From consensus to plurality: the negotiated compromise and public consultations

The University College London's Law and Bioethics colloquium, which took place in London at the beginning of July, gave me the impression that a silent revolution is taking place in bioethical discourse (1). The goalposts in bioethics may be shifting from an emphasis on trying to build a moral consensus to establishing an ethical framework that respects, and indeed upholds, plurality of opinion and belief. Roger Brownsword spoke of the better role of bioethics being to facilitate negotiation: encouraging people to talk in a way that allows for disagreement. The resulting compromise would constitute a negotiated order, rather than an imposed framework through professional discourse. Jonathan Montgomery added another layer, arguing that forcing people to behave in a certain way negates moral agency - a decision-maker must be allowed develop their own moral agency. Such an approach is illuminating and indicative of current trends - so long as the rule(s) of engagement are clearly defined - participants must be prepared to negotiate. Through enlisting a communitarian spirit, participants could - using their capacity to reason - collectively negotiate their own moral agency. Those not open to reason and persuasion would be ejected by the ones engaging in dialogue. I will attempt to briefly trace this transition from consensus to plurality in the language of the public consultation.

In November 2005, the then Chair of the Human Fertilisation and Embryology Authority (HFEA), Suzi Leather, spoke at Progress Educational Trust's conference on stem cell research. She told the conference, 'For without public confidence in a particular area, we cannot build a consensus. And without a consensus it is very difficult to sustain progress' (my emphasis) (2). Around the same time, in launching the 'Choices and Boundaries' consultation on PGD, Suzi Leather said: 'We would like to hear the views of anyone who might be affected by these choices...This way we can begin to balance the views and interests of all groups and move towards building a consensus on the issue' (my emphasis) (3).

In launching the ongoing 'Hybrids and Chimeras' consultation in 2007 the language used by the HFEA has changed remarkably. A press release states: '...the consultation process has been designed to give people clear and independent information about the research so that they have the opportunity to make a considered contribution to the debate' (my emphasis) (4). The current Chair, Shirley Harrison, points out: 'It is important to remember that this is not a referendum...we want to understand why people feel worried or enthusiastic about this research in order to help us make a judgement about the best way to proceed'. The public consultation has become a method in which those holding 'considered' opinions may help inform policy decision making. This, I believe, marks a shift from consensus building to negotiation and informed policy making. Public opinion in the latter scenario is filtered and utilised in negotiation, where disagreement can be complementary, and the resulting compromise truly fair. Previously, in seeking consensus to crudely legitimate policy decisions, the methods employed to determine the scope of ethical debate revealed a deep differentiation in underlying ideological beliefs, entrenching disagreement, and preventing a compromise position from naturally materialising. Respondents may perceive the 'consensus building' type of consultation as a forum whereby their opinion is impacting policy directly, being considered in an unaltered form. They may see responding to consultations as an opportunity to consolidate their own pre-determined viewpoint giving rise to a core element of people holding uncompromising beliefs ensuring any debate is uncomfortably polarised. Recently, however, those engaging in negotiation, or 'public dialogue', participate as much to help inform policy as to develop their own beliefs. Participants are given freedom, information, and support to develop their own moral agency, ensuring their beliefs are honestly held and rationally defensible.

To conclude, the days of the consultation as we know it may be numbered. There is limited scope to achieve negotiated compromise that, as a process, also develops peoples own moral agency in the impersonal and remote forum of the public consultation. This is where public dialogue, meetings and discussions become vital. This analysis, however, raises questions about how the results of public consultations should be used in policy making. It remains to be seen if this perceived shift from consensus-to-compromise, towards plurality-to-compromise, leads to an abandonment of universal ethics in favour of respecting moral diversity across the bioethical discourse.