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 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. (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and (...) analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium (...) approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions ], we argue that the patient needs to experience some degree of suffering, which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development. (shrink)

This paper makes a conceptual inquiry into the notion of ‘publics’, and forwards an understanding of this notion that allows more responsible forms of decision-making with regards to technologies that have localized impacts, such as wind parks, hydrogen stations or flood barriers. The outcome of this inquiry is that the acceptability of a decision is to be assessed by a plurality of ‘publics’, including that of a local community. Even though a plurality of ‘publics’ might create competing normative demands, its (...) acknowledgment is necessary to withstand the monopolization of the process of technology appraisal. The paper presents four ways in which such an appropriation of publicness takes place. The creation of dedicated ‘local publics’, in contrast, helps to overcome these problems and allows for more responsible forms of decision-making. We describe ‘local publics’ as those in which stakeholders from the different publics that are related to the process of technology implementation are brought together, and in which concerns and issues from these publics are deliberated upon. The paper will present eight conditions for increasing the effectiveness of such ‘local publics’. (shrink)

The management of water is a topic of great concern. Inadequate management may lead to water scarcity and ecological destruction, but also to an increase of catastrophic floods. With climate change, both water scarcity and the risk of flooding are likely to increase even further in the coming decades. This makes water management currently a highly dynamic field, in which experiments are made with new forms of policy making. In the current paper, a case study is presented in which different (...) interest groups were invited for developing new water policy. The case was innovative in that stakeholders were invited to identify and frame the most urgent water issues, rather than asking them to reflect on possible solutions developed by the water authority itself. The case suggests that stakeholders can participate more effectively if their contribution is focused on underlying competing values rather than conflicting interests. (shrink)

As public attitude research evolves, often becoming more complex and variable, we are coming to understand that public attitudes are also more complex and variable than can often be captured by a single opinion poll, and more sophisticated forms of analyses are needed that look not just at a breadth of attitudes, but at a breadth of publics. The Australian Department of Industry undertook a public attitude study in 2012 that was not only longitudinal, looking at changes in attitudes towards (...) nanotechnologies, but also looking at the values or worldviews that influence attitudes. The findings allowed for a segmentation of the public, into four key segments, with distinct homogenous attitudes. This allows for not just a deeper understanding of the diversity of views that exist and the worldviews that influence them, but challenges engagement practitioners to ensure they have a broad representation of participants with different attitudes and do not favour one or two segments only. (shrink)