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Introduction: Public participation can be both supported and limited by decision-makers. Therefore, citizens either participate in top-down approved formats or have to turn towards subversion. These different participation practices, called invited and uninvited, are often treated by researchers as mutually exclusive. In this article, we present the case of patient organisations' involvement in various state-controlled deliberation bodies in Russia, which does not fit into a smooth binary distinction of the patient participation practice. Instead, identified patient participation practices combine interaction approved by gatekeepers with interaction, which are subversive and grassroots-initiated. Conceptually, it means that invited and uninvited participation can be better understood as intertwined ecologies., Methods: The article is based on a qualitative ethnographic study, which includes participatory observations of the meetings of state-controlled public participation bodies, such as public councils, 51 semi-structured interviews with members of these bodies and an analysis of the relevant policy and methodological documents. Informed consent to record and transcribe all interviews was obtained. Thematic analysis has been used to produce the results., Results: Russian patient organisations often work informally and independently of state-approved practices expected from them. Some subversive practices happen outside official meetings, others become widely used best practices and others remain everyday mundane interactions, which contribute to the maintenance of the independence of patient organisations against otherwise dominating and nondemocratic state actors., Conclusion: The ecologising approach to patient participation, which interprets invited and uninvited practices as interconnected, has better explanatory power for cases in which citizens maintain independence despite all limitations associated with authoritarian settings. Conceptualising invited and uninvited practices as situations, or separate time- and space-bound events, is a helpful theoretical framework for understanding diverse and seemingly contradictory public participation practices., Patient or Public Contribution: Research participants communicated amendments to the initial research framework to incorporate their needs. Repeated interviews allowed triangulation of preliminary findings with research participants. The article is co-authored with the patient organisation representative, who has contributed directly to data analysis and presentation., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

The goal of decision-making is to select one option and disregard the others. However, deliberation can also create a memory association between the chosen and unchosen options. This study aims to investigate how choice and deliberation affect the memory of postdecision options and the underlying mechanisms. Using event-related potentials (ERPs), we examined item recognition (Experiment 1) and associative recognition (Experiment 2) following certain and uncertain decisions. In Experiment 1, items that were chosen in certain decisions were remembered better than unchosen items. There was no difference between chosen and unchosen items in uncertain decisions. Moreover, a late recollection-related LPC (a late positive component) old/new effect was larger for chosen items than unchosen items in certain decisions. The early familiarity-related FN400 and the late recollection-related LPC old/new effects were significant for chosen and unchosen items in uncertain decisions. In Experiment 2, there was no difference in performance on associative memory. A FN400 old/new effect (an index of integration) in certain or uncertain decisions was not observed. Although significant LPC old/new effects were found in both certain and uncertain decisions, no difference was found between them. These results propose that decision-making can enhance item memory performance through two distinct processes: value and elaboration. Elaboration involves focusing on the details within items rather than integrating items into a cohesive whole., (© 2024 Society for Psychophysiological Research.)

The deliberate-morality account implies that moral punishment should be decreased with time pressure and increased with deliberation while the intuitive-morality account predicts the opposite. In three experiments, moral punishment was examined in a simultaneous one-shot Prisoner's Dilemma game with a costly punishment option. The players cooperated or defected and then decided whether or not to punish their partners. In Experiment 1, the punishment decisions were made without or with time pressure. In Experiment 2, the punishment decisions were immediate or delayed by pauses in which participants deliberated their decisions. In Experiment 3, participants were asked to deliberate self-interest or fairness before deciding whether to punish their partners. Different types of punishment were distinguished using the cooperation-and-punishment model. In Experiment 1, time pressure decreased moral punishment. In Experiment 2, deliberation increased moral punishment. So far, the evidence supports the deliberate-morality account. Experiment 3 demonstrates that the effect of deliberation depends on what is deliberated. When participants deliberated self-interest rather than fairness, moral punishment was decreased. The results suggest that unguided deliberation increases moral punishment, but the effects of deliberation are modulated by the type of deliberation that takes place. These results strengthen a process-based account of punishment which offers a more nuanced understanding of the context-specific effect of deliberation on moral punishment than the deliberate-morality account., (© 2024. The Author(s).)

Introduction: The proposed concept of secure/insecure lifeattachment reflects the experience of the world and life as a good (or insecure/threatening) place to be. The present article describes the theoretical foundation, development, and validation of a revised measure that captures the phenomenon of secure/insecure life attachment. The revised scale consists of seven dimensions: (1) Coexistence, (2) Reliability, (3) Safetiness, (4) Integration, (5) Inclusion, (6) Participation, and (7) Deliberation., Methods: In three studies (N = 1,059), we examined the factor structure and the convergent and predictive validity of the Life Attachment Scale-Revised (LAS-R)., Results: Our results support a seven-factor structure of the scale, reflecting the aforementioned dimensions. Furthermore, convergent and predictive validity were established through correlations with related concepts of life satisfaction, flourishing, openness to the future, and perceived stress., Conclusion: We have devised and substantiated a scale adept at gauging dimensions of secure and insecure/disordered life attachment. Empirical evidence from statistical analyses supports the assumption that the LAS-R is psychometrically sound, establishing its reliability and validity as a dependable instrument. Thus, the scale has promising implications for developing the empirical base for research in many areas of psychology, sociology, and the social sciences., (© 2024 The Author(s). Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

The relative contribution of intuitive and reflective cognitive systems in cooperative decision making is a topic of hot debate. Research with adults suggests that intuition often favors cooperation, but these effects are contextually sensitive. Emerging evidence has shown that in many contexts children show a tendency toward intuitive cooperation, but research investigating these processes in children is sparse and has produced mixed findings. In the current study we investigated the influence of intuitive and reflective decision processes on children's fairness behavior by manipulating decision time. We tested ( N  = 158) pairs of children between 4 and 10 years of age from a rural community in Canada. Children's decisions to accept or reject allocations of candies were either made under time pressure or after a 10-s delay. We assessed the impact of decision time on children's aversion to inequitable distributions of resources by comparing their responses to equal allocations with either disadvantageous allocations or advantageous allocations. We found that children showed a greater age-related increase in advantageous inequity aversion when decisions were made under time pressure compared to when they were made after a delay. In contrast, we did not observe a significant impact of decision time on the development of disadvantageous inequity aversion. These findings suggest that intuitive decision processes may contribute to the development of fairness concerns in middle childhood., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Corbit.)

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., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In this study, we investigate what leads people to fact-check online information, how they fact-check such information in practice, how fact-checking affects their judgments about the information's credibility, and how each of the above processes is affected by the salience of the information to readers' cultural identities. Eight pairs of adult participants were recruited from diverse cultural backgrounds to participate online in joint fact-checking of suspect Tweets. To examine their collaborative deliberations we developed a novel experimental design and analytical model. Our analyses indicate that the salience of online information to people's cultural identities influences their decision to fact-check it, that fact-checking deliberations are often non-linear and iterative, that collaborative fact-checking leads people to revise their initial judgments about the credibility of online information, and that when online information is highly salient to people's cultural identities, they apply different standards of credibility when fact-checking it. In conclusion, we propose that cultural identity is an important factor in the fact-checking of online information, and that joint fact-checking of online information by people from diverse cultural backgrounds may have significant potential as an educational tool to reduce people's susceptibility to misinformation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gottlieb, Baker and Détienne.)

This article considers the normative and critical value of popular comedy. I begin by assembling and evaluating a range of political theory literature on comedy. I argue that popular comedy can be conducive to both critical and transformative democratic effects, but that these effects are contingent on the way comedic performances are received by audiences. I illustrate this by means of a case study of a comedic climate change 'debate' from the television show, Last Week Tonight . Drawing from recent scholarship on deliberation, judgment and rhetoric, I highlight both critical and transformative dimensions of the performance. I attribute these to the vignette's likely reception, which I describe as 'dissonant' - unresolved, affectively turbulent and aesthetically attuned. I argue that comedy is uniquely positioned to spur such 'dissonant' modes of engagement and, in so doing, to promote acknowledgement and reflective judgment., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

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., (© 2022. The Author(s).)

New plant breeding techniques may play an important role in improving food quality, global food security and sustainability. Previous breeding techniques have, however, met with substantial resistance from society. This study examined the role of associations and deliberation in the evaluation of breeding techniques. Breeding techniques studied included conventional breeding, gene-editing, genetic modification (cisgenesis and transgenesis), marker-assisted breeding and synthetic biology. By using focus group discussions that included individual tasks, we found that when participants relied on their spontaneous associations, gene-editing was evaluated similarly as genetic modification. However, after information provision and group discussion, gene-editing was preferred over genetic modification. Perceived naturalness was found to be the main reason for obtaining different levels of acceptance, not only between gene-editing and genetic modification but across all breeding techniques examined. These findings highlight the importance of associations and show that beliefs about naturalness remain crucial in understanding how consumers evaluate breeding techniques.

Fast-and-slow models of decision-making are commonly invoked to explain economic behaviour. However, past research has focused on human cooperation and generosity and thus largely overlooked situations where there are sharp conflicts between efficiency and equality, or between efficiency and more intuitive moral values (repugnance). Here, we contribute to fill this gap in the literature. We conducted a preregistered experiment ( n = 1500 recruited from Prolific) to assess the effects of fast, intuitive decisions, under time pressure versus slow, deliberate decisions, under time delay, on (i) people's distributional preferences and (ii) their attitudes toward repugnant transactions. The results show increased preference for equality and decreased preference for efficiency under time pressure, but no effects on moral repugnance. Exploratory analyses revealed that most of the observed treatment effects in our data were accounted for by women. Our results provide some support for theories that associate controlled cognition with concern for efficiency, and intuitive, emotional responses with inequality aversion., Competing Interests: All authors declare no conflicting interests that could have appeared to influence the submitted work., (© 2023 The Authors.)

This review article provides a topic-centered overview of the state of compromise in political theory, where compromise is increasingly discussed as a promising approach to dealing with disagreement in politics and society. Given the growing literature on compromise, a systematic approach to the topic is due. The first sections are focused on clarifying the concept of compromise, while the remainder of the article offers different perspectives on those aspects of compromise that are subject to debate., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

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., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

An intuitive style in eating decision-making, for example, basing decisions on one's gut feeling, has been related to a less healthy diet, whereas deliberately deciding what to eat, such as making plans about eating behavior, has been related to a healthier diet. The present study investigated whether nutrition knowledge, food preferences, and habit strength for healthy and unhealthy eating moderate these relationships. In total, 1245 participants took part in a preregistered cross-sectional online survey. Results revealed that neither nutrition knowledge, nor liking of healthy or unhealthy foods, nor habit strength for healthy or unhealthy eating interacted with the preference for intuition or deliberation in eating decision-making in affecting dietary intake (βs ≤ |.06|; ts ≤ |2.11|; ps ≥ .035). Instead, including the potential moderating variables in analyses rendered the effect of a preference for intuition largely non-significant. In contrast, the positive effect of a preference for deliberation was largely stable even when including the potential moderating variables. Thus, the present study confirms the general health-promoting effect of a preference for deliberation in eating decision-making. In contrast, results speak in favor of a generally minor role of a preference for intuition for healthy or unhealthy eating., (© 2022 The Authors. Applied Psychology: Health and Well-Being published by John Wiley & Sons Ltd on behalf of International Association of Applied Psychology.)

This article draws on the deliberative play framework to examine empirical examples of storytelling in an online deliberative forum: The Oregon Citizen Assembly (ORCA) Pilot on COVID-19 Recovery. ORCA engaged 36 citizens in deliberation about state policy through an online deliberative process spanning seven weeks. Drawing on literature on small stories in deliberation, we trace stories related to a policy proposal about paying parents to educate children at home. Our analysis demonstrates that storytelling activities accomplish aspects of deliberative play through introducing uncertainty, resisting premature closure, and promoting an "as if" frame that allows groups to explore the scope and implications of proposals. Forum design influences interaction and our analysis suggests that technology use and timing are key design features that can facilitate or inhibit deliberative play., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 SAGE Publications.)

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., Competing Interests: Declaration of Competing Interest We have no known conflicts of interest to disclose. All pre-registrations, materials, analysis scripts, and data available at https://osf.io/y5tdu/. We are grateful to Eric Schwitzgebel and members of the Concepts and Cognition Lab for valuable feedback on this research., (Copyright © 2023 Elsevier B.V. All rights reserved.)

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., (© 2023. The Author(s).)

Lay Abstract: What is already known about the topic Daniel Kahneman wrote a highly influential book titled 'thinking, fast and slow'. He proposes that people usually think in a rapid, automatic, intuitive style. When people realise their intuitive thinking may be wrong, a slower, effortful, deliberative style of thinking takes over. It has recently been proposed that thinking in autistic individuals can be characterised as usually thinking in the deliberative style (rather than the intuitive style that non-autistic people usually think in). What this paper adds As intuitive thinking is fast and deliberative thinking is slow, this research manipulated the time available to complete a series of reasoning questions. These questions have been developed to have intuitive answers (which are incorrect) and deliberative answers (which are correct). For the first time, a fast time manipulation (you must answer quickly) and slow (you must think about your answer before responding) was undertaken with autistic individuals. Autistic participants did produce more deliberative answers than the non-autistic participants. However, both groups produced comparably more intuitive answers and less deliberative answers in the fast condition. This shows that while autistic people tend not to use their intuition, autistic people can be encouraged to use their intuition. Implications for practice, research or policy Using rapid intuition can be useful in fast-changing contexts, such as some social situations. Future research can explore how to support autistic individuals to use their intuition when the need arises. In addition, the propensity for deliberation resulting in unbiased, correct responses reflects a strengths-based account of autism. This requires more mental effort and is less susceptible to bias and errors. This is called 'Dual Process Theory'.

The literature on patient public involvement and engagement (PPIE) in health research has grown significantly in the last decade, with a diverse range of definitions and topologies promulgated. This has led to disputes over what the central functions and purpose of PPIE in health research is, and this in turn makes it difficult to assess and evaluate PPIE in practice. This paper argues that the most important function of PPIE is the attempt to make health research more democratic. Bringing this function to the fore and locating PPIE in the wider context of changes in contemporary forms of democratic engagement provides greater conceptual clarity over what PPIE in research should be trying to achieve. Conceptualizing PPIE as a form of democratization has a number of benefits. First, theories of what are appropriate, normatively justifiable and workable criteria for PPIE practices can be developed, and this can provide tools to address the legitimacy and accountability questions that have troubled the PPIE community. Second, this work can be used to form the basis of a research agenda to investigate how PPIE in health research operates, and how it can facilitate and/or improve democratic processes in health research., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Journal of Medicine and Philosophy Inc.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

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., Competing Interests: Conflict of interest statement Nothing declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

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., (© 2023. The Author(s).)

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., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Public preferences are an important consideration for priority-setting. Critics suggest preferences of the public who are potentially naïve to the issue under consideration may lead to sub-optimal decisions. We assessed the impact of information and deliberation via a Citizens' Jury (CJ) or preference elicitation methods (Discrete Choice Experiment, DCE) on preferences for prioritizing access to bariatric surgery., Methods: Preferences for seven prioritization criteria (e.g. obesity level, obesity-related comorbidities) were elicited from three groups who completed a DCE: (i) participants from two CJs ( n  = 28); (ii) controls who did not participate in the jury ( n  = 21); (iii) population sample ( n  = 1,994). Participants in the jury and control groups completed the DCE pre- and post-jury. DCE data were analyzed using multinomial logit models to derive "priority weights" for criteria for access to surgery. The rank order of criteria was compared across groups, time points and CJ recommendations., Results: The extent to which the criteria were considered important were broadly consistent across groups and were similar to jury recommendations but with variation in the rank order. Preferences of jurors but not controls were more differentiated (that is, criteria were assigned a greater range of priority weights) after than before the jury. Juror preferences pre-jury were similar to that of the public but appeared to change during the course of the jury with greater priority given to a person with comorbidity. Conversely, controls appeared to give a lower priority to those with comorbidity and higher priority to treating very severe obesity after than before the jury., Conclusion: Being informed and undertaking deliberation had little impact on the criteria that were considered to be relevant for prioritizing access to bariatric surgery but may have a small impact on the relative importance of criteria. CJs may clarify underlying rationale but may not provide substantially different prioritization recommendations compared to a DCE.

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., Competing Interests: Conflict of interestThe authors declare there are no conflicts of interest., (© The Author(s) 2023.)

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., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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., (© The Author(s) 2022.)

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., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

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., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Human reasoning is often conceived as an interplay between a more intuitive and deliberate thought process. In the last 50 years, influential fast-and-slow dual-process models that capitalize on this distinction have been used to account for numerous phenomena - from logical reasoning biases, over prosocial behavior, to moral decision making. The present paper clarifies that despite the popularity, critical assumptions are poorly conceived. My critique focuses on two interconnected foundational issues: the exclusivity and switch feature. The exclusivity feature refers to the tendency to conceive intuition and deliberation as generating unique responses such that one type of response is assumed to be beyond the capability of the fast-intuitive processing mode. I review the empirical evidence in key fields and show that there is no solid ground for such exclusivity. The switch feature concerns the mechanism by which a reasoner can decide to shift between more intuitive and deliberate processing. I present an overview of leading switch accounts and show that they are conceptually problematic - precisely because they presuppose exclusivity. I build on these insights to sketch the groundwork for a more viable dual-process architecture and illustrate how it can set a new research agenda to advance the field in the coming years.

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., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

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 (Pennartz, 2015). 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., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

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., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Deliberative analysis enables us to weigh features, simulate futures, and arrive at good, tractable decisions. So why do we so often eschew deliberation, and instead rely on more intuitive, gut responses? We propose that intuition might be prescribed for some decisions because people's folk theory of decision-making accords a special role to authenticity, which is associated with intuitive choice. Five pre-registered experiments find evidence in favor of this claim. In Experiment 1 (N = 654), we show that participants prescribe intuition and deliberation as a basis for decisions differentially across domains, and that these prescriptions predict reported choice. In Experiment 2 (N = 555), we find that choosing intuitively vs. deliberately leads to different inferences concerning the decision-maker's commitment and authenticity-with only inferences about the decision-maker's authenticity showing variation across domains that matches that observed for the prescription of intuition in Experiment 1. In Experiment 3 (N = 631), we replicate our prior results and rule out plausible confounds. Finally, in Experiment 4 (N = 177) and Experiment 5 (N = 526), we find that an experimental manipulation of the importance of authenticity affects the prescribed role for intuition as well as the endorsement of expert human or algorithmic advice. These effects hold beyond previously recognized influences on intuitive vs. deliberative choice, such as computational costs, presumed reliability, objectivity, complexity, and expertise., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Developments in Machine Learning (ML) have attracted attention in a wide range of healthcare fields to improve medical practice and the benefit of patients. Particularly, this should be achieved by providing more or less automated decision recommendations to the treating physician. However, some hopes placed in ML for healthcare seem to be disappointed, at least in part, by a lack of transparency or traceability. Skepticism exists primarily in the fact that the physician, as the person responsible for diagnosis, therapy, and care, has no or insufficient insight into how such recommendations are reached. The following paper aims to make understandable the specificity of the deliberative model of a physician-patient relationship that has been achieved over decades. By outlining the (social-)epistemic and inherently normative relationship between physicians and patients, I want to show how this relationship might be altered by non-traceable ML recommendations. With respect to some healthcare decisions, such changes in deliberative practice may create normatively far-reaching challenges. Therefore, in the future, a differentiation of decision-making situations in healthcare with respect to the necessary depth of insight into the process of outcome generation seems essential., (© 2022. The Author(s).)

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., (© 2022. The Author(s).)

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., (© 2022. The Author(s).)

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., (Copyright © 2022. Published by Elsevier Ltd.)

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., (Copyright © 2021 Elsevier B.V. All rights reserved.)

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., (© The Author(s) 2022.)

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., (© The Author(s) 2021.)

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., Competing Interests: Conflict of interestNo potential conflict of interest is reported by the authors. Authors have no financial or non-financial interests regarding this research to declare., (© The Author(s) 2022.)

Novel management interventions intended to mitigate the impacts of climate change on biodiversity are increasingly being considered by scientists and practitioners. However, resistance to more transformative interventions remains common across both specialist and lay communities and is generally assumed to be strongly entrenched. We used a decision-pathways survey of the public in Canada and the United States (n = 1490) to test two propositions relating to climate-motivated interventions for conservation: most public groups are uncomfortable with interventionist options for conserving biodiversity and given the strong values basis for preferences regarding biodiversity and natural systems more broadly, people are unlikely to change their minds. Our pathways design tested and retested levels of comfort with interventions for forest ecosystems at three different points in the survey. Comfort was reexamined given different nudges (including new information from trusted experts) and in reference to a particular species (bristlecone pine [Pinus longaeva]). In contrast with expectations of public unease, baseline levels of public comfort with climate interventions in forests was moderately high (46% comfortable) and increased further when respondents were given new information and the opportunity to change their choice after consideration of a particular species. People who were initially comfortable with interventions tended to remain so (79%), whereas 42% of those who were initially uncomfortable and 40% of those who were uncertain shifted to comfortable by the end of the survey. In short and across questions, comfort levels with interventions were high, and where discomfort or uncertainty existed, such positions did not appear to be strongly held. We argue that a new decision logic, one based on anthropogenic responsibility, is beginning to replace a default reluctance to intervene with nature., (© 2021 Society for Conservation Biology.)

Proposals to release genetically engineered organisms in the wild raise complex ethical issues related to their safe and equitable implementation. While there is broad agreement that community and public engagement is vital to decision-making in this context, more discussion is needed about who should be engaged in such activities and in what ways. This article identifies Indigenous peoples as key stakeholders in decisions about gene-editing in the wild and argues that engagement activities need not only include Indigenous peoples but also be designed, conducted, and analyzed in ways that confront longstanding power imbalances that dismiss Indigenous expertise. We offer specific recommendations to guide deliberative activities to not only be inclusive of Indigenous peoples but also to empower their diverse, situated knowledges. We call on those committed to the inclusive design of broad public deliberation to pursue strategies that shift dominant power dynamics to include Indigenous communities in more meaningful ways., (© 2021 The Hastings Center.)

Environmental releases of gene edited (GEdOs) and gene drive organisms (GDOs) will likely occur under conditions of high uncertainty and in complex socioecological systems. Therefore, public deliberation is especially important to account for diverse interpretations of safety, risks, and benefits; to draw on experiential and public wisdom in areas of proposed release; to ameliorate dangers of technological optimism; and to increase the public legitimacy of decisions. Yet there is a "democratic deficit" in the United States' oversight system for GEdOs and GDOs, as unconflicted experts, publics, and skeptical stakeholders are most often excluded from decision-making and unavailable to critically examine potential risks and benefits or raise broader concerns about socioeconomic or cultural impacts. This article argues for the need to open up decision-making for GEdOs and GDOs, discusses the challenges for doing so within the current oversight framework, and finally, proposes institutional, policy, and attitudinal changes that are likely important for overcoming barriers to public deliberation., (© 2021 The Hastings Center.)

Popular dual-process models of thinking have long conceived intuition and deliberation as two qualitatively different processes. Single-process-model proponents claim that the difference is a matter of degree and not of kind. Psychologists have been debating the dual-process/single-process question for at least 30 years. In the present article, I argue that it is time to leave the debate behind. I present a critical evaluation of the key arguments and critiques and show that-contra both dual- and single-model proponents-there is currently no good evidence that allows one to decide the debate. Moreover, I clarify that even if the debate were to be solved, it would be irrelevant for psychologists because it does not advance the understanding of the processing mechanisms underlying human thinking.