often called "the alignment problem"-the challenge, that is, of assuring that science policy is responsive to and in some sense squares with the public's values. This issue of the Hastings Center Report launches a series of scholarly essays and articles on the ethical and social issues raised by this vast body of medical research and bench science. The series, which will run under the banner "Neuroscience and Society," is supported by the Dana Foundation and seeks to promote deliberative public engagement, broadly understood, about neuroscience. As a social goal, deliberative public engagement is both ubiquitous and elusive-called for everywhere yet difficult to undertake at a national level on a complex scientific topic. To be meaningful, deliberative public engagement must occur in many locations in a society and be carried forward by many actors. Scholarly writing might contribute in several ways.

The Conflict over Bialowieza Forest in the Light of Philip Kitcher's Ideal Deliberation.

Environmental conflicts involve many participants in the social life: citizens, foresters, the media, activists, politicians, officials and scientists. In this paper we pay special attention to scientists who provide the others with expert knowledge and proposals for solutions to ecological problems. Using the example of the ecological conflict around the strategy of protection of Bialowieza Forest against the invasion of the spruce bark beetle (Ips typographus), we will present how these scientific functions were performed as well as what communication mistakes were made, and formulate a postulate to enrich forest management with a participatory model of social debate involving scientists representing all possible approaches to the problem. Our proposal applies Kitcher's framework giving a ground for different stakeholders to come together to address complex environmental issues. Fitting into the trend of deliberative democracy, the paper provides an insight from philosophy that can be applied to controversial issues of policy and management, and how to influence an environmental change.

Assessing Facilitator Fidelity to Principles of Public Deliberation: Tutorial.

Public deliberation, or deliberative democracy, is a method used to elicit informed perspectives and justifiable solutions to ethically fraught or contentious issues that affect multiple stakeholder groups with conflicting interests. Deliberative events bring together stakeholders (deliberants) who are provided with empirical evidence on the central issue or concern and then asked to discuss the evidence, consider the issue from a societal perspective, and collectively work toward a justifiable resolution. There is increasing interest in this method, which warrants clear guidance for evaluating the quality of its use in research. Most of the existing literature on measuring deliberation quality emphasizes the quality of deliberants' inputs (eg, engagement and evidence of compromise) during deliberative sessions. Fewer researchers have framed quality in terms of facilitator inputs, and these researchers tend to examine inputs that are consistent with generic group processes. The theory, process, and purpose of public deliberation, however, are distinct from those of focus groups or other group-based discussions and warrant a mechanism for measuring quality in terms of facilitator fidelity to the principles and processes of deliberative democracy. In our public deliberation on ethical conflicts in minor consent for biomedical HIV prevention research, we assessed facilitator fidelity to these principles and processes because we believe that such assessments serve as a component of a comprehensive evaluation of overall deliberation quality. We examined verbatim facilitator remarks in the deliberation transcripts and determined whether they aligned with the 6 principles of public deliberation: equal participation, respect for the opinions of others, adoption of a societal perspective, reasoned justification of ideas, expression of diverse opinions, and compromise or movement toward consensus. In this tutorial, we describe the development of a blueprint to guide researchers in assessing facilitator fidelity, share 3 templates that will assist them in the task, and describe the results of our assessment of facilitator fidelity in 1 of the 4 sites in which we conducted deliberations.

Mini-publics in dental public health policymaking.

What are mini-publics and under what circumstances could they be applied to public health dentistry? This question is explored with reference to water fluoridation in England, a policy intervention characterised by a visceral politics that has embedded a systemic preference for non-decision-making. Mini-publics can nevertheless inform decision-making by inviting a representative sample of the affected citizenry to consider the available evidence and come to a set of conclusions and/or recommendations that if all parties cannot agree, none can reasonably object. In doing so, mini-publics have the potential to break the policy deadlock by adding an additional layer of legitimacy to the decision-making process, albeit this is dependent upon decision-makers granting value to their findings.

A democracy built on communicative action: Bahá'í political practice as a prefigurative resource for institutional effectiveness, accountability, and inclusivity.

Goal 16 of the UN sustainable development goals, which calls on the global community to "build effective, accountable and inclusive institutions at all levels," can be conceptualized as aiming at fostering communicative action, a concept developed by Jürgen Habermas to describe a mode for coordinating society grounded in deliberation. However, Habermas simultaneously provides an account of the structural transformation of the public sphere that suggests a hard limit on the capacity of mainstream capitalist liberal democracies to foster genuine communicative action in the relationships between institutions, individuals and communities. This paper therefore argues for the critical role of prefigurative politics, in which communities strive to internally embody desired socio-political forms rather than focusing on changing the wider socio-political order, as a vital resource for generating examples to inform institutional progress. The prefigurative example of the Baha'i community demonstrates norms and practices that may illustrate a path out of the dynamic Habermas identifies of system colonizing lifeworld, by fostering and protecting communicative action as the mode of social coordination. The form of communicative action found in the Baha'i community is situated in a context of a telic-organic model of relationships between individuals, communities and institutions. The paper contrasts the conceptual underpinnings of this model with individualistic conceptions of human nature that are argued to undermine liberal democracy's capacity for communicative action. At the core of communicative action within a Baha'i context is a distinctive model of deliberation, known within the community as "consultation". The paper argues that rational-critical consultation can offer a vital nuance to Habermas' ideal of communicative action as rational-critical debate in the public sphere. The formal democratic structures and processes of the Bahá'í community are also explored as an institutional example that arguably meets the challenge of Goal 16. The paper concludes with initial reflections on a process by which the prefigurative example of a Baha'i model might be brought to bear on institutional performance in wider society.

Green politics beyond the state: radicalizing the democratic potentials of climate citizens' assemblies.

In recent years, countries like France, UK, Germany, and Denmark have all carried out climate citizens' assemblies where a group of representatively selected citizens come together to discuss issues around climate politics and provide policy recommendations to decision-makers. The hope is that these deliberative-democratic innovations can circumvent the flaws of representational politics and help break the existing gridlock around climate politics. In this article, relying on the case of the Danish climate citizens' assembly that began its work in 2020, we argue that to truly realize the democratic potentials of climate citizens' assemblies, there is a need to think about how citizens' assemblies might come to multiply and proliferate in political spaces away from, or at least in addition to, those in and around the state, so they can become local drivers of democratic action and community empowerment. The argument is not that citizens' assemblies should give up on affecting the state and parliamentary politics altogether, but that we must be careful not to put too much faith in state institutions, and also look for spaces outside the state where the conditions for transformative change and democratic capacity-building currently appear more fecund. Drawing together these arguments, we offer what we call a more radical vision of the democratic potentials of climate citizens' assemblies, and provide some guidelines for what that would look like in practice.

Testing a Deliberative Democracy Engagement Intervention to Increase Guideline-Concordance Among Oral Health Providers: Results from the DISGO Cluster-Randomized, Stepped-Wedge Trial.

Background: Dental caries affects billions worldwide and in the U.S. is among the most prevalent noncommunicable diseases in both children and adults. Early in the caries process, it can be arrested by dental sealants, which are non-invasive and thus tooth sparing, however, few dentists have adopted this approach. Deliberative engagement processes enable participants to engage with diverse perspectives on a policy issue and develop and share with policy makers informed opinions about the policy issue. We examined the effects of a deliberative engagement process on the ability of oral health providers to endorse implementation interventions and to apply dental sealants. Methods: Using a stepped wedge design, 16 dental clinics were cluster randomized, and 680 providers and staff were exposed to a deliberative engagement process that included an introductory session, workbook, facilitated small group deliberative forum, and post-forum survey. Forum participants were assigned to forums to ensure diverse role representation. Mechanisms of action examined included sharing voice and diversity of opinion. Three months after each clinic's forum, the clinic manager was interviewed about implementation interventions deployed. There were 98 clinic-months in the non-intervention period and 101 clinic-months in the intervention period. Results: Compared with providers and staff in small clinics, providers and staff in medium and large clinics more strongly agreed that their clinic should adopt two of the three proposed implementation interventions targeting the first barrier and one of the two proposed implementation interventions targeting the second barrier. Compared with the non-intervention period, in the intervention period providers did not place more sealants on occlusal non-cavitated carious lesions. Survey respondents reported sharing both promotive and prohibitive voice. From the beginning to the end of the forums, most forum participants did not change their opinions about the possible implementation interventions. At the end of the forums, there was no significant within-group variability in implementation interventions endorsed. Conclusions: Deliberative engagement intervention may help clinic leadership identify implementation interventions when there is a challenging problem, a network of semi-autonomous clinics, and autonomous providers within those clinics. It remains to be determined whether there is a range of perspectives within clinics. Trial Registration: This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 12/18/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.

Political entrepreneurs in social media: Self-monitoring, authenticity and connective democracy. The case of Íñigo Errejón.

Political entrepreneurs seek to mobilise public opinion and access large audiences who are not directly interested in politics, but are exposed to the digital environment. The aim of this research was to analyse how these figures promote experimental communication uses on channels far removed from political activity. We focused on Twitch, a successful platform for promoting entertainment and learning in the video games field. To do so, we conducted a significant case study, that of Íñigo Errejón, a Spanish male Member of Parliament, in 2021 through 18 live streamings that lasted 1223 min. We specifically described the conception and use of Twitch, measured the audience's impact, analysed the accountability exercise through this platform and evaluated the deliberative quality of conversation with users. To conclude, we identified three novel contributions of Twitch to digital political communication: self-monitoring, insofar as the elected politician himself proactively exercises accountability to the public without a third party intervening; the activation of mediated authenticity as a key value in the political actor's public construction; promoting connective democracy, which would help those sectors not used to employing political information to take an interest in it by detecting attention being paid to their needs and questions.

Value creation and CSR.

A more robust, inclusive model of value creation will sharpen dominant normative theories of Corporate Social Responsibility (CSR) such as stakeholder theory and the theory of communicative/deliberative democracy. When measuring value creation, CSR theories oscillate between traditional, exchange-based approaches utilizing narrow financial metrics and value-oriented approaches embedded in prominent CSR theories. The two are often in conflict. The problem is aggravated by CSR's assumption that all firms, regardless of industry, possess the same generic responsibilities. A mining company, a sports betting service, and a medical device manufacturer are on all fours when measuring CSR success. The paper identifies a contradiction between settled normative convictions and the corporate decision making that normative CSR theories prescribe. Using the pharmaceutical industry as an example, it references the widespread conviction that during the 2019 Covid-19 pandemic some pharmaceutical companies had a responsibility to reach beyond the goal of financial optimization. It then explains why this conviction cannot be rationalized using two prominent normative theories of CSR, namely, stakeholder theory and the theory of communicative/deliberative democracy. The problem hinges on a defective model of value creation. One implication of the analysis is that healthcare companies should readjust corporate governance in order to make health a focal goal alongside that of profit. At the same time, a semiconductor firm might satisfy its CSR responsibilities by only designating profit as its focal goal. The thrust of the paper is to show why reconceiving the model of value creation can advance not only stakeholder and communicative/deliberative democracy theories, but all CSR.

The Role of Self-Interest in Deliberation: A Theory of Deliberative Capital.

How do successful deliberations unfold? What happens when they unravel? In this article, I propose that we think of the dynamics of participant engagement within deliberation as series of self-interested and reciprocal investments in and divestments from deliberative capital. This article has three parts. First, I draw on the literatures on deliberative democracy and social capital to outline a theory of deliberative capital. I highlight the important role self-interest plays in the process of those initial investments - instances of engagement in positive deliberative behaviours. Second, drawing from my experience as a facilitator, I give an account of the particular indicators of investments and divestments that we might expect to see in a given deliberative engagement. Third, I briefly outline two innovative facilitation techniques that can be utilized at the beginning or during a deliberative process that trigger self-interest, which incentivizes investments and discourages divestments.

Exploring prospects of deliberation in intractable natural resource management conflicts.

Deliberative processes are increasingly advocated as means to handle intractable natural resource management (NRM) conflicts. Research shows that disputing actors can deliberate and achieve higher degrees of mutual understanding and working agreements under ideal conditions, but the transferability of these findings to real-world intractable NRM conflicts can be questioned. This paper explores the possibilities of designing and realizing deliberation and its expected outcomes in real-world NRM conflicts. We used recommended design principles to set up deliberative processes in two intractable mining conflicts involving indigenous peoples in Northern Sweden and assessed the actors' communication and outcomes using frame analysis. The results show that the recommended design principles are hard, but not impossible, to fully implement in intractable NRM conflicts. Both conflicts proved difficult to deliberate and resolve in the sense of reaching agreements. However, the findings suggest that deliberation, as well as meta-consensus, or structured disagreement, is possible to achieve in settings with favorable conditions, e.g. good and established inter-group relations prior to the conflict. In the absence of these conditions, where relations were hostile and shaped by historical and institutional injustices, deliberation was not achieved. In both cases, polarization among the participants remained, or increased, in spite of the deliberative activities. The study highlights the importance of understanding deliberation as embedded in place specific historical and institutional contexts which shape both process and outcomes in powerful ways. More efforts should focus on alternative, or complementary, ways to handle intractable NRM conflicts, including how contested experiences of history, institutions and Indigenous rights can be addressed.

Political Bioethics.

If bioethical questions cannot be resolved in a widely acceptable manner by rational argument, and if they can be regulated only on the basis of political decision-making, then bioethics belongs to the political sphere. The particular kind of politics practiced in any given society matters greatly: it will determine the kind of bioethical regulation, legislation, and public policy generated there. I propose approaching bioethical questions politically in terms of decisions that cannot be "correct" but that can be "procedurally legitimate." Two procedures in particular can deliver legitimate bioethical decisions, once combined: expert bioethics committees and deliberative democracy. Bioethics so understood can exceed bioethics as a moral project or as a set of administrative principles to regulate medical practice; it can now aspire to a democratic project that involves ordinary citizens as far as reasonably possible. I advance this argument in four steps: (1) using the example of human germline gene editing, (2) I propose a general understanding of proceduralism, and (3) then combine two types and (4) conclude with a defense of majoritarian proceduralism. I develop this argument in terms of one example: germline gene editing.

[Parliamentary technology assessment and risk communication]. / Parlamentarische Technikfolgenabschätzung und Risikokommunikation.

Parliamentary technology assessment (TA) has developed in many countries worldwide as a specific approach to scientific policy advice. In Germany, for example, the Office of Technology Assessment at the German Bundestag (TAB) has been serving the national parliament for more than 30 years. The occurrence of unintended side effects of the scientific and technological advance, in particular of technology-induced risks, has been a major motivation of TA from its beginning until present. Its perspective on risks can be characterized by a pluralist approach observing differentiated perception and evaluation of technology-induced risks among different social groups. In particular, risk perception frequently differs between decision-makers, benefiters, stakeholders, and groups affected by possible hazards and stresses. Therefore, the social dimension of the distribution of chances and risks and their differentiated perception among various societal groups as well as between humans living today and future generations, play a major role in risk assessment by TA. Based on general ideas of deliberative democracy, TA has therefore developed approaches to involve people affected with their partially diverging risk perceptions, values, knowledge, and perspectives. In this article, the motivation and mission of TA in general, and of parliamentary TA in particular, will be introduced. The article focuses on the TA principles of inclusion and participation involving societal groups, stakeholders, and citizens in risk assessment. Lessons learned from previous risk debates, such as on nanotechnology, nuclear waste disposal, and green biotechnology, are exploited for deriving conclusions for modern risk communication at the political level.

Doctor Ex Machina: A Critical Assessment of the Use of Artificial Intelligence in Health Care.

This article examines the potential implications of the implementation of artificial intelligence (AI) in health care for both its delivery and the medical profession. To this end, the first section explores the basic features of AI and the yet theoretical concept of autonomous AI followed by an overview of current and developing AI applications. Against this background, the second section discusses the transforming roles of physicians and changes in the patient-physician relationship that could be a consequence of gradual expansion of AI in health care. Subsequently, an examination of the responsibilities physicians should assume in this process is explored. The third section describes conceivable practical and ethical challenges that implementation of a single all-encompassing AI healthcare system would pose. The fourth section presents arguments for regulation of AI in health care to ensure that these applications do not violate basic ethical principles and that human control of AI will be preserved in the future. In the final section, fundamental components of a moral framework from which such regulation may be derived are brought forward, and some possible strategies for building a moral framework are discussed.

Deliberative Public Consultation via Deliberative Polling: Criteria and Methods.

This article poses the problem of public consultation on contested policies involving new technologies and competing values or value-laden goals. It argues that Deliberative Polling, an approach developed by the author, can be usefully employed to engage representative samples to deliberate in depth in controlled experiments so as to yield a picture of the public's considered judgments. It also argues from recent experience that such consultations can be cost effectively conducted online with stratified random samples. It draws on examples from various issue domains including climate and energy as well as prototype deliberations conducted on gene editing in the wild. It sets out criteria that Deliberative Polling, as well as other designs, should satisfy if policy recommendations based on the data generated by these public consultations are to be credible.

Assessing the quality of deliberative stakeholder consultations involving allied health professionals in pediatric palliative care and hematology/oncology in Canada.

BACKGROUND: In this paper we assess the quality of six deliberative stakeholder consultations regarding the implementation of a precision diagnostic for life-threatening pediatric brain tumors. Decision makers who base policy recommendations on the outputs of consultative exercises can presuppose that all deliberants are well informed of the policy issue, that participation in the deliberative process was fair, and that overcoming implementation barriers will necessarily result in practice change. Additional evidence is therefore needed to substantiate the informational quality of the deliberation, measure the equality of participation and study the effects on stakeholder reasoning to appropriately guide uptake of proposed recommendation(s). METHODS: Using the DeVries framework for assessing the deliberative quality, we analyzed data from 44 post-consultation evaluation surveys completed by pediatric oncology and palliative care teams at two tertiary pediatric healthcare centers in Canada. We also conducted turn-taking and word-contribution analyses from the text transcriptions of each deliberation to assess equality of participation using descriptive statistics. RESULTS: Deliberants agreed the quality of the deliberative process was fair (median ratings ranging from 9-10 out of 10) and the opportunities to receive expert information and discuss with others about the implementation of a new LDT were helpful (9.5 out of 10). While the session improved understanding of the implementation barriers and opportunities, it had marginal effects on deliberants' reasoning about whether LDTs would change their own clinical practice (3-10 out of 10). Participation was proportionate in at least four of the six deliberations, where no deliberant took more than 20% of total turns and contributed equal to, or less than 20% of total words. CONCLUSION: The quality assessment we performed demonstrates high informational value and perceived fairness of two deliberative stakeholder consultations involving pediatric palliative care and oncology teams in Canada. Quality assessments can reveal how the process of deliberation unfolds, whether deliberative outputs are the result of equitable participation among deliberants and what, if any, stakeholder voices may be missing. Such assessments should be routinely reported as a condition of methodological rigor and trustworthiness of deliberative stakeholder engagement research.

Wildfire, Environmental Risk and Deliberative Planning in the Locarnese Region of Switzerland.

A survey of residents in the Locarnese region of Canton Ticino, Switzerland was used to examine perceptions of exposure to environmental risk in the context of the deliberative Swiss planning system. There is a growing risk of wildfire in the region, and unless residents' risk perceptions are understood and effectively integrated into decision making, confidence in environmental planning processes could erode. The research analyses how peri-urban residents conceptualise risk, place and environment, and how they perceive their influence over local planning outcomes. Descriptive and inferential statistics reveal high appreciation of lifestyle and amenity values, and support for firefighting services. While respondents recognise the increasing exposure to wildfires and landslides, it was the current level of urban expansion that was seen to be heightening risk at the interface between forests and settlements. Although Swiss deliberative governance arrangements offer citizens opportunities to be involved in decision making through official channels, respondents who were younger, of local background or who were less educated were particularly dissatisfied with their influence over planning. We discuss the implications of these findings for the distinctive Swiss planning system in the context of other countries' ambitions to develop more effective, democratic environmental planning. In particular, the relative ease offered by popular referenda may be creating a disproportionate sense of citizen entitlement to be heard on local planning issues. Dialogues of risk reduction must continue to evolve between the population and government actors to encourage residents to engage more fully with relevant topics of risk for their region.

Disentangling the welfarism/extra-welfarism distinction: Towards a more fine-grained categorization.

In health economics, the distinction between welfarism and extra-welfarism has been employed to discuss various epistemological and normative differences between health evaluation approaches. However, a clear consensus on the definition of either welfarism, extra-welfarism, or the differences between the two sets of approaches has not emerged. I propose an alternative set of distinctions that allows for a more fine-grained categorization of health evaluation approaches. This categorization focuses on five dimensions: (1) the maximand of an evaluation approach, (2) its sensitivity toward normative concerns that defy compensation, (3) its position on which groups of individuals or collective entities act as sources of values, (4) its sensitivity to changes of mind, and (5) the inclusion of process-external values.