Preparing popular views for inclusion in a reflective equilibrium: A case study on illness severity.

Principles for priority setting in health care are typically forged by experts influenced by the normative literature on priority setting. Meanwhile, their implementation is subject to democratic deliberation, political pressures, and administrative bureaucracy. Sometimes expert proposals are democratically rejected. This points towards a problem: on the one hand, the fact that a majority shares a moral belief does not inherently validate this belief. On the other hand, when justifying a position to others, we cannot expect much success without engaging with their moral judgments. In this work we examine the possibility of including so-called popular views in a reflective equilibrium process. In reflective equilibrium processes, we are usually interested in considered judgments rather than mere intuitions. Popular views, arguably, often do not meet this standard. To mitigate this, we propose to bolster popular views by linking them with theoretical frameworks echoing similar moral perspectives. We use illness severity as a case study and show that a set of popular accounts can provide considered judgments that merit inclusion in a publicly informed reflective equilibrium process. This is plausibly a way forward in the search for priority setting principles that are both normatively sound and acceptable to the public. Our method provides a general framework for refining available data on popular views on moral questions, including when we cannot assess the consideredness of such views.

Bioethics Without Theory?

The question that this paper tries to answer is Q: "Can good academic bioethics be done without commitment to moral theory?" It is argued that the answer to Q is an unequivocal "Yes" for most of what we could call "critical bioethics," that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also "Yes" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to "constructive bioethics," that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy.

Overlapping consensus in pluralist societies: simulating Rawlsian full reflective equilibrium.

The fact of reasonable pluralism in liberal democracies threatens the stability of such societies. John Rawls proposed a solution to this problem: The different comprehensive moral doctrines endorsed by the citizens overlap on a shared political conception of justice, e.g. his justice as fairness. Optimally, accepting the political conception is for each citizen individually justified by the method of wide reflective equilibrium. If this holds, society is in full reflective equilibrium. Rawls does not in detail investigate the conditions under which a full reflective equilibrium is possible or likely. This paper outlines a new strategy for addressing this open question by using the formal model of reflective equilibrium recently developed by Beisbart et al. First, it is argued that a bounded rationality perspective is appropriate which requires certain changes in the model. Second, the paper rephrases the open question about Rawlsian full reflective equilibrium in terms of the model. The question is narrowed down by focusing on the inferential connections between comprehensive doctrines and political conception. Rawls himself makes a demanding assumption about which connections are necessary for a full reflective equilibrium. Third, the paper presents a simulation study design that is focused on simplicity. The results are discussed, they fit with Rawls's assumption. However, because of the strong idealisations, they provide a useful benchmark rather than a final answer. The paper presents suggestions for more elaborate study designs.

Leveraging a Sturdy Norm: How Ethicists Really Argue?

Rarely do everyday discussions of ethical issues invoke ethical theories. Even ethicists deploy ethical theories less frequently than one might expect. In my experience, the most powerful ethical arguments rarely appeal to an ethical theory. How is this possible? I contend that ethical argumentation can proceed successfully without invoking any ethical theory because the structure of good ethical argumentation involves leveraging a sturdy norm, where the norm is usually far more specific than a complete ethical theory. To illustrate this idea, I present the argumentative structure of five powerful articles in the ethics literature. I further argue that the present model of ethical argumentation is consistent with the coherence model of ethical justification, but the former need not--and usually should not--invoke the latter explicitly for various practical reasons.

The Vagueness of Integrating the Empirical and the Normative: Researchers' Views on Doing Empirical Bioethics.

The integration of normative analysis with empirical data often remains unclear despite the availability of many empirical bioethics methodologies. This paper sought bioethics scholars' experiences and reflections of doing empirical bioethics research to feed these practical insights into the debate on methods. We interviewed twenty-six participants who revealed their process of integrating the normative and the empirical. From the analysis of the data, we first used the themes to identify the methodological content. That is, we show participants' use of familiar methods explained as "back-and-forth" methods (reflective equilibrium), followed by dialogical methods where collaboration was seen as a better way of doing integration. Thereafter, we highlight methods that were deemed as inherent integration approaches, where the normative and the empirical were intertwined from the start of the research project. Second, we used the themes to express not only how we interpreted what was said but also how things were said. In this, we describe an air of uncertainty and overall vagueness that surrounded the above methods. We conclude that the indeterminacy of integration methods is a double-edged sword. It allows for flexibility but also risks obscuring a lack of understanding of the theoretical-methodological underpinnings of empirical bioethics research methods.

Does reflective equilibrium help us converge?

I address the worry that reflective equilibrium is too weak as an account of justification because it fails to let differing views converge. I take up informal aspects of convergence and operationalise them in a formal model of reflective equilibrium. This allows for exploration by the means of computer simulation. Findings show that the formal model does not yield unique outputs, but still boosts agreement. I conclude from this that reflective equilibrium is best seen as a pluralist account of justification that cannot be accused of resulting in an "anything goes" relativism.

Naturalness and principle pluralism in conservation.

The concept of naturalness in biodiversity conservation remains polysemic, hampering decision-making. Although some conservationists claim ecosystem naturalness should be primarily determined by composition (integrity), others argue it should be determined by the extent of freedom from anthropogenic influence (autonomy). Problems arise when deciding how to treat affected ecosystems. Although the integrity school promotes benchmark-based active restoration, the autonomy school advocates a hands-off policy, making these 2 approaches contradictory. Moreover, expected global changes have promoted advocacy for ecosystem resilience, further complicating the debate. We argue that autonomy, integrity, and resilience are all morally valid. The conflict between them is contained by recognizing that full naturalness is an unattainable goal; restoration and rewilding processes are not an act of curation, but a contrary-to-duty obligation; principle pluralism can accommodate integrity, resilience, and autonomy as pro tanto principles in a case-specific approach; and naturalness, as an overarching value, gives unity to the plurality of principles.

Naturalidad y pluralismo de principios en conservación Resumen El concepto de naturalidad en la conservación de biodiversidad continúa polisémico, lo cual limita la toma de decisiones. Mientras algunos conservacionistas afirman que la naturalidad de los ecosistemas debe ser determinada primariamente por la composición (integridad), otros argumentan que debe ser determinada por la extensión de libertad de la influencia antropogénica (autonomía).Cuando se decide cómo tratar ecosistemas afectados surgen problemas. Mientras la corriente de integridad promueve restauración activa a partir de un punto de referencia, la corriente de autonomía defiende políticas de no intervención, dos enfoques contradictorios. Además, los cambios globales esperados han promovido propugnar por la resiliencia ecosistémica, lo cual complica el debate aún más. Argumentamos que tanto la autonomía, la integridad y la resiliencia son moralmente válidas. El conflicto entre ellas es atajado mediante el reconocimiento de la naturalidad total es una meta inalcanzable; los procesos de restauración y resilvestración no son un acto de curación, sino una obligación contraria al deber; el pluralismo de principios puede acomodar a la integridad, la resiliencia y la autonomía como principios pro tanto en un caso específico; y la naturalidad, como un valor general, proporciona unidad a la pluralidad de principios.

Normative Ethical Theorizing.

Ethical issues are ubiquitous in nursing, yet there is a dearth of scholarship in normative ethics and ethical inquiry in nursing. In a concern to motivate interest in normative ethics and inquiry to build ethical knowledge, this article highlights some of the conceptual resources of normative ethics after describing the different types of ethics, including normative ethics. These conceptual resources of normative ethics include moral theories and the method of wide reflective equilibrium.

Applicability Analysis of Gender Selection in Mitochondrial Replacement Technology / 中国医学伦理学

Whether gender selection should be conducted is a controversial topic in ethical research on mitochondrial replacement technology. Scholars put forward different moral judgments based on different positions, and after reviewing these judgments, it was found that those who support gender selection mainly rely on the utility theory and rights theory, while those who oppose gender selection mainly rely on the dignity theory and community theory. It is not difficult to find that relying on traditional moral theory to defend moral judgments or actions often leads to endless debates among "moral strangers" , and does not provide effective guidance for solving specific problems. Principlism is a systematic and comprehensive analytical approach constructed with a series of clear and effective frameworks, which can reasonably solve the differences and disagreements between different value systems and cultural concepts. In the discussion of whether gender selection should be conducted in mitochondrial replacement technology, principlism refined and balanced it through the method of reflective equilibrium, and finally obtained the best judgment plan that allows for gender selection. To truly achieve the humane purpose of avoiding harm in gender selection, it is necessary to clearly limit the objects and stages of use, and regulate them from the dual dimensions of ethics and morality, as well as policy regulation.

Unifying 'the' Precautionary Principle? Justification and Reflective Equilibrium.

The precautionary principle (PP) is an influential principle for making decisions when facing uncertain, but potentially severe, harm. However, there is a persistent disagreement about what the principle entails, exactly. It exists in a multitude of formulations and has potentially conflicting ideas associated with it. Is there even such a thing as 'the precautionary principle'? This paper analyses the debate between unificationists and pluralists about 'the PP', arguing that the debate is hindered by neglecting the question of justification. It introduces reflective equilibrium as a method of justification, and sketches how it could be applied to justify a PP.

Judgment aggregation, discursive dilemma and reflective equilibrium: Neural language models as self-improving doxastic agents.

Neural language models (NLMs) are susceptible to producing inconsistent output. This paper proposes a new diagnosis as well as a novel remedy for NLMs' incoherence. We train NLMs on synthetic text corpora that are created by simulating text production in a society. For diagnostic purposes, we explicitly model the individual belief systems of artificial agents (authors) who produce corpus texts. NLMs, trained on those texts, can be shown to aggregate the judgments of individual authors during pre-training according to sentence-wise vote ratios (roughly, reporting frequencies), which inevitably leads to so-called discursive dilemmas: aggregate judgments are inconsistent even though all individual belief states are consistent. As a remedy for such inconsistencies, we develop a self-training procedure-inspired by the concept of reflective equilibrium-that effectively reduces the extent of logical incoherence in a model's belief system, corrects global mis-confidence, and eventually allows the model to settle on a new, epistemically superior belief state. Thus, social choice theory helps to understand why NLMs are prone to produce inconsistencies; epistemology suggests how to get rid of them.

Turning the trolley with reflective equilibrium.

Reflective equilibrium (RE)-the idea that we have to justify our judgments and principles through a process of mutual adjustment-is taken to be a central method in philosophy. Nonetheless, conceptions of RE often stay sketchy, and there is a striking lack of explicit and traceable applications of it. This paper presents an explicit case study for the application of an elaborate RE conception. RE is used to reconstruct the arguments from Thomson's paper "Turning the Trolley" for why a bystander must not divert a runaway trolley from five workmen onto one. Analyzing Thomson's resulting position with the RE-criteria has two main results: Firstly, the adjustment of one of her commitments can be defended. Secondly, no justified position in RE was reached. With respect to RE as a method, the main results from this application are: (1) There is at least one conception of RE that is sufficiently specified to be applicable; (2) the RE criteria put real constraints on the process of justification; and (3) an explicit application of RE has benefits in terms of clarity while at the same time providing guidance for how the justificatory process could be continued.

Re-engineering contested concepts. A reflective-equilibrium approach.

Social scientists, political scientists and philosophers debate key concepts such as democracy, power and autonomy. Contested concepts like these pose questions: Are terms such as "democracy" hopelessly ambiguous? How can two theorists defend alternative accounts of democracy without talking past each other? How can we understand debates in which theorists disagree about what democracy is? This paper first discusses the popular strategy to answer these questions by appealing to Rawls's distinction between concepts and conceptions. According to this approach, defenders of rival conceptions of, e.g. justice can disagree without talking past each other because they share the concept of justice. It is argued that this idea is attractive but limited in application and that it fails to do justice to the dynamic and normative aspects of concept formation. Reflective equilibrium is then suggested as an alternative approach. It replaces the static contrast between a conceptual 'core' and competing conceptions by a dynamic perspective of concept formation as a partly normative undertaking: pre-theoretic language use and commitments can provide a shared starting point for developing alternative accounts which yield different concepts of, e.g. justice. This perspective provides a new understanding of how it is possible that different theorists defend rival accounts of, e.g. justice, without talking past each other.

Ethics review, reflective equilibrium and reflexivity.

BACKGROUND: Research Ethics Committees (RECs) or their equivalent review applications for prospective research with human participants. Reviewers use universally agreed principlesi to make decisions about whether prospective health and social care research is ethical. Close attention to understanding how reviewers go about their decision-making work and consider principles in practice is limited. OBJECTIVE: The study aimed to understand how reviewers made decisions in the contexts of meetings and to understand more about how reviewers approach their work. The purpose of this article is to draw on data and findings and to show how reflective equilibrium as a theoretical frame can (1) deepen understanding of ethics review and (2) permit a reflexive examination of the habitual processes of review. DESIGN AND PARTICIPANTS: Methods captured the day-to-day work of the RECs. Seventeen applications were heard during eight observations. There were 12 formal interviews with reviewers (n = 12) and with researchers (n = 8) which are not reported on in this article. ETHICAL CONSIDERATIONS: Organisational permission for the study was given by the National Research Ethics Service (NRES) whose functions became part of the Health Research Authority (HRA) during the study. The study was given favourable opinion by the University of Salford's REC (Reference HSCR11/17). FINDINGS: Data were analysed using constructed grounded theory resulting in eight themes which revealed attention to procedure and engagement with applications. Reflective equilibrium was used as a qualitative frame to interpret themes distilling them into three processes at work in review: emotion and intuition; imagination and creative thinking; and intuition and trust. DISCUSSION: Reviewers went back and forth between universal principles and considered these in the contexts of each application using the above processes. CONCLUSIONS: Reflective equilibrium offers a coherent and grounded account of review work. Reflexivity in training for reviewers is essential for improving practices. The challenges reflexivity presents can be assisted by using reflective equilibrium as a tool to illuminate tacit review processes.

Collective Reflective Equilibrium in Practice (CREP) and controversial novel technologies.

In this paper, we investigate how data about public preferences may be used to inform policy around the use of controversial novel technologies, using public preferences about autonomous vehicles (AVs) as a case study. We first summarize the recent 'Moral Machine' study, which generated preference data from millions of people regarding how they think AVs should respond to emergency situations. We argue that while such preferences cannot be used to directly inform policy, they should not be disregarded. We defend an approach that we call 'Collective Reflective Equilibrium in Practice' (CREP). In CREP, data on public attitudes function as an input into a deliberative process that looks for coherence between attitudes, behaviours and competing ethical principles. We argue that in cases of reasonable moral disagreement, data on public attitudes should play a much greater role in shaping policies than in areas of ethical consensus. We apply CREP to some of the global preferences about AVs uncovered by the Moral Machines study. We intend this discussion both as a substantive contribution to the debate about the programming of ethical AVs, and as an illustration of how CREP works. We argue that CREP provides a principled way of using some public preferences as an input for policy, while justifiably disregarding others.

Mapping, framing, shaping: a framework for empirical bioethics research projects.

BACKGROUND: There is growing interest in the use and incorporation of empirical data in bioethics research. Much of the recent focus has been on specific "empirical bioethics" methodologies, which attempt to integrate the empirical and the normative. Researchers in the field are, however, beginning to explore broader questions, including around acceptable standards of practice for undertaking such research. The framework: In this article, we further widen the focus to consider the overall shape of an empirical bioethics research project. We outline a framework that identifies three key phases of such research, which are conveyed via a landscaping metaphor of Mapping-Framing-Shaping. First, the researcher maps the field of study, typically by undertaking literature reviews. Second, the researcher frames particular areas of the field of study, exploring these in depth, usually via qualitative research. Finally, the researcher seeks to (re-)shape the terrain by issuing recommendations that draw on the findings from the preceding phases. To qualify as empirical bioethics research, the researcher will utilise a methodology that seeks to bridge these different elements in order to arrive at normative recommendations. We illustrate the framework by citing examples of diverse projects which broadly adopt the three-phase framework. Amongst the strengths of the framework are its flexibility, since (as the examples indicate) it does not prescribe any specific methods or particular bridging methodology. However, the framework might also have its limitations, not least because it appears particularly to capture projects that involve qualitative - as opposed to quantitative - research. CONCLUSIONS: Despite its possible limitations, we offer the Mapping-Framing-Shaping framework in the hope that this will prove useful to those who are seeking to plan and undertake empirical bioethics research projects.

Rationalization is rational.

Rationalization occurs when a person has performed an action and then concocts the beliefs and desires that would have made it rational. Then, people often adjust their own beliefs and desires to match the concocted ones. While many studies demonstrate rationalization, and a few theories describe its underlying cognitive mechanisms, we have little understanding of its function. Why is the mind designed to construct post hoc rationalizations of its behavior, and then to adopt them? This may accomplish an important task: transferring information between the different kinds of processes and representations that influence our behavior. Human decision making does not rely on a single process; it is influenced by reason, habit, instinct, norms, and so on. Several of these influences are not organized according to rational choice (i.e., computing and maximizing expected value). Rationalization extracts implicit information - true beliefs and useful desires - from the influence of these non-rational systems on behavior. This is a useful fiction - fiction, because it imputes reason to non-rational psychological processes; useful, because it can improve subsequent reasoning. More generally, rationalization belongs to the broader class of representational exchange mechanisms, which transfer information between many different kinds of psychological representations that guide our behavior. Representational exchange enables us to represent any information in the manner best suited to the particular tasks that require it, balancing accuracy, efficiency, and flexibility in thought. The theory of representational exchange reveals connections between rationalization and theory of mind, inverse reinforcement learning, thought experiments, and reflective equilibrium.

Rawls's Wide Reflective Equilibrium as a Method for Engaged Interdisciplinary Collaboration: Potentials and Limitations for the Context of Technological Risks.

The introduction of new technologies in society is sometimes met with public resistance. Supported by public policy calls for "upstream engagement" and "responsible innovation," recent years have seen a notable rise in attempts to attune research and innovation processes to societal needs, so that stakeholders' concerns are taken into account in the design phase of technology. Both within the social sciences and in the ethics of technology, we see many interdisciplinary collaborations being initiated that aim to address tensions between various normative expectations about science and engineering and the actual outcomes. However, despite pleas to integrate social science research into the ethics of technology, effective normative models for assessing technologies are still scarce. Rawls's wide reflective equilibrium (WRE) is often mentioned as a promising approach to integrate insights from the social sciences in the normative analysis of concrete cases, but an in-depth discussion of how this would work in practice is still lacking. In this article, we explore to what extent the WRE method can be used in the context of technology development. Using cases in engineering and technology development, we discuss three issues that are currently neglected in the applied ethics literature on WRE. The first issue concerns the operationalization of abstract background theories to moral principles. The second issue concerns the inclusiveness of the method and the demand for openness. The third issue is how to establish whether or not an equilibrium has been reached. These issues should be taken into account when applying the methods to real-world cases involving technological risks. Applying the WRE method in the context of engaged interdisciplinary collaboration requires sensitivity for issues of power and representativeness to properly deal with the dynamics between the technical and normative researchers involved as well as society at large.

Profound Intellectual Disability and the Bestowment View of Moral Status.

This article engages with debates concerning the moral worth of human beings with profound intellectual and multiple disabilities (PIMDs). Some argue that those with such disabilities are morally less valuable than so-called normal human beings, whereas others argue that all human beings have equal moral value and that, therefore, each group of humans ought to be treated with equal concern. We will argue in favor of a view that takes points from opposing camps in the debates about the moral worth of humans with such disabilities. Our position, roughly, is this: most humans with PIMDs are persons in the morally significant sense and, therefore, deserve moral consideration equal to that granted to so-called "normal" human beings. Some humans with PIMD may not be persons, but nevertheless deserve moral consideration equal to that of persons because they stand in a special relation to persons.

Bridging the Gap between Social Acceptance and Ethical Acceptability.

New technology brings great benefits, but it can also create new and significant risks. When evaluating those risks in policymaking, there is a tendency to focus on social acceptance. By solely focusing on social acceptance, we could, however, overlook important ethical aspects of technological risk, particularly when we evaluate technologies with transnational and intergenerational risks. I argue that good governance of risky technology requires analyzing both social acceptance and ethical acceptability. Conceptually, these two notions are mostly complementary. Social acceptance studies are not capable of sufficiently capturing all the morally relevant features of risky technologies; ethical analyses do not typically include stakeholders' opinions, and they therefore lack the relevant empirical input for a thorough ethical evaluation. Only when carried out in conjunction are these two types of analysis relevant to national and international governance of risky technology. I discuss the Rawlsian wide reflective equilibrium as a method for marrying social acceptance and ethical acceptability. Although the rationale of my argument is broadly applicable, I will examine the case of multinational nuclear waste repositories in particular. This example will show how ethical issues may be overlooked if we focus only on social acceptance, and will provide a test case for demonstrating how the wide reflective equilibrium can help to bridge the proverbial acceptance-acceptability gap.