Michał Zabdyr-Jamróz

Title in English: "Omnipartiality. On deliberation in governance for health with the inclusion of emotions, self-interests and expertise" Abstract: To what extent it is possible to reconcile the will of the people with expertise? That is the traditional question of democratic policymaking. However, the dilemma outlined in this way is very misleading. It suggests that citizens have no knowledge to offer on any given issue. In addition, it insinuates some peculiar resistance of the expert elite to ignorance, egoism or emotions. A more appropriate question would rather be the following: To what extent policymaking based on expertise is possible at all? Yet another question follows. Is policymaking based solely on evidence even sound? Is the traditional ideal of impartiality, an exclusion of egoism and passions from policymaking a good ideal? Author of the book argues that a good governance for health – and policymaking in general – requires the inclusion and proper balance of the three key inputs of governance: expertise, self-interest and emotions. Considering them requires going beyond typical public debates, bargaining and even beyond expert panels. It requires public deliberation in which the three inputs could engaged in a form of constructive dialogue with each other. In good governance, we should not limit ourselves to evidence insulated from material interests and strong intuitions. We cannot orient ourselves on procedural, neutral impartiality. Rather, we should move towards omnipartiality.

This commentary addresses the proposal and argumentative line presented in the paper ‘Whole Body Gestational Donation’ (WBGD) by Anna Smajdor (2023), published as an intended ‘outrageous argument’ in a dedicated special issue of Theoretical Medicine and Bioethics. We believe that the paper is fatally flawed due to its lack of engagement with relevant approaches in ethics and essential sources in health sciences as well as its insufficient, superficial, and rash argumentation. Its critical weaknesses include, among others, that it does not take any explicit ethical stance, it does not consider the societal impacts of its premise, and it hastily assumes a large degree of equivalency between WBGD and the usual organ donations. These scholarly flaws are made worse by the fact that the paper is not merely an academic thought experiment but contains important policy change proposals. As a consequence, the paper feeds into more general and systemic worries about the suitability of philosophy for public policy.

The purpose of this paper is to provide an analytical framework – derived from the Herbert L.A. Hart’s philosophy of law – for the study of the phenomenon of habit and custom from the perspective of normativity. Its starting point is the Hart’s concept of “internal aspect of rules” as a necessary criterion for the rule’s normative character. The internal aspect exists in two forms: the “recognition” based on specific rules, and “acceptance”. The concept of acceptance reveals a difference between habit and custom, by capturing the normative character of the latter. The formation of the customs – by way of unprecedented punishment of a rule’s violation – reveals the ambiguity of the term “sanction” as referring to not only the external aspect, but also to internal aspect of rules

In order to be exercised meaningfully, political freedom requires the capacity to actually identify available policy options. To ensure this, society ought to engage in deliberation as a discussion oriented towards mutual learning. In order to highlight this issue, I define deliberation in terms of the participants’ openness to preference change, i.e. the deliberative stance. In the context of the systemic approach to deliberative theory, I find several factors causing the atrophy of such a deliberative stance. I note that this state can occur not only when debaters are representatives or are in the presence of an audience, but also when they face the prospect of a binding decision. It is the latter effect that is a serious challenge to the micro-deliberative strategy, one that strives towards decisional powers being granted to deliberative minipublics. Presenting my findings, I propose—as an alternative to the power-oriented ‘ladder of participation’—a distinction between traditional co-decision and deliberative consultation, the latter one being an environment that is more conducive to deliberative stance. This new typology highlights factors that lead to preference petrification and allows for the appreciation of the non-decisional character of micro-deliberation. All of it leads to the conclusion that, in order to preserve their deliberative character in the systemic context, deliberative minipublics should not always be required to have decision-making powers.

In this paper I will juxtapose the concept of the veil of ignorance – a fundamental premise of Rawlsian justice as fairness – and solidarity in the context of the organisation of a healthcare system. My hypothesis is that the veil of ignorance could be considered a rhetorical tool that supports compassion solidarity. In the concept of the veil of ignorance, I will find some crucial features of compassion solidarity within the Rawlsian concept of “reciprocity” – located between “impartiality” and “mutual advantage”. I conclude that, even behind this “thick” veil, some essential, yet “particular” facts on health and wealth redistribution are available to decision makers. Lastly, I discover that by means of the assumption of self-interest in the original position the veil aims to convert egoism into empathy, thus invoking the solidarity of compassion that in turn could be translated into principles of the organisation of a healthcare system