national report neo socratic dialogue: spain · fluent dialogue between those attendants.schedule...

Projektbericht

Research Report

National ReportNeo Socratic Dialogue: Spain

Increasing Public Involvement in Debates on Ethical

Questions of Xenotransplantation

Emilio Muñoz, David Santos, Paolo Dordoni

Projektbericht

Research Report

Unidad de Políticas Comparadas, Madrid, CSICUniversidad Complutense de Madrid

National ReportNeo Socratic Dialogue: Spain

Increasing Public Involvement in Debates on

Ethical Questions of Xenotransplantation

Emilio Muñoz, David Santos, Paolo Dordoni

Report

Studie im Auftrag der Europäischen Kommission(Research Directorate General)

April 2004

Contact:

Emilio Munoz: +34/91/5219160email: [email protected]

The final report reflects the author’s views. The European Community is not liable for any use that may

be made of the information contained in this report.

Contents

1. Organization 1

2. Participants 4Professional experience ..................................................................................................... 6

El diálogo neo-socrático 8¿Qué sucede en un diálogo neo-socrático?............................................................................... 8

¿Cuáles son las condiciones para realizar un diálogo neo-socrático? ...................................... 9

¿Cuándo es adecuado practicar un diálogo neo-socrático? .....................................................10

3. Issues of debate 11

4. Neo Socratic Dialogue 1: Which risks should we undertake? 124. 1 From the general question to the example.........................................................................12

4.2 The chosen example ...........................................................................................................12

4.3 The example giver's judgment.............................................................................................13

4.4 Empathic work: to put oneself in the shoes of the example giver .......................................13

4.5 Critical working: toward the regressive abstraction and a common judgment ....................14

4.6 Moving to xenotransplantation.............................................................................................15

5. Neo Socratic Dialogue 2: Which risks are we allowed toundertake? 17

5.1 From the general question to the example..........................................................................17

5.2 The chosen example ...........................................................................................................17

5.3 The example's giver judgment.............................................................................................18

5.4 Critical working: toward the regressive abstraction and a common judgment ....................18

5.5 Moving to xenotransplantation.............................................................................................20

National Report Neo Socratic Dialogue: Spain— 1

1. Organization

The first dialogue was held on 27th and 28th January 2003, and the second dialogue was

held on 3rd and 4th February 2003. In both cases, the meetings took place from 6pm until

10pm during the first day, and from 10am until 6pm during the second day, aproximately.

Each event lasted 12 hours in total, including lunch, dinner and coffee breaks.

The minimum audience of the two dialogues was ten participants, although there were some

cancellations a few days before the meetings. The ratio of attendance was above 75%,

higher than expected.

Both dialogues were held in the CSIC Head Office in Madrid. We chose one big room, with

high capacity. This place was chosen in order to get a comfortable space for the participants.

Care was also taken about all details which could influence the right course of the dialogues.

All participants had to stay for more than 12 hours altogether sessions inside the room, and

this is because a pleasant atmosphere was required.

It was held a dinner for the first session and a lunch for the second session. We thought that

these acts could create a relaxed atmosphere within the participants. Almost all of them did

not meet before, and during dinner, lunch and breaks they could have friendly conversations.

This is particulary important in order to get a suitable atmosphere, that may promote a more

fluent dialogue between those attendants.Schedule sent to all participants of the first

dialogue, held on 27th and 28th January 2003.

2 — National Report Neo Socratic Dialogue: Spain

PROGRAMME

FOR THE NEO SOCRATIC DIALOGUE ABOUT SOCIAL AND

ETHICAL QUESTIONS IN XENOTRANSPLANTATION

27th and 28th January 2003

CSIC Head Office

Calle Serrano, 117 28006 Madrid

Monday 27.01.2003

18.00 Meeting in the central hall

18.15-18.40 Introduction to the participants

18.40-19.05 Presentation of the project-Emilio Muñoz

19.05-19.20 Break

19.20-20.30 Presentation of neosocratic dialogue-Paolo Dordoni

20.30-20.50 Ex-Ante questionnaire

20.50-22.15 Dinner

Tuesday 28.01.2003


9.30-11.00 First unit

11.00-11.30 Coffee break

11.30-13.00 Second unit

13.00-14.30 Lunch

14.30-15.50 Third unit

15.50-16.20 Break

16.20-17.40 Forth unit

17.40-18.00 Ex-Post questionnaire


Schedule sent to all participants of the second dialogue, held on 3rd and 4th Febraury 2003

PROGRAMME

FOR THE NEO SOCRATIC DIALOGUE ABOUT SOCIAL AND

ETHICAL QUESTIONS IN XENOTRANSPLANTATION

3rd and 4th January 2003

CSIC Head Office

Calle Serrano, 117 28006 Madrid

Monday 03.02.2003


18.20-18.35 Introduction to the participants

18.35-19.00 Presentation of the project-Emilio Muñoz

19.00-19.15 Short discussion between participants

19.15-19.30 Break

19.30-20.20 Presentation of neosocratic dialogue-Paolo Dordoni

20.20-20.40 Ex-Ante questionnaire

20.40-21.55 Dinner

Tuesday 04.02.2003


9.30-11.00 First unit

11.00-11.30 Coffee break

11.30-13.00 Second unit

13.00-14.20 Lunch

14.20-15.35 Third unit

15.35-16.00 Break

16.00-17.15 Forth unit

17.15-17.35 Ex-Post questionnaire


2. Participants

The search and selection of participants was the most complex part of the whole process in

order to prepare the two Neosocratic dialogues in Spain.

We thought that it could be very useful to get the involvement of all of those people

interviewed during the first workpackage, which dealt with the analysis of baseline

evaluation.

But some of those people did not show high interest about the neosocratic dialogue. One of

the causes could be their lack of knowledge about this method. Another cause could be the

lack of interest from their professional point of view.

Finally, some of them showed interest in the dialogue, but they expressed difficulties owed to

a full agenda. Some of these interested people told us that they did not have two whole days

in order to attend the event. It must be also taken into account that some people had to

travel to Madrid.

Some new contacts appeared during the interviews to the potential participants. We got

more than 25 possible participants after the first round. So we had enough audience,

because the appropriate size of group must go around from eight to twelve people.

Personal interviews were held in order to explain the contents and the goals of the

Neosocratic dialogue. Some of those interviews were held in several places of Spain, like

Bilbao, Barcelona and Santander, the reason underlying the higher expenditures than

expected. This fact has been detailed in the recent financial report.

We proposed then coming to the second day of the neosocratic dialogue, in order to foster

the participation of those participants who argued lack of time. The explanation about the

project and the neosocratic method was given during the previous evening. Since these

details have been exposed in a formal letter addressed to all potential participants, so it was

not necessary to attend to this previous session. This choice was offered to all those people

who could not spend so much time.

A short letter was presented during the previous interview. This letter explained all those

details related to the neosocratic dialogue, in order to facilitate the understanding to all

participants. A copy of this letter is attached to this deliverable, entitled "Neo socratic

dialogue presentation"1.

1 This letter is written in Spanish. Paolo Dordoni has the original text in English.


The audience could contact with the Spanish facilitor, Paolo Dordoni, by electronic mail in

order to solve all those doubts neither explained nor understood in the presentation letter.

This facility allowed all the potential participants to learn more details about the method of

the neosocratic dialogue.

The final timetable was sent to all participants one week before the event. We tried to spend

enough time to have several breaks to facilitate the work of the facilitor and moderator, Paolo

Dordoni. The audience could have large rests during dinner and lunch in order to create a

warm atmosphere to facilitate the discussion.

It must be underlined that the timetable of the first dialogue is not the same as the second

one, because we made later modifications.

The list of all the participants is given in the table below. Some of them did not attend the two

days. This is the case of Mr. Jaime Lissavetzky in the first dailogue and Mr. Santiago Lamas

in the second dialogue.

6 — N

ation

al Rep

ort N

eo S

ocratic D

ialog

ue: S

pain

Nam

eE

du

cation

Pro

fession

al experien

ceE

lectron

ic mail o

r teleph

on

e

Antonio A

lonsoIndustrial E

ngineerP

resident of FE

TC

O, S

panishfederation of heart transplantedpatients

+34917510479

+34617408765

Javier Am

ayraD

egree in Biological S

cience,U

niversity of País V

asco. Master

Degree in B

usiness Adm

inistration.

Interested in managem

ent ofbiotechnology com

panies.javieram

ayra@hotm

ail.com

Manuel A

riasP

rofessor of Medicine, U

niversity ofC

antabria.D

irector of Renal Transplant U

nit ofM

arqués de Valdecilla H

ospital,S

antander.

nefarm@

humv.es

Luis Antonio

Cam

pilloD

egree in Law, U

niversity of San

Pablo, M

adrid. Degree in B

usinessA

dministration, U

niversity of Com

illas,M

adrid.

Several charges in com

panies relatedto financial sector. Interested inm

anagement of biotechnology

companies.

Luiscampillo@

wanadoo.es

Carolina C

astejónD

egree in Chem

istry, UN

ED

University.



panies.C

[email protected]

Carm

en Coira

Degree in C

hemistry and D

egree inB

usiness Adm

inistration, Autonom

ousU

niversity of Madrid.



panies.m

ccm@

alteco.es

Teresa Díez

Degree in V

eterinary Medicine.

Interested in consultancy firms related

to biotechnology.T

diez@escuelabioforum

.es

Javier Fernández

Degree in P

eriodism, C

omplutense

University, M

adrid.R

esponsible for Com

munication

Departm

ent of CS

ICJfernandez.carvajal@

univ.mecd.es

José Antonio

García

Degree in Law

.Law

yer. President of A

LCE

R, S

panishA

ssociation of Renal P

atients.F

[email protected]

Em

ilio Hum

anesD

egree in Biochem

istry.Interested in m

anagement of

biotechnology companies.

Em

ilio.humanes@

terra.es

Santiago Lam

asP

h. Doctor in M

edicine, Com

plutenseU

niversity, Madrid.

Scientifical researcher in the

Biological R

esearch Centre, C

SIC

.Interested in vascular biology.

Slam

[email protected]

Natio

nal R

epo

rt Neo

So

cratic Dialo

gu

e: Sp

ain—

7

Jaime Lissavetzky

Ph. D

octor in Chem

istry, Com

plutenseU

niversity, Madrid.

Deputy of the S

ocialist Party, P

SO

E.

Jaime.lissavetzky@

diputado.congreso.es

Rafael M

áñezD

egree in Medicine.

Director of Transplant U

nit, JuanC

analejo Hospital. R

esearcher onxenotransplants.

Manez@

canalejo.org

Enrique M

arínD

egree in Law.

Lawyer. Law

teacher in Alcala

University. E

xpert comm

unicator aboutnew

technologies.

Marinpalm

[email protected]

Am

elia Martín

Ph. D

octor in Law, U

niversity of País

Vasco.

Teacher of Penal Law

, UN

ED

University. C

ollaborator of Inter-U

niversity Chair of Law

and Hum

anG

enome, U

niversities of Deusto and

País V

asco.

Am

[email protected]

Blanca M

endozaP

h. Doctor in Law

, Autonom

ousU

niversity of Madrid.

Teacher of Law, A

utonomous U

niversityof M

adrid.B

lanca.mendoza@

uam.es

José Antonio M

esaD

egree of Biology.



panies.Jam

esa@m

i.madritel.es

Izaskun Monsalve

Degree in P

harmacy, C

omplutense

University, M

adrid.R

esponsible for the Pharm

acy Service

in FR

EM

AP

Clinic.

Monsalve@

wanadoo.es

Sara M

onteroD

egree in Philosophy, A

utonomous

University, M

adrid.Interested in E

thical aspects ofbiotechnology.

Sm

[email protected]

Rosario P

ardoD

egree in Molecular B

iology.Interested in biotechnologicalapplications.

Charopardo@

yahoo.es

Nuria R

amírez

Degree in P

eriodism, C

omplutense

University, M

adrid.E

ditor in Science section of A

BC

.N

ramirez@

abc.es

Sergio S

erranoD

egree in Psychology, A

utonomous

University of M

adrid.W

orking with teenagers in risky

environment.

Sergio1977es@

yahoo.es

Asier U

rruelaP

h. Doctor in Law

, University of

Deusto.

Mem

ber of Inter-University C

hair of Lawand H

uman G

enome, U

niver-sities ofD

eusto and País V

asco. Teacher in Lawat U

niversity of País V

asco.

Asurruela@

hotmail.com

8 — N

ation

al Rep

ort N

eo S

ocratic D

ialog

ue: S

pain

at University of P

aís Vasco.

Natio

nal R

epo

rt Neo

So

cratic Dialo

gu

e: Sp

ain—

9


Letter sent to all attendants to explain the Neosocratic dialogue:

El diálogo neo-socrático

Queridos participantes,

Gracias por aceptar la invitación para participar en el diálogo neo-socráticopropuesto en el proyecto europeo sobre "Incremento del compromiso público en el debateético sobre xenotrasplantes".

En esta carta ofrecemos una breve descripción de la metodología de realización deldiálogo neo-socrático y además le indicamos como puede participar en ello. De esta forma,esperamos responder a algunas de las preguntas que se le pueden plantear, así comofacilitar su colaboración en el diálogo. Pueden también consultar la página web del proyectoen esta dirección http://space.ihs.ac.at/departments/soc/xeno-pta/

Las fechas propuestas son: 27 y 28 enero; 30 y 31 enero; 3 y 4 febrero; 6 y 7febrero; 10 y 11 febrero. Cada participante sólo colaborará en un diálogo, pero se debenseñalar varias opciones para organizar el evento con mayor flexibilidad. Se celebrará en lasede de la Unidad de Políticas Comparadas (Calle Alfonso XII, 18. Planta 5ª. 28014 Madrid).

¿Qué sucede en un diálogo neo-socrático?

El diálogo neo-socrático es un novedoso método para clarificar diferentes yfundamentales convicciones a través de un pensamiento racional y discursivo.

El punto de partida de un diálogo neo-socrático es una pregunta -llamada "preguntafundamental"- que es aplicada a una decisión específica o, también, a situaciones dedecisiones complejas (en nuestro caso, la investigación en el campo de losxenotrasplantes).

Es importante subrayar que un diálogo neo-socrático no es un medio adecuado parasolucionar un problema específico o para tomar una decisión concreta que está en laagenda en el presente. Tampoco es un medio de recoger información de un temadeterminado. Por este motivo, si consideramos el tema "Riesgo", no podemos discutircuestiones del tipo: "¿Cómo podemos reducir el riesgo de infecciones en la investigación dexenotrasplantes?" o "¿Cuáles son los riesgos presentes en la puesta en práctica de losxenotrasplantes?". Una pregunta adecuada para el diálogo sería del tipo: "¿Cuáles son lascondiciones o criterios para evaluar un riesgo?" o "¿Cuándo es posible aceptar un riesgo?".

Empezando con una pregunta general y amplia, el diálogo tiene que ser dirigido, enprimer lugar, hacia una situación de la vida cotidiana, el llamado "ejemplo". Por haberelegido un ejemplo de la vida cotidiana, los participantes tienen a disposición un materialcomún, útil para proceder en el discurso. El dialogo tiende a ser más concreto, personal,mientras los participantes tienden a concentrarse sobre un problema especifico. Además, yeso es muy importante, la discusión sobre una situación de la vida cotidiana hace posiblereconstruir los valores comunes y las posturas éticas de personas que trabajan en camposdiversos.

Un ejemplo adecuado para iniciar el diálogo debería cumplir estos criterios:


• Se refiere a una situación concreta, no es algo hipotético (el ejemplo es unaexperiencia real, se tratan hechos de que hemos tenido experiencia directa en lavida diaria en alguna ocasión).

• Es algo relevante para el tema del diálogo (el análisis y discusión de este ejemploes relevante para la "pregunta fundamental" que origina el diálogo).

• Es comprensible para todos los participantes (todos los participantes deben sercapaces de ponerse en la situación marcada por el ejemplo y vivida por uno de losparticipantes).

• No es muy complicado pero tampoco trivial (los participantes deben pensar que elejemplo es interesante y que puede ser discutido en un tiempo limitado).

• No debe tener demasiadas implicaciones emocionales (el proponente el ejemplotiene que poder hablar de su experiencia sin demasiados problemas)

• Se refiere a una situación pasada (el proponente el ejemplo tiene que poderrecordarse de la situación expuesta en un cierto detalle

Una vez elegido y explicado el ejemplo, los participantes reflexionarán sobre el juiciodado en esa situación por el proponente el ejemplo, para descubrir reglas y principios másgenerales. Estas son razones o condiciones generales (normas, principios, valores, etc.),comúnmente aceptadas, para la validez del juicio. Si hay alguna opinión en contra, entoncesel grupo buscará razones generales que sean aceptados por todos. De esta forma, el grupobuscará una base racional para el consenso.

¿Cuáles son las condiciones para realizar un diálogo neo-socrático?

El peculiar modo de diálogo practicado en un dialógo neo-socrático requiere de unfacilitador cualificado. En nuestro proyecto europeo, contamos con tres facilitadores, unopara cada país involucrado. El facilitador es una persona experta y con una formaciónespecífica para moderar el diálogo neo-socrático. Debe sustentar y promover el proceso deldiálogo en el grupo, gracias a sus aportaciones de tipo metodológicos y estructurales,poniendo también atención a la interacciones entre los participantes. Sin embargo, elfacilitador no puede influir en el proceso de argumentación en lo que concierne a loscontenidos mismos del discurso.

Los participantes también deben considerar que un diálogo neo-socrático es undiálogo orientado al entendimiento recíproco y no un debate o una discusión de caráctercompetitivo. En un diálogo, los participantes examinan las razones para conseguirintuiciones y entendimiento reciproco. En una discusión o debate, los participantes intentanconseguir que los otros actuen cómo ellos quieren. Los participantes deben orientar sucomportamiento hacia el diálogo y no hacia un debate.


Diálogo Discusión

Investigar y ofrecer razones Ofrecer sólo la opinión personal

Pensar en común Pensar en contra del otro

Posibilidad de cambiar las propiasopiniones

Presentar las ideas propias como inalterables.

Argumentar sistematicamente. Argumentar ad hominem en contra de alguien.

Escuchar educadamente y entender Interrumpir y argumentar sin orden.

Tener un objetivo común, buscar elconsenso.

Tener a menudo secretos objetivos personales.

Los participantes deben orientar su pensamiento hacia los cuatro aspectosesenciales del diálogo neo-socrático:

• Pensar haciendo referencia a la experiencia (partimos con el análisis de un ejemploconcreto, personal).

• Pensar autónomamente (damos crédito a nuestras preguntas, dudas y argumentos).

Pensar en común (estamos interesados en un entendimiento recíproco y en unconsenso, y, si no es posible, a mostrar la racionabilidad de los distintos argumentos).

• Pensar orientados a la búsqueda de la verdad (intentamos contestar a nuestra preguntafundamental).

¿Cuándo es adecuado practicar un diálogo neo-socrático?

Aquí se exponen algunas situaciones en las que es útil el diálogo neo-socrático:

• Los participantes quieren alcanzar una comprensión común sobre conceptos ypresunciones fundamentales.

• Los participantes tienen que tratar con preguntas o problemas fundamentales queafectan a la vida de una comunidad o a un equipo de trabajo dentro de un campoespecífico.

• Los participantes pertenecen a diferentes profesiones o disciplinas y buscan un lenguajecomún para alcanzar la comprensión y poder dialogar.

• Un problema decisivo debe ser investigado con respecto a los criterios que forman labase de una posible solución.

Les agradecemos la atención prestada y su disposición para participar en el diálogoy esperamos haberles clarificado el objetivo y desarrollo del proceso. Para mayorinformación, escriban directamente al facilitador del diálogo. En el caso de España, es PaoloDordoni, que tiene la siguiente dirección: [email protected]

Un saludo.


3. Issues of debate

The issue chosen was about the infection risks related to xenotransplantation. As it could be

seen in the previous workpackage, these risks are the main obstacle in the

xenotransplantation research.

The first part of the project, titled "Baseline evaluation", showed that risks of infection were

the most important barrier in the development and application of transplants between pigs

and human beings. It was the most presented issue in the analysis of press and during the

personal interviews.

These infections could cause pandemies in our society, like other cases like AIDS or Eboli

virus. The benefit of a transplant only affect to one person, the patient. But, on the other

hand, the possible infections put whole society's health at risk. We have individual benefit

versus collective risk.

In the first dialogue participants should choose between two questions, giving argument for

their decision. The two questions were:

• which risks should we undertake?

• Which risks aree we allowed to undertake ?

The question chosen was the first one, "Which risks should we undertake?".

The same process was followed in the second dialogue. The two questions were:

• Which risks are we allowed to undertake?

• Which risks should we avoid?

The question chosen was the first one also which risks are we allowed to undertake?


4. Neo Socratic Dialogue 1: Which risks should weundertake?

4. 1 From the general question to the example

The first step was to find a suitable example as a starting point to discuss the general

question. The results of this first research endeavour were eight different examples,

connected to the general question in different ways. The group started a process of

argumentation to choose the more suitable one.

At the end of this process, one of the example was chosen with majority (8 to 1). (The main

argument motivating this choice was that this example was concerned with a collective risk

and in this sense it could have been easily related to the XTP context). The only person who

disagreed about this choice, declared that, even if that example was not his favourite one, it

would not be a problem at all to work with it.

4.2 The chosen example

The chosen situation was a risky one. The proposer of the example, referred as example

giver in the following, decided to go by car to a funeral of a colleague in an other city, far

away from her own, 300 km. With she there were also two other friends, unable to drive. At

the moment of taking the decision to start, a decision that she shared with her friends, she

was confident with herself, even if she was a bit afraid about the possibility to sleep during

that travel. When she started, she was in a hurry. It was early time in the day, she had not

slept well and she felt emotionally bad.

Other contextual features were mentioned during the clarification of the example: the fact

that the car she was driving was not her own car; that this car had been only recently

repaired and that she had not already made that route. The example giver drove without

making a pause, talking with her friends, without having the impression that the risk was

becoming too great, as for instance the impression to fall into sleep.

The situation was risky because there was the possibility to have an accident and to involve

other persons. In this sense, the possible persons affected by the action of the example

giver, could have been the same example giver, her friends, other people present in the

road, but also her family as well as the family of her colleague, in the case she has not

arrived, because of an accident. Her main interest was to keep proximity with the family of

her colleague and to accomplish her moral obligation to be there.


During the clarification of the example the participants asked her for possible alternative of

actions: to look for other persons able to drive before starting, to make a rest during the

travel, to inform oneself about the road before to leave. She answered not to have taken into

consideration those possibilities.

4.3 The example giver's judgment

The facilitator asked the example giver the following question: "Should you undertake the

risk in that situation?". She answered that she had not asked herself such a question, when

she took the decision. She had acted more instinctively.

To the following question of the facilitator "What do you think today of your action?", this was

her answer: "The risk should be undertaken, because there were the possibilities to control

it, to come back (in the sense to have some alternative at disposal)".

Some of the participants expressed dissent regarding the action as well as the example

giver's judgment. "The risk should not be undertaken because she was not aware of it, but

she was compelled by a sense of moral obligation."

The example giver, then, considering the observations of the participants, decided to modify

her judgment in the following way: "The risk should be undertaken, because there was a

moral obligation."

4.4 Empathic work: to put oneself in the shoes of the example giver

The emotional aspects present in this example supported an empathic attitude of the group

towards the example giver and fostered an interpretation of the question proposed by the

facilitator "Should we undertake a risk in that situation?" in descriptive terms, pointing out at

the casual relation between the action of the example giver and her emotional state.

In this sense the group also agreed that "The risk should be undertaken, because she has

had a moral obligation" (the fact to have such a moral obligation justify, in fact, and make it

plausible such an action. Such argument were expressed as follows: "I have already acted in

a similar way, it is comprehensible" and so on…).

Nevertheless, the judgement that reached consent was specified under those conditions in

the following way:

"The risk had to be undertaken because there was a moral obligation, under the condition of

not to have had a negative personal experience in the past in a similar situation; the risk was


measurable and it did not happen anything" (this last addition was made by the example

giver).

In this empathic phase some general themes arose during the dialogue. Those were

considered, for some participant of the group, important aspects to deepen into. Here they

are:

1. The role that in the perception of a risk plays the fact to have had a precedent

experience.

2. The role that can play the fact to be conscious or not of the risk joined with the

factors that influence this consciousness.

3. The way of evaluating a risk: in particular; what kind of criteria do we have to

evaluate, to graduate, to quantify a risk?.

4. What is a risk?

4.5 Critical working: toward the regressive abstraction and a commonjudgment

In order not to confine the discussion to a factual and empathic investigation, the facilitator

suggested the group to ask themselves whether their arguments would be also estimated

valid as ethical justifications of that action. This led in a first moment the participants to

question on the meaning of ethics and to support the presumption that ethics was something

individual and cultural. Instead of discussing in an abstract way what ethics is, the facilitator

suggested then to try to answer to the general question "Which risk should we undertake?"

taking into account the example given, the arguments alleged before as material of the

dialogue and clarifying that the question was not only to understand as a factual, or personal

one.

The group then worked together to the conditions that make it legitimate to undertake a risk,

trying to make explicit the presupposition of their judgment. It is necessary to remember that

the group, before starting the empathic investigation, has presented a dissent on the

judgments of the example giver. Here there are the results of the group on which consent

was reached, taking into account the work developed before. (Most of the results were

clarified thanks to the concrete situation of the example).

C.J. 1 "We should undertake those risks in which":


• risk and benefit have been correlated, in the sense that there should be a proportion

between means (risk) and end (benefit). This correlation should be clarified in the sense

of a relationship between the probability that something happens (statistical criteria) with

that of its seriousness, without forgetting that the evaluation of the risk is a process

occurring in the time at short, medium, large scale.

• risks should affect the minor number of possible persons involved and imply the smallest

possible danger.

• we have tried to foresee the risk, taking into account the impossibility to have already a

control of it. (In fact a complete control of a risk would eliminate it).

A question was emerging: What kind of criteria do we have to evaluate a risk? Do we have

only individual, social and cultural criteria? Is ethics only an individual and cultural matter?.

Time was going. To the answer reached the group it was added another one, expressed in

negative terms and both related to the original example:

C.J. 2. "We should not undertake those risks, in which, even if the number of persons

involved is limited, the risk is potentially very dangerous. The assumption of a risk will

depend on the probability it will happen and the benefit it will imply."

It could have been also a further theme of discussion, the question whether it is sufficient or

not to foresee the risk to undertake it. A participant suggested that it could have been

necessary to have the possibility of coming back, to have alternatives.

Even if these judgments were general, they arose from the example and in this sense they

were often clarified using the example as material.

4.6 Moving to xenotransplantation

In this phase it was asked the participants to connect the dialogue results to the XTP

problematics. Participants observed that the criteria we had reached could have also been

useful and relevant for XTP. They mentioned in particular the common results expressed by

the two judgments, one in a positive, and the other in the negative form we have already

mentioned in the precedent section as C.J. 1 (common judgment 1) and C.J. 2 (common

judgment 2)

This sort of results could have been a suitable base and a point of departure for further

investigation on the ethical problems concerning XTP. It was also mentioned that the group


had founded a consensus on a common judgment, in a relatively short time, and in presence

of a plurality of actors, with different perspectives.

During the discussion it was underlined the question "Who does estimate a risk?" as well

the problematics of the subjectivity involved in being aware of the risk as further themes in

which it could have been interesting to investigate to answer to the general question of the

dialogue.


5. Neo Socratic Dialogue 2: Which risks are weallowed to undertake?

5.1 From the general question to the example

Participants worked in the first part to find a suitable example. From the eleven examples

proposed, one peculiar example was chosen by a majority decision after a long arguing

process, as suitable for the question and the topic of the research XTP.

Nine persons chose this example as the first preference, two other, chose it as a second

preference. No one expressed his/her refusal to work with it. For the participants, the

example was suitable because it was concerned with a collective risk, allowed analogies with

epidemic problems, as it dealt with HIV infection. It did not pose additional ethical problems,

as it could be with an example with possible abortion implications. Moreover, the example

appeared to provide grounds for, at least in a certain sense, to measure the probability of the

risk.

5.2 The chosen example

The situation chosen was a risky one. The example giver had accepted a grant that had let

him to research in a laboratory working on HIV infections. The risk depended, apart from the

same sort of investigations, on the bad condition of the working place. It was a restructured

patients room, in which the required obligatory conditions of security were lacking. The

example giver had not the possibility to change those facts, even if he had spoken with the

responsible of the investigation.

During the clarification phase of the example, the example giver added that he could have

also made other choices. In that moment, he was working. He was not impelled to accept

this opportunity. He was just reflecting on what to do, whether to begin a master, to research

in the cyto-genetics, or to do other things, among these, to accept this grant.

Before deciding to accept the grant, his best preference, he talked with the other

researchers, as well as with his partner and family. The first one for conveying the situation

of risk; the second one to share (to counsel and to support) his decision, even if, he clarified,

this decision was a personal one.

Once he took the decision to accept the grant, he tried to negotiate some conditions of

security. Nevertheless, failing in this effort, he accepted the alleged risk.


The main risk was that of an accident in the laboratory with a consequent infection of HIV

that could affect the example giver as well as other persons. Other risks were not to achieve

a professional satisfaction and a better economic situation. The affected persons by the

action, then, were the example giver, his colleagues, his family, the persons who lived in

contact with him, etc.

During the clarification of the example the example giver became aware of other possible

risks: the possibility to be affected by other illnesses, as well as to face the problem

connected to denounce the situation at the authority, in the case he had made it. The benefit

was clear: to achieve the grant and improve his economic and professional situation.

Also in this case, participants showed some possible alternative actions that the example

giver seemed not to have taken into account: the possibility to accept the grant and then to

deny to work in such a condition; to bargain; to denounce; to speak with other persons,

looking for other responsibilities.

5.3 The example's giver judgment

The facilitator asked the example giver to answer this question: "Were you allowed to

undertake the risk in that situation?" The facilitator clarified the meaning of the expressions

"to be allowed to" in the sense of an ethical justification and not simply of a matter of fact.

The example giver answered "Yes, it was allowed because I consider my self capable to

reduce the risks, assuming additional precautions (concerning blood, wound, gush)". The

facilitator asked the other participants, whether they agreed on this sort of argumentation

and asked "Was it allowed to undertake the risk in that situation?"

5.4 Critical working: toward the regressive abstraction and a commonjudgment

• From the judgment of the example giver to the judgment of the other participants

It started the process of the argumentation, moving from the example giver judgment to the

judgment of the participants, and from this one to its presuppositions and the answer of our

general question. Unlike the first dialogue, in this second one, it was not necessary first to

discuss empathically the decision of the example giver. It was then possible to start the slow

process of regressive abstraction in a different way.

In a round session the participants, accepting that their answer was also an affirmative one,

formulated them with different sort of argumentations. In this phase prevailed different kind of

answers, even if linked with common themes. The main lines of the argumentation were two.


The first one, with some differences between the participants, was concerned with the

elements that made this decision justifiable from an ethical point of view:

He was allowed to undertake the risk because the damage was under control; the

measures adopted to prevent the risk were sufficient (he had a previous knowledge

of the risk; he was directly involved in the situation and he should have been very

careful; he had increased the measure of security); the probability of the risk was

minimum; there was more a personal risk than a collective one; benefit were greater

than risks, it was an autonomous choice. The different answer of the participants

enriched themselves in a reciprocal way, working in the same direction.

The second one, the minority opinion, pointed out some factual considerations:

He was allowed to undertake the risk, because there was no conflict of values in the

example giver; or he was acting according to his own values.

• From the judgments of each participants to the judgment of the group

The facilitator recompiled those arguments in the form of general themes, after having

listened and summarized the main lines of arguments of the participants and wrote them on

a table, asking the participants eventually to make additions or corrections.

The factors that had to be taken into account to estimate if it is allowed or not to undertake a

risk expressed by the participants were: knowledge of the risk; control of the damage;

precaution measure; autonomy of decision; other persons affected by the actions; relation

between benefit and risk (quality of risk, quantity of risk, uncertainty), emotional interest,

values not in conflict; influence of the context; to be involved in the investigations.

• Towards a common judgment: the answer to the general question

It was time to try to answer in a collective way to our general question and to make explicit

the common criteria and convictions, which could sustain our judgment.

Working with the example as material of references and with the theme and line of

argumentation developed, and referring to the table, the group tried to answer at the general

question: "Which risks are we allowed to undertake?".

After a large process of argumentation, made of integrations, corrections, and specification

of the arguments, the group agreed with this answer:


"It is allowed to undertake those risks, in which existing a reasonable knowledge of the risk,

the relationship between risk and benefit, is clearly favourable to the individual and collective

benefit".

During the process it was pointed out the problem of a reasonable knowledge: "When is

knowledge reasonable?" The observations of the participants were the following ones: "A

knowledge is reasonable, when we have sufficient data and those data allow us to predict

the risk".

Nevertheless we have also to take into account the uncertainty present in a risk in its

different levels: the probability that something happens (uncertainty predictable); the

probability that something unattended can happen (uncertainty unpredictable); the

seriousness of what happens (with an objective estimation (quantification, how many people

may be involved, etc.) or with a subjective estimation (qualification on how serious is the

risk).

During this discussion other open questions arose as: "Who should be able and how is it

possible to evaluate a reasonable knowledge?", "What role does it play confidence in such

an evaluation?", "What is a risk?".

5.5 Moving to xenotransplantation

Participants considered that now it would have been possible to compare the results of the

dialogue with the different list of risks and benefit that we had offered the first evening.

Nevertheless, they mainly centred their attention on one of the open question that arose

during the dialogue ("Who will evaluate the risk in XTP and how to do it?") as a pre-condition

to answer to our general question.

It was not clear "who" should have been the main evaluator of the risk, whether the patient,

the patient and the family, the scientist involved, or other scientist not directly involved, etc.

In particular, it was questionable the suggestion made by one of the participants, for whom,

experts, if not directly interested in the research, should have been the more suitable

evaluators of the risk.

It seemed that the evaluation of the risk depends on the type of risk we are discussing about,

whether it is the risk of the patient, or that of a pandemics, for instance.

Moreover, the conviction that the evaluation should have been a task only of the experts and

the scientist became doubtful: experts and researchers are actually undertaking risks, which

do not affect only themselves. This means that we have to question who evaluate the risk

when actually undertake the experts, when there are other subjects involved. The group


moved slowly to the conviction that we had to include more actors in the decision process of

risk assessment, like politicians, ethicists, law experts. It was not also clear, whether, in the

case of the acceptability from a scientific point of view of XTP, the main role of the evaluation

should have been left only to the patients, to the patient and the family, or, and in a certain

extent, to the same society. We can detect as a general, even if not unanimous, line of

consideration of the group that in XTP we have to include more actors in the decision

process, as well as, the conviction that an evaluation made only by scientist or patients is

inadequate to the peculiar context of XTP.

Authors: Emilio Muñoz, David Santos, Paolo Dordoni

Title: National Evaluation Report Neo Socratic Dialogue: Spain. Increasing Public Involvement in

Debates on Ethical Questions of Xenotransplantation

Projektbericht/Research Report

© 2004 CSIC

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