Eliciting normative judgments for ethically and politically legitimate policy-making

Area of Science:

• Bioethics
• Political Science
• Public Policy

Background:

• Societies require politically legitimate decision-making for complex ethical and policy challenges.
• Direct public voting (referendums) and deliberative methods (CREP) are two approaches to public decision-making.

Purpose of the Study:

• To comparatively assess referendums and the Collective Reflective Equilibrium in Practice (CREP) method for generating politically legitimate policymaking.
• To use personal responsibility for health in healthcare resource allocation as a case study.

Main Methods:

• Comparative analysis of decision-making procedures.
• Empirical methods to elicit lay and expert judgments (surveys, focus groups, citizen juries).
• Integration of ethical theories, principles, and guidelines with public views.

Main Results:

• Referendums provide procedural legitimacy but risk oversimplification and 'tyranny of the majority'.
• CREP integrates nuanced, reason-sensitive, and bias-filtered public views, accommodating disagreement.
• CREP examines conditional opinions and justificatory reasons, screening for bias.

Conclusions:

• Political legitimacy requires both procedural participation and alignment with nuanced public views.
• CREP offers stronger substantive political legitimacy than referendums, especially in ethically contentious areas like healthcare.
• CREP constructively incorporates disagreement for ethically justifiable and publicly defensible policy recommendations.