Before moving on to describe the third stage of the discussion process (where we look at the potential real-world implications of the possibilities in order to consolidate and revise them), I’d like to focus this week’s posting on what we mean by taking a conceptual approach in the discussion process. As I mentioned in last week’s post, we think of taking a conceptual approach in our discussions as a way to cut to the heart of the matter.  We think it can be an important way to help the discussion participants to focus on what really matters, rather than getting hung up on particular details. It also helps open people up to discover more connections and interconnections, since it can free them from holding rigidly onto the specifics of particular cases.  So, let me reach back to the example of a discussion of human genetic technologies and give you some examples of what it might look like to move the discussions to a more conceptual level.

Developing Conceptual Questions or Concerns

When your discussions start, they’ll likely focus on a lot of concrete examples that lead to very specific questions. There tends to be a lot of storytelling at this point, which is natural.  Your task is to use these stories (or particular examples) as springboards for the discovery of underlying issues or bigger ideas (actually there’s usually a fair amount of storytelling throughout the process, but participants gradually get more adept at following these stories to the deeper points they disclose).  In the genetic technology discussions, people brought up specific questions like these:

• What if parents at risk for having kids with Tay-Sachs disease could use genetic testing of their embryos in vitro fertilization so they could make sure their kids did not have the disease?
• What if, while they were doing the above testing, the parents could select embryos that would develop other likely traits?
• How would you feel if you were the child born of those parents, who selected many of your physical and even behavioral traits?
• What if there was a genetic manipulation that could fix defective genes–such as those with Tay-Sachs?
• What if you were a child born with a genetic disorder that could have been prevented with genetic testing or fixed with a genetic therapy but your parents chose not to for religious reasons?  What if they chose not to for economic reasons?

From specific questions like those, you might eventually develop bigger or more conceptual questions like these (among others):

• Who in our society should get to decide the big questions about using or not using genetic technologies?
• What might be the different factors that affect these decisions–such as economics, cultural or religious concerns, concerns about social justice, concerns about maximizing personal health or public health, etc.?
• How might we address concerns about unequal access to these technologies?
• How might we address concerns about the ways these technologies could affect our sense of personal or human identity and/or our social roles and social relationships?

Developing Conceptual Possibilities

When you first start thinking up some different ways that society might respond to these questions, it’s likely that these possibilities will be fairly concrete or fragmentary, like these:

• For-profit corporations might decide only to develop those genetic technologies that promise of high-profits
• We might want to maximize public health by publicly funding the development of some genetic technologies
• We could let majority vote decide what genetic technologies we might ban, even if this is just for religious reasons
• There could be protections for individuals facing employment discrimination based on information revealed by genetic testing
• Markets might open up to trade in people’s genetic information (like the markets that trade in personal financial data)
• We could protect individual’s rights to make their own decisions about how to use–or not use–genetic technologies
• We could let the free-market decide, through insurers or for-profit service providers, who will get to make those decisions
• The government might mandate the use of some genetic technologies (like the model of requiring vaccinations)
• We could let government make it so everyone could get to make some basic level of choices about using genetic technologies
• We could educate people so they’d be empowered to make their own informed decisions

Many of these initial ideas might spell out different actions or different ways to put an idea into practice (people might start talking about a handful of different ways you could set up a public health approach). Over time you would probably start to notice some connections among these ideas. You might start to notice some common themes that would allow you to combine some of these into a more robust description of a broad possibility.  For example:

• You might use the theme of “letting the market decide” to develop a possibility where for-profit commercial agents would largely determine the direction for developing human genetic technologies and where people would have access to whatever genetic technologies they could afford.
• You might use the theme of maximizing public health to develop a possibility where the public, acting through its government, essentially determines the directions for developing human genetic technologies and determines who will use what technologies. You might think about ways that collective resources could be pooled to help society meet collective goals (for example, to have a healthier society overall).
• You might use the themes of letting individuals decide and of marshaling collective resources to develop a possibility where people would be empowered to make their own choices (for example by publicly supported education about those choices) among genetic technologies to which every citizen, regardless of financial status, would have access.
• You might use the themes of making a cultural or moral appraisal of genetic technologies to develop a possibility where there is more of a blanket evaluation of whether these technologies should even be allowed.

Of course, you’d likely discover and develop more themes than these, but these would be a way to get started. Each of these might begin to stand out as a distinct answer to some of the big questions that emerged in the first stage of the discussions. Now, as the discussions move ahead, you’d gradually flesh out more of the thinking behind each of these. From your earlier discussions, you’d likely be able to fill in some of the different thinking about the different values that might shape each of these policy possibilities. You’d probably find ways to fold together some of the more concrete initial ideas into a broader possibility. Once these take shape, you’ll be ready to start thinking about some of their likely real-world implications.

–Jeff Prudhomme