The Fruits of Moral Disagreement: Conversations and Questions from the Inaugural Ethox-Uehiro Workshop on Moral Disagreement

Tess Johnson, GLIDE Postdoctoral Researcher in the ethics of pandemic preparedness, surveillance and response and Alberto Giubilini, Senior Research Fellow, Uehiro Oxford Institute

On the 11 June 2024, members of the Uehiro Oxford Institute and the Ethox gathered at St. Anne’s College for an afternoon discussion on the nature, value, and disvalue of moral disagreement, as part of a strengthened collaboration between the two institutes within the new Wellcome-funded ANTITHESES research platform.

 The following inaugural Ethox-Uehiro lecture at St Cross college featured Professor Peter Singer discussing moral disagreements he has faced through the course of his career, in a talk entitled, ‘Disagreeing on Ethical Questions, Fruitfully and Otherwise”.

In this post, we focus on the workshop, and the fruits of our inter-centre discussion.  Roger Crisp has summarised and discussed Peter Singer’s lecture in a separate post.

The value of consensus

After Michael Parker, Director of the Ethox Centre, introduced the Antitheses platform and its focus on moral disagreement, in the first session, we questioned the value of consensus and articulated some reasons in favour of “suspension of judgement” in the case of radical disagreement.

Dominic Wilkinson, Deputy Director of the Uehiro Oxford Institute offered a defense of Margaret Thatcher’s approach to consensus: essentially, the encouragement of dissensus instead. He considered several implied arguments Thatcher had in favour of dissensus, including that it underlines the purpose of leadership (which in her view meant to take authority in situations of dissensus, rather than to create consensus); that it avoids the risks of ‘groupthink’ that may arise under conditions where consensus is encouraged or required; and that it is more democratic than consensus because it avoids the elite imposing its views and allows for the appropriate representation of diverse views.

It seems to us that there is much work to be done to explore how much dissensus might be needed to adequately represent a diverse range of views on any issue in a pluralistic society. For instance, in qualitative interviews, researchers seek to achieve saturation levels by interviewing enough participants such that they begin to see replication of views on an issue. This reassures them that most/all views have been heard. What can we learn from that approach about a possible ‘saturation level’ for moral disagreement, so that we can be confident enough that disagreeing views are appropriately collected and represented?

In the second talk, Roger Crisp, Director of the Uehiro Oxford Institute, explored the value of suspending judgement in cases of irresolvable disagreement. There is a long history of adversarial approaches in ethical and political debates, and philosophers in particular have a penchant for oppositional dialogues in academic publications. Yet, is there not a kind of epistemic virtue in the suspension of judgement? He held that if we enter into disagreement with an epistemic peer—someone we have good reasons to consider as knowledgeable as we are on the topic in question—and we have no mode of further investigation, the virtuous thing to do may be not to hold firm to our position and try to persuade the opponent with better arguments, but rather to be willing to suspend final judgement. This idea can operate on an individual level, like when two bird-watchers agree to suspend judgement on whether what they saw was one species or another), but also on a collective level. We would propose that although it may be difficult for individuals to actually suspend their judgement (as opposed to merely ‘agreeing to disagree’), where there is enough disagreement acknowledged within a population, we might still achieve collective suspension of judgement. This is might be akin to the idea of collective clinical equipoise within a medical community concerning best practice with regard to a particular treatment, but this as a possible analogous concept would need further research.

Platforms for moral disagreement

In the second set of discussions, we turned to platforms for moral disagreement, and how moral disagreements may play out differently in different settings. Cristina Voinea from the Uehiro Oxford Institute, spoke about the distorted perception of others’ beliefs and intentions which may occur during disagreement on social media platforms. This platform for disagreement may have several disadvantages that make it less likely to produce fruitful conversation and the potential benefits of disagreement. First, it is highly anonymous, which means that psychological features that usually make us less willing to dismiss others in face-to-face or identifiable interactions do not apply. Second, with reward systems that favour popularity and likes over consideration of other’s viewpoints and moderate response, we are encouraged to present our views as more polarised and contrasting with others’. Cristina suggested the use of a term introduced by Nguyen (2024), ‘value capture’, to describe the process of simplifying or stereotyping our otherwise-nuanced set of values when we are in certain social environments, so that they are more easily absorbed by others in social media environments.

Federica Lucivero from the Ethox Centre was next to speak, on the topic of research ethics structures and practices, and whether there should be more platforming for moral disagreement both within research ethics committees, and through the rest of the research cycle. She pointed out how in clinical trial research, researchers may feel that once they have received ethics approval, there should be no more dilemmas they face, and they ought simply to follow their protocol. However, as recent work on moral distress, benefit-sharing, and equitable research partnerships shows, there are numerous areas of continued ethical dilemmas within the research process. The lack of space given for researchers to raise these issues at later stages in the research process may impoverish our ethical analysis of research as a whole, and may create more conditions for moral distress in the face of unacknowledged moral disagreement for researchers. Yet, as she pointed out, opening up space for disagreement may also come at a cost: how can a concrete decision be made and followed through in research if we leave more avenues for disagreement? Whose advice should a researcher follow in cases of later moral disagreement? Such questions may be appropriate areas for further work through the new research platform.

In the third and final conversation, we looked into substantive cases and issues of moral disagreement. James Hart from the Ethox Centre discussed how moral disagreement has come up in his work on priority-setting in the context of health system resource allocation. There are often disagreements about the appropriate allocation of resources across conditions or among patients. Where consensus cannot be achieved, there is a turn toward ‘fair processes’, whereby the focus shifts from the procedure followed to arrive at a decision, rather than on the outcome: if there is no guarantee that a substantively fair outcome can be achieved, perhaps an alternative is to rely on fair procedures, instead. In a fair process, committees ensure disagreement is represented and accounted for by giving voice to all the views, even if the final decision about how to allocate resources might not satisfy some of those.

Mehrunisha Suleman from the Ethox Centre capped off the afternoon with the final talk, on issues of moral disagreement in her work on antiracist medicine. In the pursuit of antiracist medicine, should we seek to do away with treatments and diagnostic methods that differentiate according to race? Her starting point was that race is a social construct to begin with, which doesn’t underlie any consistent biological differences between populations, as is becoming better understood. So what would be the justification for medical practices that take into account a patient’s race for diagnostic purposes? Some argue that such practices should be abandoned altogether because they exacerbate discrimination and stigma at the societal level and promulgate an incorrect assumption. Yet, others disagree: they would emphasize that, whilst there is no biological basis of race, there are distinct geographic or genetic populations who, for instance, may have a predisposition toward certain hereditary conditions, or who may share a more or less effective response to a certain drug. It is in their medical interest that such factors are considered. Whilst people on each side of this argument may share the same core goal, and the same values concerning improved patient care and outcomes, their ideas about how to serve those values and achieve that goal are radically different. Does this constitute moral disagreement if values are shared, and if so, how should it be addressed?

Next steps

By the end of the workshop, we had covered significant breadth of topics. There were several points at which we noted further research might be useful. For instance, in addition to questions from the first session surrounding clinical equipoise as a conceptual analogue to suspension of ethical judgement, we might consider additional questions arising from the second session. For instance, should we turn to evolutionary biology here when we think of the evolution of psychological mechanisms that were used to encourage in-group commitment and punish norm transgressions in harsh environmental conditions? Perhaps these mechanisms are now holding us back from engaging meaningfully in moral disagreement during our online interactions. Regarding the final set of talks, we might look into difficult disagreements that occur even in the context of shared goals, and whether procedures for addressing these constitute a form of ‘retreat’, as suggested at the workshop. In conferring legitimacy to the decisions made, does fair procedure do all that needs to be done?

Whilst we did not have the chance to investigate any of the questions of this blog post in great depth, it moved us some steps in the direction of mapping the terrain of moral disagreement both at the conceptual and at the practical level. The workshop has provided the motivation and the opportunity to encourage collaboration between members of the two centres, and, within the ANTITHESES platform we look forward to future iterations involving other centres and disciplines, too.