Triangular Reflective Equilibrium: A Conscience-Based Method for Bioethical Deliberation

Abstract

Following a discussion of some historical roots of conscience, we offer a systematized version of reflective equilibrium. Aiming at a comprehensive methodology for bioethical deliberation, we develop an expanded variant of reflective equilibrium, which we call 'triangular reflective equilibrium' and which incorporates insights from hermeneutics, critical theory and narrative ethics. We focus on a few distinctions, mainly between methods of justification in ethics and the social practice of bioethical deliberation, between coherence in ethical reasoning, personal integrity and consensus formation, and between political and moral deliberation. The ideal of deliberation is explicated as a sharing of conscience within a special commitment to sincerity and openness to persuasion. Personal growth in wisdom is an indirect by-product of the continuous practice of moral deliberation. This is explicated in the light of Sternberg's balance theory of wisdom and in the context of medicine as a profession embodying altruistic responsibilities of care in democratic and pluralistic societies.

Bioethics Without Theory?

“…It has been suggested that "… today 'reflective equilibrium' (RE) is considered the method of casedeliberation in bioethics in general and within its principlist paradigm in particular." 4 Norman Daniels defines reflective equilibrium in the following way in the Stanford Encyclopedia of Philosophy:…”

The dilemma of good clinical practice in the study of compromised standards of care

“…Deliberate rationing of scarce health resources on the basis of age is highly controversial. Like any other form of rationing, it depends on open deliberation for justification and legitimization [ 6 , 7 ], and not on inconclusive evidence and a motivation to save money.…”