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Toward More Legitimate Bioethics Policy: Using the Methods of “Big Picture Bioethics”

Toward More Legitimate Bioethics Policy: Using the Methods of “Big Picture Bioethics”. Susan Dodds University of W ollongong Rachel Ankeny University of Sydney. Introduction: Big Picture Bioethics. Focuses on novel approaches to the ethical and political analysis of health policy-making

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Toward More Legitimate Bioethics Policy: Using the Methods of “Big Picture Bioethics”

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  1. Toward More Legitimate Bioethics Policy: Using the Methods of “Big Picture Bioethics” Susan Dodds University of Wollongong Rachel Ankeny University of Sydney

  2. Introduction: Big Picture Bioethics • Focuses on novel approaches to the ethical and political analysis of health policy-making • Integrates diverse disciplinary perspectives (political philosophy, bioethics, feminism, law, history and philosophy of science), resulting in new bioethics methodologies • Comparative analyses of policy-making processes and content (Australia and Canada) • Co-investigators: Rachel Ankeny and Jason Grossman, University of Sydney, Françoise Baylis and Jocelyn Downie, Dalhousie University, (Fiona Mackenzie, RA and Kerry Ross, student researcher)

  3. BPB: Three Case Studies • Provision of publicly-funded health services (what should be recognised as legitimate diagnoses and appropriate treatments; what should be publicly funded ) • Governance of research involving humans (mechanisms and content) • Regulation of research on human embryos, human embryonic stem cells, and human cloning (whether, what, how, and content)

  4. Key Focal Points of ‘Big Picture Bioethics’ • the justification of policy processes that lead to regulation (or decisions not to regulate) • the conditions that contribute to the legitimacy of policy • the social and political context of issues • that we aren’t in ideal speech situations; that we aren’t all perfectly rational; and perhaps most importantly, that significant ethical, political, and social disagreements exist

  5. Two Approaches to Legitimacy • Rawlsian: Ultimately able to determine what our shared and overlapping values are; can achieve a level of consensus about matters in the political realm through a process of reflective equilibrium • Habermasian: Possibility of communication in principle, but leaves open the scope of the political (or public); through a process of seeking to deliberate towards an outcome, consensus may be possible

  6. Demands of Public Policy • Determinate (if not definitive) outcome • Public justifiability • Attending to the fact of ethical disagreement • Relative legitimacy: • Process viewed as open to concerns of all those affected • Those affected and policy makers are able to articulate why the policy is thought to be justified

  7. The Challenge of Deliberation (preconditions) • All those involved must ‘play the deliberation game’ • Deliberators need to be concerned for the common good and for reciprocity • Given these preconditions, cultures of deliberation must be developed rather than adversarial contest as well as grounds for acknowledgment of diversity • Public deliberation about areas of scientific research may require a level of skepticism re: “experts” who may have partial grounds for their views • A range of habits of public reasoning and public fora for debate, discussion, and dissemination of knowledge need to be fostered (esp. for oppressed groups)

  8. What is Bioethics as Usual? • Personal morality • Professional ethics • Institutional ethics • Application of normative ethical theory to health care and medicine • Principlism

  9. Problems • No agreement on foundational ethical assumptions • Reliance for legitimacy on consulting public opinion or reflecting public values • Reliance on experts and assumption of deficit model

  10. Alternative Approaches: Empirical Bioethics • Synthesis between ethical and social science perspectives • Social science methods used • Opinion polls/ surveys • Open-ended interviews • Focus groups/ citizen juries

  11. Challenges for Empirical Bioethics • Framing problems • Masking of underlying value systems • Pathologies of deliberation: • Polarisation • Strategic positioning • Cultures of “winning arguments”

  12. What’s New about BPB? • Compare current debates in political philosophy • Gutmann & Thomson: health policy deliberation • Dryzek: citizen juries on health allocation • Young: distinguishing justice and democracy; emphasis on inclusive processes

  13. Conclusions • BPB as an approach to policy process evaluation • Approach avoids assumptions about consensus (e.g., that it can be reached, that we have shared fundamental values, etc.) • Avoids pre-figuring particular roles, scope, or issues • Leaves open the question of whether legitimacy is always obtainable

  14. Big-Picture Bioethics Policy-Making and Liberal Democracy For further information Australian Research Council Discovery Project website http://uow.edu.au/arts/research/bigpicturebioethics/ • sdodds@uow.edu.au • rankeny@science.usyd.edu.au

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