The Natural Tendency for Wide and Careful Listening: Exploring the Relationship Between Open-Mindedness and Psychological Science

We take open-mindedness to be a component of intellectual humility, as much of the recent empirical literature regarding intellectual humility does but contrary to what some philosophers think. More particularly, we understand intellectual humility as having a self-directed component, which is concerned primarily with the regulation of confidence we have on our own epistemic goods and capacities, and an other-directed component, which is concerned primarily with one's epistemic openness to others so to improve one's epistemic situation. Given that the open-minded person is disposed give new ideas serious consideration, it is crucial that she both listens widely and carefully to other's ideas. In this paper, we examine whether there is evidence to suggest that we have a natural, evolved tendency for this wide and careful listening related to open-mindedness. We conclude that there is indication of a natural tendency for wide listening, especially an in-group tendency. However, careful listening lacks more substantive empirical studies. It seems that human infants are much more inclined to be charitable and attentive to in-group cues or opinions. This is important evidence to deconstruct the idea of a natural tendency of virtuous intellectual humility that opens up the discussion for the role of social learning in cultivating and maintaining a virtuous life.

Differences in Art Appreciation in Autism: A Measure of Reduced Intuitive Processing

Art appreciation reflects an initial emotional and intuitive response to artwork evaluation, although this intuitive evaluation can be attenuated by subsequent deliberation. The Dual Process Theory of Autism proposes that individuals with Autism Spectrum Disorder (ASD) have a greater propensity to deliberate and reduced intuition compared to matched controls. Evaluations of high- and low-quality artworks were undertaken by 107 individuals with a diagnosis of ASD and 145 controls. Controls consistently evaluated high-quality artworks to be much better quality than the low-quality artworks, reflecting intuitive processing. The ASD sample showed a reduced difference in evaluations between high- versus low-quality artwork, which reflects reduced intuitive processing and greater deliberative processing and is consistent with predictions by the Dual Process Theory of Autism.

The implications of listening during political conversations for democracy

There is a dearth of research on listening in the context of political conversation. Yet there is theoretical reason to believe that political listening could be an important pathway toward several democratically important outcomes including increased exposure to difference, mutual understanding, and decreased polarization. Unfortunately, listening in political contexts associated with deeply held moral beliefs and strong social identities may be among the most difficult settings for listening to flourish. On the other hand, listening is reciprocal within dyads and so a foothold of listening could, through subsequent social contagion, have potentially widespread effects. This article will review theory and research on political listening, as well as relevant scholarship on listening outside of the political domain.

The Mode of Communication as a Driver of Sustainable and Equitable Asymmetric Common Pool Resource Use

Most experimental studies on common pool resource usage focus on situations in which actors are in symmetric positions when they use the resource. Many real-world cases do not fit this scenario because users are in asymmetric positions regarding their ability to benefit from the resource. Examples range from irrigation systems to climate change mitigation. Moreover, while there is large evidence on the effects of communication on social dilemmas, few studies focus on different modes of communication. We compare the effects of unstructured and structured communication on the provision of an infrastructure for a common pool resource and appropriation of the provided resource. Structured communication applied rules that are based on the ideals of democratic deliberation. Participants made contribution and appropriation decisions in an incentivized experiment. In the experiment, both communication and deliberation increased contributions in comparison to a baseline. Interestingly, deliberation attenuated the effect of the player position more than communication. Our results suggest that deliberation may be useful for overcoming asymmetric commons dilemmas in the field.

COVID-19 vaccine deliberation in individuals directly impacted by incarceration

Delays in vaccinating communities of color to COVID-19 have signaled a need to investigate structural barriers to vaccine uptake, with mass incarceration demanding greater characterization as a potential factor. In a nationally representative survey from February-March 2021 (N = 1,157), exposure to the criminal legal system, defined as having been incarcerated in prison or jail or having had a family member or close friend incarcerated, was associated with higher odds for COVID-19 vaccine deliberation. Individuals with criminal legal system exposure reported lower confidence in physician recommendation as a reason to get vaccinated. They were also more likely to decline vaccination out of fear it would cause COVID-19 infection, and that the vaccine might be promoted as a political tool. Our analysis suggests that populations impacted by the criminal legal system would benefit from targeted vaccine outreach by trusted community members who can address distrust during current and future pandemics.

Philosophy instruction changes views on moral controversies by decreasing reliance on intuition

What changes people's judgments on moral issues, such as the ethics of abortion or eating meat? On some views, moral judgments result from deliberation, such that reasons and reasoning should be primary drivers of moral change. On other views, moral judgments reflect intuition, with reasons offered as post-hoc rationalizations. We test predictions of these accounts by investigating whether exposure to a moral philosophy course (vs. control courses) changes moral judgments, and if so, via what mechanism(s). In line with deliberative accounts of morality, we find that exposure to moral philosophy changes moral views. In line with intuitionist accounts, we find that the mechanism of change is reduced reliance on intuition, not increased reliance on deliberation; in fact, deliberation is related to increased confidence in judgments, not change. These findings suggest a new way to reconcile deliberative and intuitionist accounts: Exposure to reasons and evidence can change moral views, but primarily by discounting intuitions.

Evidence-Informed Deliberative Processes for UHC: Progress, Potential and Prudence Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide"

In their recent article on evidence-informed deliberative processes (EDPs) for health benefit package decisions, Oortwijn et al examine how the different steps of EDP play out in eight countries with relatively mature institutions for using health technology assessment (HTA). This commentary examines how EDP addresses stakeholder involvement in decision-making for equitable progress towards universal health coverage (UHC). It focuses on the value of inclusiveness, the need to pay attention to trade-offs between desirable features of EDP and the need to broaden the scope of processes examined beyond those specifically tied to producing and using HTAs . It concludes that EDPs have contributed to significant progress for health benefit design decisions worldwide and holds much potential in further application. At the same time, this commentary calls for prudence: investments in EDPs should be efficiently deployed to enhance the pre-existing legislative, institutional and political framework that exist to promote fair and legitimate healthcare decisions.

Do conspiracy theorists think too much or too little?

Conspiracy theories explain distressing events as malevolent actions by powerful groups. Why do people believe in secret plots when other explanations are more probable? On the one hand, conspiracy theorists seem to disregard accuracy; they tend to endorse mutually incompatible conspiracies, think intuitively, use heuristics, and hold other irrational beliefs. But by definition, conspiracy theorists reject the mainstream explanation for an event, often in favor of a more complex account. They exhibit a general distrust of others and expend considerable effort to find 'evidence' supporting their beliefs. In searching for answers, conspiracy theorists likely expose themselves to misleading information online and overestimate their own knowledge. Understanding when elaboration and cognitive effort might backfire is crucial, as conspiracy beliefs lead to political disengagement, environmental inaction, prejudice, and support for violence.

An ethical analysis of policy dialogues

BACKGROUND

A policy dialogue is a tool which promotes evidence-informed policy-making. It involves deliberation about a high-priority issue, informed by a synthesis of the best-available evidence, where potential policy interventions are discussed by stakeholders. We offer an ethical analysis of policy dialogues - an argument about how policy dialogues ought to be conceived and executed - to guide those organizing and participating in policy dialogues. Our analysis focuses on the deliberative dialogues themselves, rather than ethical issues in the broader policy context within which they are situated.

METHODS

We conduct a philosophical conceptual analysis of policy dialogues, informed by a formal and an interpretative literature review.

RESULTS

We identify the objectives of policy dialogues, and consider the procedural and substantive values that should govern them. As knowledge translation tools, the chief objective of policy dialogues is to ensure that prospective evidence-informed health policies are appropriate for and likely to support evidence-informed decision-making in a particular context. We identify five core characteristics which serve this objective: policy dialogues are (i) focused on a high-priority issue, (ii) evidence-informed, (iii) deliberative, (iv) participatory and (v) action-oriented. In contrast to dominant ethical frameworks for policy-making, we argue that transparency and accountability are not central procedural values for policy dialogues, as they are liable to inhibit the open deliberation that is necessary for successful policy dialogues. Instead, policy dialogues are legitimate insofar as they pursue the objectives and embody the core characteristics identified above. Finally, we argue that good policy dialogues need to actively consider a range of substantive values other than health benefit and equity.

CONCLUSIONS

Policy dialogues should recognize the limits of effectiveness as a guiding value for policy-making, and operate with an expansive conception of successful outcomes. We offer a set of questions to support those organizing and participating in policy dialogues.

Practical Reasoning and Practical Argumentation: A Stakeholder Commitment Approach

This paper examines the conceptual and terminological overlap between theories and models of practical deliberation developed within the fields of Practical Reasoning (PR) and Practical Argumentation (PA). It carefully delineates the volitional, epistemic, normative, and social commitments invoked and explicates various rationales for attributing the label 'practical' to instances of reasoning and argumentation. Based on these analyses, the paper develops a new approach to practical deliberation called the Stakeholder Commitment Approach (SCA). By distinguishing between 'problem holder' and 'problem solver', and specifying the distributions of attributable commitments among the stakeholders, the SCA introduces an extension and refinement of the grounds for assigning the label 'practical' that brings PR and PA closer together.

Moral and Social Values in Evidence-Informed Deliberative Processes for Health Benefit Package Design Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide"

An evidence-informed deliberative process (EDP) is defined as "a practical and stepwise approach for health technology assessment (HTA) bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values." In this commentary, I discuss some considerations for EDPs that arise from acknowledging the difference between social and moral values. First, the best practices for implementing EDPs may differ depending on whether the approach is grounded in moral versus social values. Second, the goals of deliberation may differ when focused on moral versus social values. I conclude by offering some considerations for future research to support the use of EDPs in practice, including the need to assess how different approaches to appraisal (eg, more quantitative versus qualitative) impact perceptions of the value of deliberation itself.

[World Breastfeeding Week 2022: a call for deliberation.]

The last World Breastfeeding Week (SMLM, its initials in spanish) was a proper moment to deliberate on the facts, values and duties that are related to breastfeeding in order to give it value as a human phenomenon capable of providing well-being and creating healthy, emotionally stable and more fair. Along with the indicators that show the consumption of breastmilk in the child population, facts and values of mothers, fathers, civil society are examined; the health system, labor and development models. The duties are organized in optimal outputs that are grouped in the steps of the Initiative for the Humanization of Birth and Breastfeeding Assistance (IHAN, its initials in spanish), the warm chain of support; as well as in the policies of humanization and quality of service of the governing bodies of health. The deliberation shows the mother as the center of attention and her duty in charity for her baby; also the responsibility of health personnel as protagonists of change, supporting, educating and basing the value that breastfeeding has for both development model.

[Prevention: with citizen participation.]

Learning from the SARS-CoV-2 consequences is essential in order to anticipate future pandemics. Moreover, it is a compelling reason to make substantive improvements in both public health and prevention systems. However, preparedness seems a difficult task when people show pandemic fatigue or question decisions that would affect their personal sphere. To deal with such reactions, it seems important to leave open some avenues for citizens' involvement, a strategy recommended by the World Health Organization and the European Commission. Here the main argument is in favor of a civic approach of prevention: 1) Preparedness to anticipate future pandemics is a duty; 2) But, so far, it is not a priority issue for the political agenda; 3) Neither is citizens' collaboration in the governance of health policy. Therefore, we could ask about the channels of communication and participation that are available to citizens, entities or stakeholders, to discuss public health issues.

How to evaluate the quality of an ethical deliberation? A pragmatist proposal for evaluation criteria and collaborative research

Ethics designates a structured process by which important human values and meanings of life are understood and tackled. Therein, the ability to discuss openly and reflect on (aka deliberation) understandings of moral problems, on solutions to these problems, and to explore what a meaningful resolution could amount to is highly valued. However, the indicators of what constitutes a high-quality ethical deliberation remain vague and unclear. This article proposes and develops a pragmatist approach to evaluate the quality of deliberation. Deliberation features three important moments: (1) broadening and deepening the understanding of the situation, (2) envisioning action scenarios, (3) coming to a judgment based on the comparative evaluation of scenarios. In this paper, we propose seven criteria to evaluate ethical deliberations: (1) collaborative diversity, (2) experiential literacy, (3) organization of experiences, (4) reflective capacity to instrumentalize the experiences of others, (5) interactional creativity, (6) openness of agents, (7) quality of the reformulation of scenarios. These criteria are explained and applied to the three moments of deliberation. Based on these criteria, three kinds of outcomes for deliberations are identified and discussed: good ethical deliberations, partial ethical deliberations, bad ethical deliberations. Our proposal will guide researchers and practitioners interested in the evaluation of the quality of ethical deliberations. It provides a reference tool that allows them to identify the possible limitations of a deliberation and to implement actions aimed at correcting these limitations in order to achieve the desired qualitative objectives.

Spanning the boundaries between policy, politics and science to solve wicked problems: policy pilots, deliberation fora and policy labs

Current crises have highlighted the importance of integrating research, politics and practice to work on solutions for complex social problems. In recent years, policy deliberation fora,  policy pilots and policy labs have increasingly been deployed to mobilise science to produce solutions, help create popular support and guide implementation of policies addressing major public policy problems. Yet, we know little about how these approaches manage to transcend the boundaries between research, politics and practice. By systematically comparing policy deliberation fora, policy pilots and policy labs, this paper explores their mechanisms of boundary spanning including relationship and trust building, knowledge translation and developing solutions. We situate our analysis in healthcare policy and climate change policy in Germany, two contrasting policy fields that share a perpetual and escalating sense of crisis. Our findings suggest that deliberation fora, policy pilots and policy labs address different dilemmas of policymaking, namely the idea dilemma, the implementation dilemma and the legitimacy dilemma. All three approaches reduce wicked problems to a manageable scale, by grounding them in local decision-making, reducing their scope or reducing the problem analytically. We argue that despite their ambition to modernise democratic practices, unless they are institutionally well embedded, their effects are likely to be small scale, local and temporary.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-022-01187-y.

Challenges and Opportunities for Deliberative Processes for Healthcare Decision-Making Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide"

The second edition of the practical guide for evidence-informed deliberative processes (EDPs) is an important addition to the growing guidance on deliberative processes supporting priority setting in healthcare. While the practical guide draws on an extensive amount of information collected on established and developing processes within a range of countries, EDPs present health technology assessment (HTA) bodies with several challenges. (1) Basing recommendations on current processes that have not been well-evaluated and that have changed over time may lead to weaker legitimacy than desired. (2) The requirement for social learning among stakeholders may require increased resourcing and blur the boundary between moral deliberation and political negotiation. (3) Robust evaluation should be based on an explicit theory of change, and some process outcomes may be poor guides to overall improvement of EDPs. This comment clarifies and reinforces the recommendations provided in the practical guide.

Expert hearings in mini-publics: How does the field of expertise influence deliberation and its outcomes?

One of key goals of deliberative mini-publics is to counteract expert domination in policymaking. Mini-publics can be expected to democratize expertise by providing citizens with good opportunities for weighing expert information. Yet, there are concerns about undue influence of experts even within mini-publics. We test these expectations by analysing data from an online mini-public organized in Finland in March 2021. The topic of deliberation was measures taken to contain the COVID-19 pandemic. We examine whether experts' field of specialization and the order of expert hearings had an impact on how participants' views developed. We find that neither the field of expertise nor the order of hearings had systematic effects on participants' perceptions on containment measures. The results suggest that interactive modes of expert hearings in mini-publics seem not to be prone to domination by experts.

Exploring prospects of deliberation in intractable natural resource management conflicts

Deliberative processes are increasingly advocated as means to handle intractable natural resource management (NRM) conflicts. Research shows that disputing actors can deliberate and achieve higher degrees of mutual understanding and working agreements under ideal conditions, but the transferability of these findings to real-world intractable NRM conflicts can be questioned. This paper explores the possibilities of designing and realizing deliberation and its expected outcomes in real-world NRM conflicts. We used recommended design principles to set up deliberative processes in two intractable mining conflicts involving indigenous peoples in Northern Sweden and assessed the actors' communication and outcomes using frame analysis. The results show that the recommended design principles are hard, but not impossible, to fully implement in intractable NRM conflicts. Both conflicts proved difficult to deliberate and resolve in the sense of reaching agreements. However, the findings suggest that deliberation, as well as meta-consensus, or structured disagreement, is possible to achieve in settings with favorable conditions, e.g. good and established inter-group relations prior to the conflict. In the absence of these conditions, where relations were hostile and shaped by historical and institutional injustices, deliberation was not achieved. In both cases, polarization among the participants remained, or increased, in spite of the deliberative activities. The study highlights the importance of understanding deliberation as embedded in place specific historical and institutional contexts which shape both process and outcomes in powerful ways. More efforts should focus on alternative, or complementary, ways to handle intractable NRM conflicts, including how contested experiences of history, institutions and Indigenous rights can be addressed.

Reinforcing Science and Policy, With Suggestions for Future Research Comment on "Evidence-Informed Deliberative Processes for Health Benefit Package Design - Part II: A Practical Guide"

Oortwijn et al continue their guide to good practice in the use of deliberative processes in health technology assessment (HTA) based on a survey of international practice. This is useful, and I applaud their care in maintaining objectivity, especially regarding the treatment of moral and politically controversial issues, in reporting how jurisdictions have handled such matters in designing HTA procedures and in their execution. To their suggestions for future research, I add: the historical development of deliberation in healthcare decision-making and in other fields of public choice, with comparisons of methods, successes and failures; development of guidance on the design and use of deliberative processes that enhance decision-making when there is no consensus amongst the decision-makers; ways of identifying and managing context-free and context-sensitive evidence; and a review of high-level capacity building to raise awareness of HTA and the use of knowledge translation and exchange (KTE) and deliberation amongst policy makers, especially in low and middle-income countries.

What is neurorepresentationalism? From neural activity and predictive processing to multi-level representations and consciousness

This review provides an update on Neurorepresentationalism, a theoretical framework that defines conscious experience as multimodal, situational survey and explains its neural basis from brain systems constructing best-guess representations of sensations originating in our environment and body [1]. It posits that conscious experience is characterized by five essential hallmarks: (i) multimodal richness, (ii) situatedness and immersion, (iii) unity and integration, (iv) dynamics and stability, and (v) intentionality. Consciousness is furthermore proposed to have a biological function, framed by the contrast between reflexes and habits (not requiring consciousness) versus goal-directed, planned behavior (requiring multimodal, situational survey). Conscious experience is therefore understood as a sensorily rich, spatially encompassing representation of body and environment, while we nevertheless have the impression of experiencing external reality directly. Contributions to understanding neural mechanisms underlying consciousness are derived from models for predictive processing, which are trained in an unsupervised manner, do not necessarily require overt action, and have been extended to deep neural networks. Even with predictive processing in place, however, the question remains why this type of neural network activity would give rise to phenomenal experience. Here, I propose to tackle the Hard Problem with the concept of multi-level representations which emergently give rise to multimodal, spatially wide superinferences corresponding to phenomenal experiences. Finally, Neurorepresentationalism is compared to other neural theories of consciousness, and its implications for defining indicators of consciousness in animals, artificial intelligence devices and immobile or unresponsive patients with disorders of consciousness are discussed.

The Future Ethics of Artificial Intelligence in Medicine: Making Sense of Collaborative Models

This article examines the role of medical doctors, AI designers, and other stakeholders in making applied AI and machine learning ethically acceptable on the general premises of shared decision-making in medicine. Recent policy documents such as the EU strategy on trustworthy AI and the research literature have often suggested that AI could be made ethically acceptable by increased collaboration between developers and other stakeholders. The article articulates and examines four central alternative models of how AI can be designed and applied in patient care, which we call the ordinary evidence model, the ethical design model, the collaborative model, and the public deliberation model. We argue that the collaborative model is the most promising for covering most AI technology, while the public deliberation model is called for when the technology is recognized as fundamentally transforming the conditions for ethical shared decision-making.

Public participation: healthcare rationing in the newspaper media

Background

It is impossible to meet all healthcare demands, but an open and fair rationing process may improve the public acceptability of priority setting in healthcare. Decision-making is subject to scrutiny by newspaper media, an important public institution and information source for discussions about rationing. In Norway, healthcare rationing has been subject to public debate both before and after the establishment of “The National System for Managed Introduction of New Health Technologies within the Specialist Health Service” (New Methods) in 2013.

Aim

To describe and assess the development of the public debate on Norwegian healthcare rationing through three cases in print media.

Methods

We purposively sampled Norwegian newspaper articles between 2012 and 2018 concerning three reimbursement decisions in the Norwegian system. The reimbursement decisions were ipilimumab (Yervoy, n = 45) against metastatic melanoma, nivolumab (Opdivo, n = 23) against non-small cell lung cancer, and nusinersen (Spinraza, n = 68) against spinal muscular atrophy. Cases were analysed separately using the qualitative method of systematic text condensation.

Results

Our analysis highlighted four common themes—money, rationales, patient stories, and process—and a unique theme for each case. Ipilimumab was uniquely themed by rationing rejection, nivolumab by healthcare two-tiering, and Spinraza by patients’ rights. We found wide media deliberation among a multitude of stakeholders in all cases. Perceptions of rationing were found to be chiefly aligned with previous empirical research. We found that the media reported more frequently on opposition to rationing compared to findings from previous studies on Norwegian healthcare decision-making attitudes. We think this was influenced by our selection of cases receiving extraordinary media attention, and from media sources being subject to political communication from special interest groups.

Conclusion

We observed that the introduction of New Methods institutionalised Norwegian healthcare rationing and isolated the public debate into conversations between stakeholders and decision makers outside the political sphere. The findings from these three extraordinary debates are not generalisable and should be seen as a stakeholder learning opportunity regarding media coverage and engagement with expensive specialist healthcare decision-making in Norway.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07786-w.

Deliberation and confidence change

We argue that social deliberation may increase an agent's confidence and credence under certain circumstances. An agent considers a proposition H and assigns a probability to it. However, she is not fully confident that she herself is reliable in this assignment. She then endorses H during deliberation with another person, expecting him to raise serious objections. To her surprise, however, the other person does not raise any objections to H. How should her attitudes toward H change? It seems plausible that she should (i) increase the credence she assigns to H and, at the same time, (ii) increase the reliability she assigns to herself concerning H (i.e. her confidence). A Bayesian model helps us to investigate under what conditions, if any, this is rational.

Patient participation in priority setting: Co-existing participant roles

Reflecting a 'participatory turn' in healthcare, a variety of activities have been adopted in many countries to harness the views of patients, relatives and service users. While celebrated as a way of empowering patients and increasing the legitimacy of decisions that impact on patient care, critics contend that practices of patient participation often fall short of the ideals they purport to implement. In this article, we investigate how patients' participation in medical priority setting corresponds with the regulative ideals of deliberation and how the practices of participation influence the ability of patients to make their voices heard. Building on document analysis and semi-structured interviews with 12 patient representatives and four scientific officers in the Danish Medicines Council, the analysis demonstrates that conflicting notions of valid knowledge constituted a main challenge for patient participation. The study contributes to the literature on patient participation through a conceptualization of four co-existing participant roles: 1) compliant keepers of experiential knowledge, 2) lay experts investing in evidence production, 3) knowledge translators engaged in alliance building, and 4) demonstrators promoting public contestation. We suggest that a main challenge for PP initiatives is to take into account this variation in patients' engagement.

Augmenting salivation, but not evaluations, through subliminal conditioning of eating-related words

Correlating eating-related words (CS) with positively valenced words (US+) may augment eating-associated motivational responses (e.g., preingestive salivation) with minimal CS knowledge. We tested this claim using a subliminal conditioning procedure, where CS and US were presented under subliminal and supraliminal visual conditions. Three groups of Brazilian undergraduates (N = 69) viewed eating-related words (CS) or their scrambled counterparts (non-CS) followed by positive (US+) or neutral (US-) words. A free-selection visibility check confirmed that subliminally presented CS and non-CS had not been detected by any group. Participants exposed to CS/US+ pairings produced significantly more saliva relative to participants exposed to CS/US- and non-CS/US+ pairings. Reliable induction of salivation, coupled with null outcomes across evaluation measures, suggests that affective information related to eating can subliminally augment preingestive salivation with minimal deliberation.

What is evidence as evidence is used? A case of dualism?

How ‘evidence’ is conceptualised, generated and deployed in meso-level policy implementation on the ground is critical to health delivery. Using the case of a large-scale health service reconfiguration in northwest England, this study began as a narrative investigation into how different data types and sources are prioritised as NHS administrative structures change over time. During the research, one unpopular reconfiguration decision, the downgrading of a hospital, was challenged using judicial review. Suddenly, a key decision was being based not upon ‘facts and data’ type evidence but upon evidence of adherence to administrative procedure. This transferred focus away from the ever-shifting categories and hierarchies of data ‘types’ towards an emphasis on process. By comparing two deliberative contexts—committee and judicial review—this article proposes that evidence can be understood as simultaneously entity and process. As health service reconfigurations continue in response to austerity, integration agendas, evolving organisational landscapes, and demographic and political change, it is increasingly important to recognise the different meanings and uses of evidence.

Deliberative Q-method: A combined method for understanding the ecological value of urban ecosystem services and disservices

There is a need, in the ecosystem valuation literature to compliment the economic methods with sociocultural valuation methods that capture and facilitate a better understanding nuanced social and cultural values that are difficult to measure. Yet, sociocultural valuation methods are often critiqued for their lack of structured and replicable procedures and for often maintaining limited internal research validity. Accordingly, this paper demonstrates the development and application of a mixed-methods valuation approach to better recognize non-use social and cultural values by integrating the triad of deliberation, local ecological knowledge, and value quantification. We operationalized this method in Amman, Jordan where we analyzed how local experts value, based on their local ecological knowledge, the ecosystem services supplied by the City's urban water features (fountains, ponds, and streams).•We combine the conventional Q-method and focus group to yield a group deliberative Q-method.•The deliberative Q-method facilitates a structured valuation framework.•The deliberative Q-method method produces rich qualitative data.•The rigorous statistical analysis of deliberative Q-method improves internal validity and streamlines qualitative data coding.•The rigorous statistical analysis of deliberative Q-method weighs competing values to better understand polarized and consensus views.

Setting the space for deliberation in decision-making

Decision-making models in the behavioral, cognitive, and neural sciences typically consist of forced-choice paradigms with two alternatives. While theoretically it is feasible to translate any decision situation to a sequence of binary choices, real-life decision-making is typically more complex and nonlinear, involving choices among multiple items, graded judgments, and deferments of decision-making. Here, we discuss how the complexity of real-life decision-making can be addressed using conventional decision-making models by focusing on the interactive dynamics between criteria settings and the collection of evidence. Decision-makers can engage in multi-stage, parallel decision-making by exploiting the space for deliberation, with non-binary readings of evidence available at any point in time. The interactive dynamics principally adhere to the speed-accuracy tradeoff, such that increasing the space for deliberation enables extended data collection. The setting of space for deliberation reflects a form of meta-decision-making that can, and should be, studied empirically as a value-based exercise that weighs the prior propensities, the economics of information seeking, and the potential outcomes. Importantly, the control of the space for deliberation raises a question of agency. Decision-makers may actively and explicitly set their own decision parameters, but these parameters may also be set by environmental pressures. Thus, decision-makers may be influenced-or nudged in a particular direction-by how decision problems are framed, with a sense of urgency or a binary definition of choice options. We argue that a proper understanding of these mechanisms has important practical implications toward the optimal usage of space for deliberation.

Taking stock of the availability and functions of National Ethics Committees worldwide

Background

National Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception.

Methods

Data on the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC’s country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes.

Results

124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%).

Conclusion

Our study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-021-00614-6.

Toward Citizen Dialogue-led Environmental Governance: An Exploratory Case Study in Post-Fukushima Japan

This paper reports on an exploratory case study to help facilitate a culture of dialogue in Japan. There is an emphasis on proposing methods for polyphonic dialogue among citizens, and between citizens and experts, to effectively manage the environment. This paper argues that a culture of dialogue is essential to pluralistic participatory environmental governance. A random sampling-based citizen dialogue-involving experts and citizens-regarding radioactive waste disposal was held in Japanese cities. Three proposed methods-politeness-based facilitation dialogue, evidence-based and position-explicit presentations by experts with differing views and experts reflecting in tandem with citizens engaged in dialogue-might lead to enhanced positive attitudes toward dialogue with others holding different views, as well as better internal self-deliberation. Attitudes for dialogue were measured empirically. The current research suggests that explicit treatment of pluralistic positions and views among citizens and experts would be a key factor for quality social learning and resilience for uncertainty.

The Effect of Cognitive Load on Intent-Based Moral Judgment

When making a moral judgment, people largely care about two factors: Who did it (causal responsibility), and did they intend to (intention)? Since Piaget's seminal studies, we have known that as children mature, they gradually place greater emphasis on intention, and less on mere bad outcomes, when making moral judgments. Today, we know that this developmental shift has several signature properties. Recently, it has been shown that when adults make moral judgments under cognitive load, they exhibit a pattern similar to young children; that is, their judgments become notably more outcome based. Here, we show that all of the same signature properties that accompany the outcome-to-intent shift in childhood characterize the "intent-to-outcome" shift obtained under cognitive load in adults. These findings hold important implications for current theories of moral judgment.

The Coming of Age of Risk Governance

Proposed as an advanced conceptualization of how to handle risk, risk governance begins with the critique and expansion of the traditional idea and standard practices of risk analysis. In developments over the last two decades, proponents of a more integrative approach on governing risks have moved further away from distinct conceptions of risk assessment, risk management, and risk communication and toward the processes and institutions that guide, restrain, and integrate collective activities of handling risk. In early formulations of what risk governance entails, the superiority of the interplay between risk evaluation and risk management over linear and simple deductions from risk assessment to risk management was established precisely by developing a distinctive rationality of how to proceed. Later, the International Risk Governance Council recaptured this distinctive rationality that institutionalized processes should embody the interplay of the assessment of risks and related concerns, their sociopolitical appraisal, and the logical inference for risk management. Recently, this approach has been refined and augmented toward an integrative and adaptive concept of risk governance and toward a postnormal conception of risk governance. Main characteristics are a new concept of differentiated responsibility and deliberation in which expertise, experience, and tacit knowledge are integrated, forming the core of legitimate political risk decision making.

Potential roles of the rodent medial prefrontal cortex in conflict resolution between multiple decision-making systems

Mammalian decision-making is mediated by the interaction of multiple, neurally and computationally separable decision systems. Having multiple systems requires a mechanism to manage conflict and converge onto the selection of singular actions. A long history of evidence has pointed to the prefrontal cortex as a central component in processing the interactions between distinct decision systems and resolving conflicts among them. In this chapter we review four theories of how that interaction might occur and identify how the medial prefrontal cortex in the rodent may be involved in each theory. We then present experimental predictions implied by the neurobiological data in the context of each theory as a starting point for future investigation of medial prefrontal cortex and decision-making.

Neural signatures underlying deliberation in human foraging decisions

Humans have a remarkable capacity to mentally project themselves far ahead in time. This ability, which entails the mental simulation of events, is thought to be fundamental to deliberative decision making, as it allows us to search through and evaluate possible choices. Many decisions that humans make are foraging decisions, in which one must decide whether an available offer is worth taking, when compared to unknown future possibilities (i.e., the background). Using a translational decision-making paradigm designed to reveal decision preferences in rats, we found that humans engaged in deliberation when making foraging decisions. A key feature of this task is that preferences (and thus, value) are revealed as a function of serial choices. Like rats, humans also took longer to respond when faced with difficult decisions near their preference boundary, which was associated with prefrontal and hippocampal activation, exemplifying cross-species parallels in deliberation. Furthermore, we found that voxels within the visual cortices encoded neural representations of the available possibilities specifically following regret-inducing experiences, in which the subject had previously rejected a good offer only to encounter a low-valued offer on the subsequent trial.

Deliberation decreases the likelihood of expressing dominant responses

Deliberation is commonly assumed to be a central characteristic of humans' higher cognitive functions, and the responses following deliberation are attributed to mechanisms that are qualitatively different from lower-level associative or affectively driven responses. In contrast to this perspective, the current article's aim is to draw attention to potential issues with making inferences about mechanisms of deliberation based on characteristics of the observed decision outcomes. We propose that a consequence of deliberation is to simply reduce the likelihood of expressing immediately available (dominant) responses. We illustrate how this consequence of deliberation can provide a parsimonious explanation for a broad range of prior research on decision-making. Furthermore, we discuss how the present perspective on deliberation relates to the question of how the cognitive system implements nondominant responses based on associative learning and affective prioritization rather than voluntary decisions. Beyond the present article's theoretical focus, for illustrative purposes, we provide some empirical evidence (three studies, N = 175) that is in line with our proposal. In sum, our theoretical framework, prior empirical evidence, and the present studies suggest that deliberation reduces the likelihood of expressing dominant responses. Although we do not argue that this is the only consequence or mechanism regarding deliberation, we aim to highlight that it is worthwhile considering this minimal consequence of deliberation as compared with certain higher cognitive functions in the interpretation of deliberation outcomes.

The power to convene: making sense of the power of food movement organizations in governance processes in the Global North

Dominant food systems, based on industrial methods and corporate control, are in a state of flux. To enable the transition towards more sustainable and just food systems, food movements are claiming new roles in governance. These movements, and the initiatives they spearhead, are associated with a range of labels (e.g., food sovereignty, food justice, and community food security) and use a variety of strategies to enact change. In this paper, we use the concept of relational fields to conduct a post-hoc analysis of nine cases, examining how social movement organizations and other actors actively create new deliberative governance spaces. We argue that successes are related to the "power to convene," a process-oriented approach that increases movements' capacity to mobilize; leverage different types of power; and integrate, coordinate, and build a systems-oriented vision. The power to convene and create deliberative spaces is demonstrated in a variety of contexts and often results in outcomes that further movement aims, including policy change and repositioning food movement actors vis-à-vis others in the field. Our findings suggest that success is not only measured as policy outcomes, but as an advantageous repositioning of social movement actors that enables them to be part of governance processes beyond simple policy advocacy.

Beyond the numbers: a critique of quantitative multi-criteria decision analysis

When setting priorities for health, there is broad agreement that a range of social values and ethical principles beyond clinical and cost-effectiveness matter, but exactly how health technology assessment (HTA) should account for a broader set of criteria remains an area of ongoing debate. In light of this, we welcome a recent review paper by Baltussen et al. evaluating the potential of different multi-criteria decision analysis (MCDA) approaches to enable HTA agencies to incorporate a broader set of values in their appraisals. The authors describe three approaches to MCDA-qualitative MCDA, quantitative MCDA, and MCDA with decision rules-laying out their relative advantages and disadvantages and providing recommendations for how they can best be implemented. While we endorse many of the authors' assessments and conclusions, including the critical role of deliberation in any MCDA approach and the undertaking of qualitative MCDA at a minimum, we take a stronger position regarding the flaws of quantitative MCDA and strongly caution against it. We find quantitative MCDA antithetical to at least two of the ways MCDA is intended to improve HTA recommendations: (i) enhancing quality and (ii) promoting transparency. Quantitative MCDA may mask the complex tradeoffs that exist within and between decision criteria and remain generally inaccessible to those who are not well-versed in its technical methods of appraisal. We advocate for a predominantly qualitative approach to MCDA appraisal centered around deliberation and supplemented with decision aids to help account for health opportunity costs.

Use of Evidence-Informed Deliberative Processes - Learning by Doing Comment on "Use of Evidence-informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe"

The article by Oortwijn, Jansen, and Baltussen (OJB) is much more important than it appears because, in the absence of any good general theory of "evidence-informed deliberative processes" (EDP) and limited evidence of how they might be shaped and work in institutionalising health technology assessment (HTA), the best approach seems to be to accumulate the experience of a variety of countries, preferably systematically, from which some general principles might subsequently be inferred. This comment reinforces their arguments and provides a further example.

Introduction: Perspectives on Democracy

This article explores diverse views on both the current challenges and limits as well as the reforms and innovations of existing democracies at the beginning of the twenty-first century. First, it argues that socioeconomic inequality, new populism, new forms of communication, and globalization have stimulated a renewal of interest in analyzing the "frontiers of democracy." Democracies have reacted with different innovations and reforms in order to meet these challenges. The authors trace the phases of respective research from studies on singular, standalone instances to normative as well as empirical work on participatory (direct democratic and deliberative) systems. Finally, they advocate for combining the conceptual approach of defining democracy by the fulfillment of democratic values with rigorous empirical evaluation of the contributions (old and new) that institutions and procedures provide in order to fulfill these values and meet the mentioned challenges.

Using deliberative methods to establish a sufficient state of capability well-being for use in decision-making in the contexts of public health and social care

BACKGROUND

Health maximisation is unlikely to be a relevant objective for social care, where service users and the workforce have distinct priorities and needs. NICE permit use of a small number of capability-based measures for the evaluation of social care, including ICECAP-A, a measure with five attributes, each with four levels.

AIM

To establish a sufficient state of capability well-being, as defined by ICECAP-A, through public deliberation, and evaluate and critically reflect on the deliberative process.

METHODS

A series of one-day/6.5 h citizens' workshops were conducted, with recruitment from within purposively selected local authority areas. Workshops consisted of a mixture of background information, individual tasks, group discussion and voting. Representatives from each workshop were then invited to attend a 'consensus workshop'. Follow-up interviews facilitated evaluation of the deliberative process.

RESULTS

62 participants took part in deliberative work, across eight workshops. Participants actively engaged and provided positive feedback about their experience. Key considerations for participants included: the realistic ability of public services to enhance some areas of well-being; not removing incentives for self-help and avoiding state intrusion; building resilience and enabling people to 'give back to society'; ensuring that people are not left with a standard of well-being that is morally indefensible. The resulting sufficient state of capability well-being (defined by ICECAP-A) was 3,3,3,3,3 (where the best possible state is 4,4,4,4,4).

CONCLUSION

Through a deliberative approach, representatives of the public were able to debate a complex social issue and reach a consensus decision on a sufficient state of capability well-being.

Identifying Perceptions and Preferences of the General Public Concerning Universal Screening of Children for Familial Hypercholesterolaemia

BACKGROUND/AIMS

Familial hypercholesterolaemia (FH) is a common genetic disorder that, if untreated, predisposes individuals to premature coronary heart disease. As most individuals with FH remain undiagnosed, new approaches to detection are needed and should be considered a priority in public health genomics. Universal screening of children for FH has been proposed, and this study explores public perspectives on the acceptability of this approach.

METHODS

A one-day deliberative public forum was held in Perth, WA, Australia. Thirty randomly selected individuals were recruited, with self-reported sociodemographic characteristics used to obtain discursive representation. Participants were presented with information from a variety of perspectives and asked to discuss the information provided to identify points of consensus and disagreement. The data collected were analysed using thematic analysis.

RESULTS

Of the 17 participants at the forum, 16 deemed universal screening of children for FH to be acceptable. Fifteen of these 16 believed this was best performed at the time of an immunisation. Participants proposed a number of conditions that should be met to reduce the likelihood of unintended harm resulting from the screening process.

DISCUSSION/CONCLUSION

The outcomes of the forum suggest that establishing a universal screening programme for FH in childhood is acceptable to the general public in WA.

MCDA-based deliberation to value health states: lessons learned from a pilot study

BACKGROUND

Health economists have shown a growing interest in deliberation and multi-criteria decision analysis (MCDA) as possible pathways to transparently integrate value judgments in cost-utility analyses. In line with these developments, this study piloted a consensus process to derive a German value set for the Short-Form Six-Dimension (SF-6D). In a conference setting, a group was tasked to deliberate on scores and weights for the SF-6D from the perspective of a self-determined and independent life.

METHODS

The one-day consensus conference was based on a deliberative process in combination with the MCDA method MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique). According to MACBETH, participants were asked to qualitatively rate pairwise comparisons of SF-6D health states. The scoring within each dimension was conducted in parallel group sessions. Final agreement on the scores as well as weights for the SF-6D dimensions were derived in a subsequent plenary assembly. Results were analyzed using the software M-MACBETH and qualitative content analysis.

RESULTS

A total of 34 participants were recruited. While each of the 6 small groups presented a consented score, the plenary assembly reached consensus on all dimensions apart from pain. Concerning dimension weights, some participants favored prioritizing pain and mental health. Others disputed that trade-offs between dimensions and thus assigning weights were not acceptable in a context where this may involve withholding care from someone. As a consequence, no consensus on a value set was reached. Participants identified the group size of the plenary session and the applied weighting procedure as main obstacles to the process.

CONCLUSIONS

This pilot study presents a consensus-based approach for valuing health-related quality of life. However, further research is needed on deliberative processes that yield quantifiable results. Future conferences should explore smaller group sizes, longer durations of the deliberative process and alternatives to the additive value function applied in MACBETH.

The perirhinal cortex supports spatial intertemporal choice stability

In order to optimize outcomes in the face of uncertainty, one must recall past experiences and extrapolate to the future by assigning values to different choice outcomes. This behavior requires an interplay between memory and reward valuation, necessitating communication across many brain regions. At the anatomical nexus of this interplay is the perirhinal cortex (PRC). The PRC is densely connected to the amygdala and orbital frontal cortex, regions that have been implicated in reward-based decision making, as well as the hippocampus. Thus, the PRC could serve as a hub for integrating memory, reward, and prediction. The PRC's role in value-based decision making, however, has not been empirically examined. Therefore, we tested the role of the PRC in a spatial delay discounting task, which allows rats to choose between a 1-s delay for a small food reward and a variable delay for a large food reward, with the delay to the large reward increasing after choice of each large reward and decreasing after each small reward. The rat can therefore adjust the delay by consecutively choosing the same reward or stabilize the delay by alternating between sides. The latter has been shown to occur once the 'temporal cost' of the large reward is established and is a decision-making process termed 'exploitation'. When the PRC was bilaterally inactivated with the GABA(A) agonist muscimol, rats spent fewer trials successfully exploiting to maintain a fixed delay compared to the vehicle control condition. Moreover, PRC inactivation resulted in an increased number of vicarious trial and error (VTE) events at the choice point, where rats had to decide between the two rewards. These behavioral patterns suggest that the PRC is critical for maintaining stability in linking a choice to a reward outcome in the face of a variable cost.

Attachment style predicts cooperation in intuitive but not deliberative response in one-shot public goods game

Cooperation is an important prosocial behaviour that is of great significance to individuals and society. The social heuristics hypothesis (SHH) systematically explains how cooperation is interactively affected by intuitive and deliberative processes. On the one hand, the intuitive process can be either cooperative or selfish, which is determined by previous experience. On the other hand, the deliberative process could support either a cooperative decision or a selfish decision, depending on which strategy could maximise the current payoff. This research aims to investigate the mechanism of cooperation. Attachment style was selected as a proxy for previous experience to examine whether and how previous life experience shapes intuitive response. Time constraint (Studies 1 and 2) and cognitive load (Study 3) were manipulated to dissociate the intuitive and deliberative processes. In addition, cooperation was assessed by adopting one-shot public goods games. Results showed that attachment avoidance (Studies 1, 2, and 3) and attachment anxiety (Study 3) significantly predicted cooperation in the intuition condition, whereas these associations were insignificant in the deliberation condition (Studies 1, 2, and 3). These findings provide further support for the SHH and shed new light on the mechanism of cooperation.

Boundedly rational expected utility theory

We build a satisficing model of choice under risk which embeds Expected Utility Theory (EUT) into a boundedly rational deliberation process. The decision maker accumulates evidence for and against alternative options by repeatedly sampling from her underlying set of EU preferences until the evidence favouring one option satisfies her desired level of confidence. Despite its EUT core, the model produces patterns of behaviour that violate standard EUT axioms, while at the same time capturing systematic relationships between choice probabilities, response times and confidence judgments, which are beyond the scope of theories that do not take deliberation into account.

Tradeoff Negotiation: The Importance of Getting in the Game Comment on "Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage"

Swiss-CHAT's playful approach to public rationing can be considered in terms of deliberative process design as well as in terms of health policy. The process' forced negotiation of trade-offs exposed unexamined driving questions, and challenged prevalent presumptions about health care demand and about conditions of public reasoning that enable transparent rationing. While the experiment provided grounds for optimism that public deliberation can contribute to the design of fair insurance service-packages, it also left unanswered questions. What are the ethical and policy implications of non-consensuses? What is the presumed relationship between process and justice of outcome?

Addressing vaccine hesitancy requires an ethically consistent health strategy

BACKGROUND

Vaccine hesitancy is a growing threat to public health. The reasons are complex but linked inextricably to a lack of trust in vaccines, expertise and traditional sources of authority. Efforts to increase immunization uptake in children in many countries that have seen a fall in vaccination rates are two-fold: addressing hesitancy by improving healthcare professional-parent exchange and information provision in the clinic; and, secondly, public health strategies that can override parental concerns and values with coercive measures such as mandatory and presumptive vaccination.

MAIN TEXT

It is argued that such conflicting, parallel approaches seriously risk undermining trust that is crucial for sustaining herd immunity. Although public health strategies can be ethically justified in limiting freedoms, a parent-centered approach seldom acknowledges how it is impacted by contemporaneous coercive measures. In addition, the clinical encounter is not well suited to helping parents consider the public dimensions of vaccination, despite these being important for trust formation and informed decision-making. Efforts to address vaccine hesitancy require more consistent engagement of parental and citizen views. Along with evidence-based information, debates need to be informed by ethical support that equips parents and professionals to respond to the private and public dimensions of vaccination in a more even-handed, transparent manner.

CONCLUSION

Efforts to address vaccine hesitancy need to avoid simple reliance on either parental values or coercive public policies. To do this effectively requires increasing citizen engagement on vaccination to help inform a parent-centered approach and legitimize public policy measures. In addition, cultivating a more ethically consistent strategy means moving beyond the current silos of health ethics - clinical and public health ethics.

Honesty Speaks a Second Language

Theories of dishonest behavior implicitly assume language independence. Here, we investigated this assumption by comparing lying by people using a foreign language versus their native tongue. Participants rolled a die and were paid according to the outcome they reported. Because the outcome was private, they could lie to inflate their profit without risk of repercussions. Participants performed the task either in their native language or in a foreign language. With native speakers of Hebrew, Korean, Spanish, and English, we discovered that, on average, people inflate their earnings less when they use a foreign language. The outcome is explained by a dual system account that suggests that self-serving dishonesty is an automatic tendency, which is supported by a fast and intuitive system. Because using a foreign language is less intuitive and automatic, it might engage more deliberation and reduce the temptation to lie. These findings challenge theories of ethical behavior to account for the role of the language in shaping ethical behavior.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.