Eliciting normative judgments for ethically and politically legitimate policy-making

Contemporary societies face pressing ethical and policy challenges that require politically legitimate decision-making processes. This paper comparatively assesses how two public decision-making procedures - referendums and the empirical bioethical method of Collective Reflective Equilibrium in Practice (CREP) - perform in generating politically legitimate policymaking, using personal responsibility for health in healthcare resource allocation as a case study. While referendums appear to ensure political legitimacy through direct public voting, they often produce merely coarse-grained outcomes that fail to capture the nuanced reasoning underlying public preferences, risking oversimplification and 'tyranny of the majority'. By contrast, CREP integrates lay and expert judgments, elicited through empirical methods such as surveys, focus groups, and citizen juries, with ethical theories, principles, and guidelines in an effort to arrive at ethically justifiable and publicly defensible policy recommendations. The paper argues that political legitimacy requires not only procedural participation but also alignment with nuanced, reason-sensitive, and bias-filtered public views that constructively accommodate disagreement. Against this background, the analysis concludes that by examining conditional and context-specific opinions, eliciting justificatory reasons behind judgments, screening for bias and prejudice, and constructively incorporating disagreement into policy synthesis, CREP can provide stronger substantive political legitimacy than referendums, something of particular importance especially in ethically contentious domains like healthcare.