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Projektbericht
Research Report
National Evaluation ReportNeo Socratic Dialogue: Spain
Increasing Public Involvement in Debates onEthical Questions of Xenotransplantation
David Santos, Emilio Muñoz, Gloria Ponce and Paolo Dordoni
Projektbericht
Research Report
Unidad de Políticas Comparadas, Madrid, CSICUniversidad Complutense de Madrid
National Evaluation ReportNeo Socratic Dialogue: Spain
Increasing Public Involvement in Debates onEthical Questions of Xenotransplantation
David Santos, Emilio Muñoz, Gloria Ponce and Paolo Dordoni
Report
Studie im Auftrag der Europäischen Kommission(Research Directorate General)
April 2004
Contact:
Emilio Munoz: +34/91/5219160email: emiliomz@iesam.csic.es
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. Objectives 1
2. Methods 2
3. Input 33.1 Was it possible to enrol all relevant actors in the Neo Socratic Dialogue? .......................... 3
3.1.1. Composition and characteristics of the participants in the Spanish NSD................. 3
3.1.2. General points and scientific comments ................................................................... 6
3.2 What do participants think about XTP?................................................................................ 9
3.2.1 Connection with XTP ................................................................................................. 9
3.2.2 Level of information ................................................................................................... 9
3.2.3 Attitudes towards XTP ..............................................................................................10
3.2.4 Summary ..................................................................................................................15
3.3 What are their motivations, goals and expectations for the Neo Socratic Dialogue?..........17
3.3.1. Participants motivations...........................................................................................17
3.3.2 Expectations .............................................................................................................17
4. Process 214.1. and 4.2. Which issues and lines of arguments were debated during the Neo Socratic
Dialogue? ..................................................................................................................................21
4.2.1 Transfer from the dialogue to the XTP issue ............................................................40
4.3 Which coalitions as well as conflicts of interests did exist or develop?...............................46
4.4 Which problems did arise?..................................................................................................47
4.5 Was the process managed efficiently?................................................................................49
5. Output 535.1 Which results did the Neo Socratic Dialogue have? ...........................................................53
5.2 Was consensus reached? If not, why not?..........................................................................54
5.3. Was it possible to mark dissent?........................................................................................55
5.4. Was it possible to formulate policy options? ......................................................................55
5.6. Were their expectations/motives/goals fulfilled? ................................................................61
5.7. Was it possible to disseminate the results of the Neo Socratic Dialogue into a wider
discussion? ...............................................................................................................................70
5.8. In which way were the results of the Neo Socratic Dialogue brought in the
xenotransplantation debate?.....................................................................................................70
6. Impact 716.1. Which consequences do participants think that the Neo Socratic Dialogue will have for
their professional and private everyday life? ............................................................................ 71
6.2. Did the dialogue change their awareness of ethical problems of xenotransplantation?.... 71
6.3. Did the dialogue change their communicative patterns and capabilities in related ethical
questions? ................................................................................................................................ 72
7. Resonance 757.1. Did the Neo Socratic Dialogue have a resonance in the policy making process, scientific
community, media, public debate or industry? ......................................................................... 75
8. Summary and conclusion 768.1. Goal 1: To raise awareness of relevant actors and the public for ethical questions of XTP76
8.2. Goal 2: Discuss ethical problems of XTP .......................................................................... 78
8.3. Goal 3: Clarify the responsabilities of various actors for ethical questions of XTP ........... 81
8.4. Goal 4: To provide information to decision makers about the ethical basis and
consequences of XTP .............................................................................................................. 82
8.5. Consensual policy options for ethical problems of XTP .................................................... 83
8.6. To improve the communicative patterns and capabilities of actors in the field to cope with
ethical questions arising from modern science and technology ............................................... 84
Index of tables
Scheme 1: Participants 7
Table 1: Connection with XTP 9
Table 2: Information stand in XTP 10
Table 3: Overall attitude towards XTP 11
Table 4: Specific attitudes towards XTP 12
Table 5: Specific attitudes towards XTP 14
Table 6: Categories of expectations 18
Table 7: Expectations about the NSD 19
Table 8: Assessment of the facilitator’s interventions 49
Table 9: Assessment of the facilitator’s characteristics 50
Table 10: Assessment of the usefulness of the results of the NSD 53
Table 11: Assessment of the group’s activities 58
Table 12: Assessment of group characteristics 59
Table 13: Realization ox expectations 61
Table 14: Assessment of the outcomes of the NSD 62
Table 15: Comparison of expectations about and experiences with the NSD 65
Table 16: Relation between expectations about and experiences with NSD 66
Table 17: Relation between expectations about and experiences with NSD1 67
Table 18: Relation between expectations about and experiences with NSD2 68
Table 19: Assessment by school grades 69
Table 20: Willingness to recommend the NSD to colleagues 69
Table 21: Assessment of the usefulness of the NSD for the own work 71
National Evaluation Report Neo Socratic Dialogue: Spain — 1
1. Objectives
This work package is dedicated to the evaluation of the input, the process, the output and
the impact of the Neo Socratic Dialogue.
Its objectives are:
• To examine whether the Neo Socratic Dialogue reached its goals.
• To identify factors which furthered and/or hampered the accomplishment of these goals.
• To act as quality control measurement by providing structure to collect, “feed-back” and
analyse learning processes during the project (evaluator “as critical friend”).
• To provide the basis for recommendations, whether and how the Neo Socratic Dialogue
can be transferred to ethical debates on other technologies (tailored to target groups and
regions).
The expected result of this work package is to clarify whether the Neo Socratic Dialogue is
an appropriate instrument to discuss controversial ethical issues in science, medicine and
technology.
2 — National Evaluation Report Neo Socratic Dialogue: Spain
2. Methods
We used the following methodologies for the evaluation of the two Spanish NSDs1.
Analysis of records and documentation of the dialogue: We recorded the transfer phase of
the two NSDs. These transcripts provided the bases to report about the results about the
issue of xenotransplantation of the NSDs.
Ex-ante and follow-up questionnaires: For the ex-ante and ex-post survey we asked the
participants to fill in two questionnaires, one at the beginning and one at the end of the NSD.
All participants filled in these questionnaires, which means that altogether we have 38
questionnaires. In the first questionnaire we asked the group members about their motivation
to participate in the NSDs, their knowledge stand about XTP, their judgment about the ethical
issues of XTP and some statistical data. In the second questionnaire we asked them about
their experiences with and an assessment of the NSD.
Interviews with participants and the facilitator: We interviewed 18 of the 19 participants.
Despite several attempts we were unable to arrange interviews with one participant from the
first NSD. Interviews took place between August 29th and September 20th 2003; all of them
we did by telephone. The telephone interviews were recorded and we also took notes.
1 The evaluation team consisted of Emilio Muñoz and David Santos. Emilio Muñoz and David Santos were presentat the two NSD. Both dialogues were taped by a technical assistant. Paolo Dordoni was the facilitor andcollaborated in the Evaluation and Description of the NSDs. David Santos did the data processing of thequestionnaires and the interviews with participants and Gloria Ponce also collaborated with the interviews.
National Evaluation Report Neo Socratic Dialogue: Spain — 3
3. Input
3.1 Was it possible to enrol all relevant actors in the Neo SocraticDialogue?
The Baseline Evaluation carried out during the first part of XENO project served to show
clearly that there was a limited debate on xenotransplantation in Spain both by its extent and
scope. Those results provided additional empirical data to the reasons underlying the very
positive-almost unique case in the developed world-public opinion existing in Spain on
xenotransplantations applications.
All these clues had to be taken into account when proceeding to the selection of participants
in the Neosocratic Dialogues (NSD). After the long and lively debate hold during the “kick-off”
meeting of the project in Vienna (mid February 2002), it has been assumed by the Spanish
team that the selection of participants has to be based looking to a mix population which
must have some links on information on xenotransplants, but obviously possessing a varying
degree of connection to the topic. In sum, knowledge, information, interest, ethical and
normative representations on xenotransplantation, or at least, on bioethical issues were the
key words to create the pools of possible attendants. The invited persons were distributed
according to the representation provided in Scheme 1(see below)
3.1.1. Composition and characteristics of the participants in the Spanish NSD.
3.1.1.1 First NSD.
The first dialogue started with 10 participants for the introduction of the exercise. The
composition was as follows:
One of them (1st participant) was one of the Spanish researchers carrying out basic research
and experimental xenotransplants from pigs to babouins. This participant has been involved
in contracts with firms, and have been working in hospitals.
Another one (2nd participant), also tightly linked to the xenotransplants issue, was the head of
the transplantation unit of a quite relevant hospital from the Spanish National Health System.
Interestingly, this participant has been involved in the social analysis of xenotransplantation
perception among specialists and patients by carrying out a survey on this topic between the
health professionals and patients with kidney diseases. This person holds quite important
information on xenotransplatations’s possibilities, limits and drawbacks.
4 — National Evaluation Report Neo Socratic Dialogue: Spain
Third participant was a journalist, one of the most actively involved in the elaboration of
press information on the xenotransplantation issue. This journalist belongs to one of the
most relevant newspapers (rating third in terms of audience) and the documents published
on the topic were part of the content analysis performed during the Baseline Evaluation of
the project.
The fourth participant classifies as an expert in the juridical aspects of biotechnology, who is
collaborating with a well credited and specific chair on Human Genome and Law, located in
the Basque Country and supported by public and private institutions (a Bank Foundation, the
Regional Basque Government and the University of Deusto). The knowledge of this
participant on the normative aspects related to xenotransplants is high, but quite limited on
scientific and technical aspects.
The fifth participant holds a degree in Veterinary Sciences and has been involved in the few
initiatives existing in Spain on “Education Training” in biotechnology firms managements. At
the beginning of 2003, there were in Spain a few postgraduate courses addressing those
topics. The person invited has been involved in two of them.
The lay-interested people were represented by four participants, carrying out studies on the
acquisition of managerial skills for biotechnology companies. One out of the four (6th
participant), holds a degree in life sciences related disciplines but it is particularly interested
in the business aspects of biotechnology, socio-economic relation to policy makers and
consulting. A second one (7th participant) was a holder of a university degree on Law and is
interested in the normative aspects of biotechnology. The third one (8th participant) holding a
degree on Chemistry is particularly interested in the social aspects of biotechnology, their
evolution and development. The fourth and last one (9th participant), belonging to this group,
holds a degree on Chemistry and possesses previous working experience in the
pharmaceutical industry.
Two other participants invited were attending only part of the exercise. One of them is a
journalist, responsible for the institutional communication department from Spanish
Research Council (CSIC), who had to confront an institutional meeting and consequently
was able to attend only the introduction (first day) and one unit of the second day. The other
participant was a representative of the Socialist Party (PSOE) in the Spanish Parliament,
who has a strong commitment on scientific and technological issues. Unfortunately, political
commitments limited the participation to the introductory part of the NSD (evening of the first
day).
In sum, nine persons attended the whole event. But it is necessary to indicate that only eight
of them have responded to the ex-ante and ex-post questionnaires. All the data gathered in
the numerical analysis refers to 8 participants for the First Dialogue.
National Evaluation Report Neo Socratic Dialogue: Spain — 5
3.1.1.2 Second NSD.
Two participants (1st and 2nd participants) were presidents of the Spanish Transplanted
Patients Associations: one from kidney transplants and the other from heart transplants.
Both are extremely interested in xenotransplantation looking to it as a possible alternative to
allotransplants. They have been following debates on scientific, technical, and ethical issues
related to xenotransplantation and uncovered during the NSD the interests and worries of
patients.
The third participant is member of the previously mentioned chair on Human Genome and
Law, who has been involved in the ethical aspects surrounding the applications of
biotechnology applied to human beings and requiring the use of animals. A very significant
publication in Spanish on the juridical and ethical aspects of xenotransplants witnesses both
the qualifications and skills of this participant.
A fourth participant holds a degree in Law, being professor of Criminal Law in one of the
most important universities from Spain located in Madrid, and carries out great interest for
the socio-juridical aspects of biotechnology.
A fifth participant is researcher in biomedical sciences at CSIC, holds a degree in Medicine
and is specialist in cardiovascular diseases. This participant has been actively involved in
European research projects and hold responsibilities as Spanish representative in the Health
area of the Framework Programme; possesses quite significant information on the issue of
xenotransplantation ranging from technical to the ethical aspects.
The sixth participant holds a university degree in Law but possesses a hybrid culture as
having been involved in the obtention of a doctoral degree on the Human Genome topic
tackling both the scientific and juridical aspects, under a double direction for the preparation
of the doctoral dissertation: a molecular biologist and a law philosopher (natural law
specialist).
The seventh participant holds a university degree in Philosophy and is dealing in the
academic career in ethical aspects of biotechnology, having carried out participations in
national and foreign courses on Bioethics.
The eighth participant holds a degree on Pharmaceutical Sciences while being involved in
studies and analysis of public perception of biotechnology.
The ninth participant holds a university degree on Philosophy and was invited because
showing a great interest in the Neosocratic Dialogue by its possible application and
translation to the field of psychology. This participant was likely the one possessing the
6 — National Evaluation Report Neo Socratic Dialogue: Spain
lowest level of knowledge about biotechnology, though being aware of a general level of
information on the aspects of biotechnology which are at stake.
The tenth and eleventh participants were selected from people involved in a postgraduate
course on biotechnology. The first one of them holds a degree in Biological Sciences and is
increasingly interested in the promotion and production of biotechnological products through
private firms and public agencies, products being understood in a wide sense from education
to communication.
Lastly, the 11th participant holds a degree in Biology and is interested in the ethical aspects of
biotechnology.
As it has been illustrated the total number of participants in the second NSD was 11,
however, one of them (the 5th participant) had to leave during the middle of the second
session, though has been continuously interested in the follow-up of the exercise.
3.1.2. General points and scientific comments
The distribution of the participants according to their professional skills and interests is given
in Scheme 1.
National Evaluation Report Neo Socratic Dialogue: Spain — 7
One of the ethical problems raising controversies in the developed countries relies to the use
of animals as source of organs. Though this problem reaches limited scope in Spain, the
Spanish team considered of interest to invite the defenders of animal rights and contacts
were made with the three more representative associations. In spite of the efforts, none of
them attended, arguing problems of agenda (the three are university professors). This
explains their absence as depicted in Scheme 1. A similar situation did occur with
representatives of political parties. The number of political actors involved in scientific and
technical issues in Spain is rather low. Contacts with the two most representative and
publicly active, one from the conservative Popular Party and second from the left-center
Socialist Party (PSOE) resulted in the acceptance of the second one, though the resulting
participation was not significant. It can be concluded that political actors were not present in
the NSD in Spain.
In summary, the team participants in both NSD’s were between 24 and 59 years olds, the
mean was 36; 37% of them were under 30 and only 32% above 40. Eleven participants were
male and eight female. All of them were educated people though their involvement and level
PoliticiansDecision makers
(They did notparticipate in
NSDs)
Journalists(One participant)
No governmentalorganizations
Animal rights defenders(They did not participate in
NSDs)
Patients(Two participants)
People interested inBiotechnology (several
aspects: industry,consultancy, Law, Ethics,
public perception, training,public communication, etc.)
Fourteen participants
OthersOne participant
NSD1NSD2
Professionals(XTP Researchers,
Transplants doctors, etc.)
(Three participants)
8 — National Evaluation Report Neo Socratic Dialogue: Spain
of knowledge on biotechnology varied. The Spanish team intention was to hold the NSD’s
with a mixed population of participants in terms of information on the topic subject of the
NSD, but with the organizers possessing a profound knowledge on the biographies and
value recognition of each one of them. The direction would favor an in-depth qualitative
analysis of the outcomes of the evaluation what is in agreement with the main strengths
evolved by the Spanish team along its research agenda during the last decade. This may
help to overcome the statistical limitations of the exercise by the low samples involved and
the possible biases in the selection.
From the information gathered, it may be anticipated that the participants in the 1st NSD
would have a blend position with respect to connection to the xenotransplantation issue but
feeling a lower attraction by the method (this first group characterized by a “positivist
position”), whereas the participants in the 2nd NSD would be characterized by showing a
higher attractiveness for the value issues and for the methodology of the dialogue (it could
be named as a group with “moral valuing position”).
The summing up of the main differences between the two groups is as follows. As shown in
Table 1, the members of NSD 2 reveal a tighter relationship with xenotransplantation than in
NSD 1 group. The predominance of juridical educated people in this first group with limited
knowledge counteracts the presence of two highly qualified technical experts in this group,
whereas the average technical expertise is higher in the second group even for those
holding a primary education on juridical topics. The same argument must apply to the
explanation of the high level of information on xenotransplants observed for the NSD 2 group
(see table 2).
With regard to the question on general attitudes about xenotransplantation, no marked
differences were observed for both groups. Among the positive attitudes the questions “XTP
could reduce the bases for organ trade” and “There is fundamental difference between the
case of animals as nutrition and organ uses” collected more support from the participants in
the first NSD.
The reverse is found with the items “There are no less problematic alternatives within
foreseeable future” and “Physicians obligation to cure individual patients is more important
than a potential risk for the population” which are counting on greater support among the
participants in the second NSD.
Regarding the negative attitudes, there are some important differences between the two
NSD. Scientifically based items like the breeding and use of source animals contradicts
criteria of breeding according to species “XTP crosses the species border between humans
and animals” and “Genetic engineering of source animals is necessary to use their organs
for humans” received more support from the members of NSD 1 group. On the other hand,
value based items like “ It cannot be excluded that pathogens from the donor animal are
National Evaluation Report Neo Socratic Dialogue: Spain — 9
transmitted to the patient and, in the worst case, spread in the population” and “XTP patients
could have psychological problems because of having an animal organ” did get more
support from the second NSD group.
In the remaining items, there were no significant differences.
In broad terms, and taking into account the limits of our analysis, the differences between the
two NSD groups can be explained by the contrast between “positivism” (first group) and
“moral valuing” (second group).
3.2 What do participants think about XTP?
3.2.1 Connection with XTP
An important percentage of participants (53%) declared in the surveys their strong or
medium professional or personal links to xenotransplantation issues. The remaining 47%
state a weak or non-existent relationship with the topic. This even distribution does not
permit to draw clear conclusions on this issue.
From Table 1, it can be seen that the connection with xenotransplantation was slightly higher
for the second NSD (compare mean values. It is worth to remind that 1, 2, 3, 4 values stand
for “Strong”, “Medium”, “Minor” and “None”, respectively).
Table 1: Connection with XTP
Str
ong
Med
ium
Min
or
Non
e
Mea
n
Std
.
Dev
iatio
n
How strong is the relationshipbetween you professionaland/or voluntary tasks and theissue XTP?
4
(2/2)
6
(1/5)
7
(4/3)
2
(1/1)
2,37
(2,50/2,27)
0,96
(1,07/0,90)
(Source: CSIC-Survey 2003)
3.2.2 Level of information
Information of the NSD participants emerges as a factor which may influence the outcomes
of the dialogues. To test this influence, a question was included in the questionnaire
submitted to participants previously to the development of the dialogue.
10 — National Evaluation Report Neo Socratic Dialogue: Spain
The results are presented in Table 2. More than half of the participants declared to be full or
fairly informed on the xenotransplantation issue. No one answered as “Not informed”, a
result which guaranteed a basal level of information to the topic of the dialogue. The
participants in the second NSD show better results at this respect, mean value of 2,00 as
compared to 2,38 for the first dialogue. The participants in the second dialogue then
averaged as “Fairly informed”. This result matches well with the previous result on the
degree of connection with xenotransplantation.
Table 2: Information stand in XTP
Ful
ly
info
rmed
Fai
rly
info
rmed
Littl
e
info
rmed
Not
info
rmed
Mea
n
Std
.
devi
atio
n
How do you estimate yourinformation stand about XTP?
6
(2/4)
4
(1/3)
9
(5/4)
2,16
(2,38/2,00)
0,9
(0,92/0,89)
(Source: CSIC-Survey 2003)
3.2.3 Attitudes towards XTP
The participants were questioned on their general opinion on xenotransplantation by asking
the agreement degree on the following statement: “In broad terms, I consider
xenotransplantation as a positive medical application for the future”.
Taking together both dialogues, an overwhelming majority (84%) expressed their agreement
(responses “Agree very much” and “Rather agree”). Results are shown in the Table 3. Only
two participants (second NSD) declared “Rather do not agree” and a single participant
identified him/her self as “undecided”.
Results are very similar for each one of the dialogues taken separately, though the positive
attitude was slightly higher for the first NSD. In any case, the positive attitude towards
xenotransplantation as a medical technology overpassed 75% or participants (see Table 3).
National Evaluation Report Neo Socratic Dialogue: Spain — 11
Table 3: Overall attitude towards XTP
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t
agre
e
I don
’t ag
ree
I am
unde
cide
d
Mea
n
Std
.
devi
atio
n
To what extent do youagree with the followingstatement about XTP.Altogether I consider XTPa desirable futuretreatment.
4
(3/1)
12
(7/5)
2
(0/2)
0
(0/0)
1
(1/0)
2,05
(2,00/2,13)
0,91
(1,10/1,64)
(Source: CSIC-Survey 2003)
To go in depth in the knowledge on the attitudes towards xenotransplants, all participants
were asked about their respective degree of agreement on 16 statements, six of them being
positive and 10 expressing negative positions. The results are shown in the Tables 4 and 5.
Around 80% of the participants expressed their positive opinion about xenotransplantation as
a solution to overcome the problem of organ shortage. No significant differences were found
between the two dialogues.
A clear majority of the participants (74%) gave a positive support to the issue that
xenotransplants can be an efficient solution to improve the patients quality of life. Again,
there were no significant differences at this respect between the participants in the two
dialogues.
A minor proportion (only 58%) expressed a positive opinion regarding the eventual reduction
of organ trade. In this issue, there are marked differences between the two groups. The
participants in the first NSD gave an average of 2,00, equal to the “Rather agree” level while
the participants in the second dialogue got a 2,82 as average, a figure that is near to the
“Rather do not agree” level. The participants in the second NSD, precisely those having
shown a higher degree of information and knowledge about xenotransplantation, were more
sceptical about this crucial issue. The contraposition between the “positivist” and the “moral
valuing” positions may explain this difference.
A similar proportion, 58%, expressed their agreement with the argument that the use of
animals as a source of organs is similar to their use for food. Again, as in the previous case,
the matching between the two groups is very uneven. The mean for the first dialogue
participants amounts to 2,25, a value near to the level “Rather agree”, but the mean for the
second group of participants is 2,73, a value closer to the “Do not agree” level. The
participants in the second dialogue were prone to consider that the two types of cases are
different in terms of acceptability and feasibility. A similar argument to that expressed above
could take account of the different score.
12 — National Evaluation Report Neo Socratic Dialogue: Spain
A little more than half of the participants expressed the view that xenotransplants are a
valuable alternative because there are no less problematic alternatives within foreseeable
future. There are not significant differences between the two groups, though the participants
in the second dialogue show a certain positive bias towards the issue (they gave results
closer to the “Rather agree” level).
Last, but not least, the great majority of the participants, 80%, do not support the statement
that “the election is to cure or solve the problems of individuals without taking care of the
risks of infection for all the population”. The members participating in the first NSD were
more critical about this issue, as all of them chose the option “Do not agree”. Though we
have to admit that the interpretation is not a straight one, we would like to argue on the
predominance of a “positivist”, professional position as to explain this result.
Table 4: Specific attitudes towards XTP
I consider XTP asdesirable from an ethicalperspective because....
I agr
ee v
ery
muc
h
I rat
her
agre
e
agre
e
I don
’t ag
ree
I am
und
ecid
ed
Mea
n
Std
. dev
iatio
n
1. XTP can solve theexisting shortage ofhuman organs
5(1/4)
10(5/5)
3(2/1)
0(0/0)
1(0/1)
2,05(2,13/2,00)
0,97(0,64/1,18)
2. XTP could savehuman lives andcould improvepatients quality of life
4(1/3)
10(4/6)
3(3/0)
0(0/0)
2(0/2)
2,26(2,25/2,27)
1,15(0,71/1,42)
3. XTP could reducethe bases for organtrade
2(1/1)
9(6/3)
6(1/5)
1(0/1)
1(0/1)
2,47(2,00/2,82)
0,96(0,53/1,08)
4. There is nofundamentaldifference betweenthe use of animals asnutrition and organdonors
4(1/3)
7(5/2)
4(1/3)
2(1/1)
2(0/2)
2,53(2,25/2,73)
1,26(0,89/1,49)
5. There are no lessproblematicalternatives withinforeseeable future
1(0/1)
10(5/5)
5(0/5)
2(2/0)
1(1/0)
2,58(2,88/2,36)
0,96(1,25/0,67)
6. Physicians’obligation to cureindividual patients ismore important thana potential infectionrisk for thepopulation
1(0/1)
0(0/0)
5(0/5)
12(8/4)
1(0/1)
3,63(4,00/3,36)
0,83(0,00/1,03)
(Source: IHS-Survey 2003)
National Evaluation Report Neo Socratic Dialogue: Spain — 13
We move now to the results obtained from the participants’ reaction to the statements
containing negative messages (see Table 5).
There is an important decision between the participants on the possibility that the
xenotransplants may cause infections to the patient and to all population.
A 32% chose the option “Rather agree” and 42% chose the option “Rather do not agree”. A
forth part of the participants were “undecided”.
A similar situation was found for the question related to the possible reduction of human
donors if the xenotransplants initiative evolved positively. The 42% of participants gave
support to this argument, while the 57% opposed to it. It is clear from this that there is no a
situation of unanimity.
On the other side, there is a majority about the question of the need of restriction of
fundamental rights in the patients by monitoring them to ensure safety. 84% opposed to this
restriction.
The remaining questions obtained a great variety of results. A 57% of the participants did not
agree with the statement that the xenotransplanted patients will suffer psychological
problems. This value rises slightly to 63% for the first group (“positivism slightly dominating”).
There was not, among the participants in the NSD, a strong position for defending the animal
rights. A 68% of the participants disagreed with the statement that the “use of animals” for
this use contradicts normal breeding criteria and rules.
More that half of the participants gave opinion against the argument that the use of animal
organs implies the crosses of species barriers. It is important in relation to this item, the high
level of participants (21%) choosing the option “undecided”. This specialized question
requires a good proficiency on science aspects.
The question number seven underlying the need to use genetic engineering for making
better the use of animals as donors got a very asymmetric result. The mean for the first
group amounts to 1,88, a value close to the option “Rather agree”. The mean for the second
group is 3,27, a value overpassing the option “Do not agree”. However, the strong
quantitative discrepancy is due to the fact that two participants in the second dialogue chose
the option “Undecided” whose numerical value is 5, thus provoking a non-well substantiated
increase in the average.
A great majority (84%) opposed to the argument that the research in xenotransplants will
divert funds towards high-tech medicine, thus jeopardizing basic, primary healthcare. Still a
14 — National Evaluation Report Neo Socratic Dialogue: Spain
higher percentage (94%) did not agree with the argument that by using animals as organ
donors, they are transformed into spare parts for human benefit.
63% of the participants expressed opinion against the argument that xenotransplants will
reduce the funding for primary healthcare in the countries of the Third World. It seems to be
clear that the lack of resources to this goal in the less developed countries is not a
consequence of the research effort in the developed countries, but that it relies on more
complex causes.
Table 5: Specific attitudes towards XTP
I consider XTP from
an ethical
perspective as not
desirable because…
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t agr
ee
I don
’t ag
ree
I am
und
ecid
ed
Mea
n
Std
. Dev
iatio
n
1. It cannot beexcluded, thatpathogens fromthe donoranimal aretransmitted tothe patient and,in the worstcase, spread inthe population.
1(0/1)
6(3/3)
8(2/6)
0(0/0)
4(3/1)
3,00(3,38/2,73)
1,20(1,41/1,01)
2. XTP couldfurther decreasethe willingnessin the populationto donatehuman organs
2(1/1)
6(2/4)
7(4/3)
4(1/3)
2,68(2,63/2,73)
0,95(0,92/1,01)
3. It might benecessary toconstrictfundamentalliberty rights(e.g. byquarantine) tominimize therisk oftransmission ofpathogens fromdonor animals topatients and thepopulation.
0(0/0)
3(1/2)
8(3/5)
8(4/4)
3,26(3,38/3,18)
0,73(0,74/0,75)
4. XTP patientscould havepsychologicalproblemsbecause ofhaving ananimal organ.
1(1/0)
6(1/5)
9(4/5)
2(1/1)
1(1/0)
2,79(3,00/2,64)
0,92(1,20/0,67)
National Evaluation Report Neo Socratic Dialogue: Spain — 15
I consider XTP from
an ethical
perspective as not
desirable because…
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t agr
ee
I don
’t ag
ree
I am
und
ecid
ed
Mea
n
Std
. Dev
iatio
n
5. The breedingand use ofsource animalscontradictscriteria ofbreedingaccording tospecies.
1(0/1)
2(2/0)
9(4/5)
4(1/3)
3(1/2)
3,32(3,13/3,45)
1,06(0,99/1,13)
6. XTP crosses thespecies borderbetweenhumans andanimals.
0(0/0)
5(4/1)
1(0/1)
9(4/5)
4(0/4)
3,63(3,00/4,09)
1,12(1,07/0,94)
7. Geneticengineering ofsource animalsis necessary touse their organsfor humans
4(3/1)
6(3/3)
3(2/1)
4(0/4)
2(0/2)
2,68(1,88/3,27)
1,34(0,83/1,35)
8. XTP will tiefunds in high-tech medicine,which could bemissing inprimary healthcare
1(0/1)
1(1/0)
10(6/4)
6(0/6)
1(1/0)
3,26(3,13/3,36)
0,87(0,83/0,92)
9. XTP reducesanimals to organdonors.
0(0/0)
1(0/1)
8(5/3)
10(3/7)
3,47(3,38/3,55)
0,61(0,52/0,69)
10. XTP will tie upfunds indevelopedcountries, whichmight be missedfor primaryhealth care in 3rd
world countries.
1(0/1)
4(2/2)
8(3/5)
4(2/2)
2(1/1)
3,11(3,25/3,00)
1,05(1,04/1,10)
(Source: CSIC-Survey 2003)
3.2.4 Summary
The participants in the two Spanish NSDs were credited with different skills and interests:
researchers involved in xenotransplantation, representatives of transplant patients,
journalists, bioethicits, students on Bioethics, scientists. Half of them declared to have a
professional or personal link (”Strong” or “Medium”) with the issue of xenotransplantation.
The same percentage stated to possess a high or very high level of information on
xenotransplants. Nobody considered to be a lay person on the topic.
16 — National Evaluation Report Neo Socratic Dialogue: Spain
The possible solution to organ donor shortage was the most supported positive argument for
the use of xenotransplants. The improvement in the quality of life of patients needing a
transplant was the second in the positive scale of values. The last and less appreciated
argument was the one pointing out to the obligation of health professionals to cure the
patients, independently of the risks that could involve the general public.
The participants expressed disagreement with the negative arguments on xenotransplants.
The only one receiving some supports refers to the fact that xenotransplants may reduce the
number of human donors.
It can be said that, a great majority of the Spanish participants in both NSD exercises hold
positions in support of xenotransplantation. Only one declared as undecided and no one was
against the medical technology.
The summing up of the main differences between the two groups is as follows. As shown in
Table 1, the members of NSD2 reveal a tighter relationship with xenotransplantation than in
group NSD1. The predominance of juridical educated in this first group with limited
knowledge counteracts the presence of two highly qualified technical experts in this group,
whereas the average technical expertise is higher in the second group even for those
holding a primary education on juridical topics. This same argument must apply to the
explanation of the high level of information on xenotransplantation observed for the NSD2
group (see Table 2).
With regard to the question on general attitudes about xenotransplantation, no marked
differences were observed for both groups. Among the positive attitudes, the questions “XTP
could reduce the bases for organ trade” and “There is no fundamental difference between
the case of animals as nutrition and organ uses” collected more support from the participants
in the first NSD. The reverse is found with the items “There are no less problematic
alternatives within foreseeable future” and “Physicians’ obligation to cure individual patients
is more important than a potential infection risk for the population”, which are counting on
greater support among the participants in the second NSD.
Regarding the negative attitudes, there are some important differences between the two
NSD. Scientifically based items like “The breeding and use of source animals contradicts
criteria of breeding according to species”, “XTP crosses the species border between humans
and animals” and “Genetic engineering of source animals is necessary to use their organs
for humans” received more support from the members of the NSD1 group. On the other
hand, value based items like “It cannot be excluded, that pathogens from the donor animal
are transmitted to the patient and, in the worst case, spread in the population” and “XTP
patients could have psychological problems because of having an animal organ” did get
more support from the second NSD group. In the remaining items there were no significant
differences.
National Evaluation Report Neo Socratic Dialogue: Spain — 17
In broad terms, and taking into account the limits of our analysis, the differences between the
two groups can be amounted for by the contrast between “positivism” (first group) and “moral
valuing” (second group).
3.3 What are their motivations, goals and expectations for the NeoSocratic Dialogue?
3.3.1. Participants motivations
According to the ex-ante questionnaire of the first dialogue, most of the participants attended
the meeting due to two motivations: because of their interest in xenotransplantation as a
result of the biotechnology and because of their interest in the methodology of the Neo
Socratic dialogue. These are the two main answers to the open questions about
expectations.
Some examples of these opinions about expectations are, extracted from the ex-ante
questionnaires:
• NSD1-1: “Es un tema de mi interés y una línea de investigación de mi grupo” (professional interest).
• NSD1-3: “Interés por un tema de biotecnología con fuertes implicaciones éticas y emocionales en el conjunto
de la sociedad actual” (professional and ethical implications).
• NSD1-4: “Aprender a escuchar y adquirir información sobre los avances científicos en el campo de los
xenotrasplantes” (to learn about the topic).
• NSD1-8:”Conocer la actitud de personas procedentes de distintos ámbitos sobre el xenotrasplante, que
constituye mi trabajo cotidiano” (to know other views).
• NSD2-2: “La preocupación por la materia, así como la posibilidad de intercambiar conocimientos y aportar
ideas en la discusión” (interest for the topic and for exchanging views).
• NSD2-4: “Conocer el método para la toma de decisiones y obtención de conocimiento” (to know the method).
• NSD2-7: “La posibilidad de participar en la construcción de unas bases éticas en un tema científico, además
de conocer un método totalmente desconocido” (to know the method and building ehtics).
• NSD2-9: “La implicación directa en el tema como alternativa terapéutica de garantía para la mejora de la
calidad de vida de los pacientes afectados. La curiosidad por conocer con más profundidad sus pros y
contras” (to explore the therapeutic alternatives).
3.3.2 Expectations
The Austrian group, as leaders of the Project, has proposed 22 statements to be addressed
to the participants for their assessment using a range from 1 to 5. The statements have been
18 — National Evaluation Report Neo Socratic Dialogue: Spain
grouped into four categories: “Topic of XTP”, “Method of NSD”, “Qualities of the dialogue”,
“Personal rewards from the dialogue” as shown in Table 6.
Table 6: Categories of expectations
Interest in the topic from other participants
New insights into the ethics of XTP
New information about XTP
A clear answer, how to deal with the problem XTP
To reach at a consensus concerning XTP
Topic of XTP
To change my position towards XTP
To learn to know the NSDMethod of the NSD
To get to know a different form of discussion
A clearly structured discussion
An exciting discussion with regards to content
To have a high level conversation
A dialogue equal to all participants
An open atmosphere
Tolerance to my opinion
That other participants listen to me and try to understand
Qualities of the dialogue
That other participants refer to my arguments
To learn to know other people and their standpoint
To develop my communicative skills
To better understand other participants’ position
To convince others with my point of view
Time to think about an ethical problem
Personal rewards from the dialogue
To clarify my own standpoint
The results are shown in Table 7, in a numerical scale from 1 to 5 corresponding to a
qualitative range from “Very much expectation” to “No expectation”. The issue receiving the
most high expectation was “To get to know a different form of discussion”, followed by “An
exciting discussion with regards to the content”, “To better understand other participants’
position”, “A dialogue equal to all participants” and “To learn to know the NSD”.
These five expectations with the highest scores are counterbalanced by other five the least
positive rating such as: “That other participants refer to my arguments”, “To convince others
National Evaluation Report Neo Socratic Dialogue: Spain — 19
with my point of view”, “To change my position towards xenotransplantation”, “That other
participants listen to me and try to understand” and “Time to think about an ethical problem”.
It can be seen that the methodological categories: “Method of the NSD” and “Qualities of the
dialogue” are those receiving the highest appraisal from the participants. The most specific
issue related to the case selected, xenotransplantation, seemed to raise the lowest
expectations among the participants.
Table 7: Expectations about the NSD
Personally I am expecting…
high
expe
ctat
ion
2 3 4
5 =
no
expe
ctat
ion
Mea
n
Std
.D
evia
tion
1. Interest in the topic also from otherparticipants
72/5
84/4
42/2
1,84(2,00/1,73)
0,76(0,76/0,79)
2. An exciting discussion with regards tocontent
125/7
62/4
11/0
1,42(1,50/1,36)
0,61(0,76/0,50)
3. To get to know a different form ofdiscussion
157/8
31/2
10/1
1,26(1,13/1,36)
0,56(0,35/0,67)
4. To learn to know other people and theirstandpoint
94/5
104/6
1,53(1,50/1,55)
0,51(0,53/0,52)
5. A dialogue equal to all participants113/8
74/3
11/0
1,47(1,75/1,27)
0,61(0,71/0,47)
6. An open atmosphere103/7
84/4
11/0
1,53(1,75/1,36)
0,61(0,71/0,50)
7. New insights into the ethics of XTP103/7
75/2
20/2
1,58(1,63/1,55)
0,69(0,52/0,82)
8. To learn to know the NSD114/7
73/4
11/0
1,47(1,63/1,36)
0,61(0,74/0,50)
9. A clearly structured discussion6
1/58
6/24
1/31
1/02,05
(2,25/1,91)1,03
(1,16/0,94)
10. To have a high level conversation4
1/3105/5
41/3
11/0
2,11(2,25/2,00)
0,81(0,89/0,77)
11. To better understand other participants’position
134/9
43/1
21/1
1,42(1,71/1,27)
0,69(0,488/0,65)
12. Time to think about an ethical problem9
4/57
3/42
1/11
0/12,74
(2,63/2,82)0,87
(0,74/0,98)
13. To develop my communicative skills3
1/28
4/44
2/24
1/32,47
(2,38/2,55)1,02
(0,92/1,13)
14. New information about XTP4
2/27
4/32
1/15
1/41
0/12,58
(2,13/2,91)1,26
(0,99/1,38)
15. Tolerance to my opinion2
0/2126/6
52/3
2,16(2,25/2,09)
0,60(0,46/0,70)
16. That other participants refer to myarguments
21/1
62/4
83/5
32/1
3,63(3,75/3,55)
0,90(1,04/0,82)
17. To clarify my own standpoint5
2/38
3/51
0/14
3/11
0/12,37
(2,50/2,27)1,26
(1,31/1,27)
18. That other participants listen to me and tryto understand
11/0
42/2
114/7
20/2
11/0
2,89(2,75/3,00)
0,88(1,16/0,63)
20 — National Evaluation Report Neo Socratic Dialogue: Spain
Personally I am expecting…
1 =
ver
yhi
ghex
pect
atio
n
2 3 4
5 =
no
expe
ctat
ion
Mea
n
Std
.D
e via
tion
to understand 1/0 2/2 4/7 0/2 1/0 (2,75/3,00) (1,16/0,63)
19. To reach at a consensus concerning XTP3
0/36
3/37
5/22
0/21
0/12,58
(2,63/2,55)1,07
(0,52/1,37)
20. To change my position towards XTP4
2/2114/7
32/1
10/1
3,05(3,00/3,09)
0,78(0,76/0,83)
21. A clear answer, how to deal with theproblem XTP
136/7
51/4
11/0
2,37(2,38/2,36)
0,60(0,74/0,50)
22. To convince others with my point of view1
1/02
1/16
2/45
1/45
3/23,58
(3,50/3,64)1,17
(1,51/0,92)
(Source: CSIC-Survey 2003)
The item “A dialogue equal to all participants” received a higher appraisal as an expectation
from the second dialogue group. The members of the second group also gave better
assessment to the item “An open atmosphere”, “A clearly structured discussion” and “To
better understand other participants’ position”. Those differences in the appraisal maybe a
reflection of the group composition and consequently of the fluid dynamics experienced
during the second dialogue as compared to the first one.
On the other hand, the expectation “New information about XTP” received more support from
the members of the first dialogue. This may result from the combination of more professional
attitude shown by this group together with the presence of a higher proportion in it of less
informed people. This could result in a positive outcome about the gain of information and
“knowledge” about the topic.
Two persons who work in the xenotransplantation field attended the first dialogue. They are
considered two of the most relevant researchers in this field in Spain. Their main
expectations were to get more information about the opinion of the audience about
xenotransplantation.
In the second dialogue, the two main motivations registered in the ex-ante questionnaire
were: to get more information about xenotransplantation and the ethical implications; to learn
about the methodology of the Neo Socratic dialogue and its possible applications to other
kinds of decisions in science and technology.
Two representatives of patient associations attended the second dialogue. Their relation with
the issue of allotransplantation and xenotransplantation was very strong, because they both
had received an organ some years ago. One expert in ethical questions of xenotrans-
plantation also attended the meeting. The rest of participants did not have a very strong link
with xenotransplantation.
National Evaluation Report Neo Socratic Dialogue: Spain — 21
4. Process
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, approximately.
Each event lasted 12 hours in total, including lunch, dinner and coffee breaks.
The minimum audience of the two dialogues was eight 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 particularly important in order to get a suitable atmosphere, that may promote a more
fluent dialogue between those attendants2.
4.1. and 4.2. Which issues and lines of arguments were debated duringthe Neo Socratic Dialogue?
The description of the process is based on the report prepared by the facilitator. The
evaluation team includes it in the report as a frame of reference for the dynamics of the
exercise but it is not considered as a part of the evaluation exercise.
In the following description, participants are identified as according to the characterisation
given in section 3.1.
2 Extracted from the Deliverable 5.
22 — National Evaluation Report Neo Socratic Dialogue: Spain
First Dialogue
Theme: Which risks to take?
Question: Which risks should we undertake?
First session
Towards the example
Examples:
• The first example was provided by participant seventh (the second among those
classified in section 3.1 as lay persons). This participant did not answer the
questionnaires: To buy a motorbike (The risk depends on the driver's action as well on
the other drivers- unpredictability)
• Second example was provided by the third participant: To drive the car with the risk to be
heavy with sleep (risk for myself and for other persons). To have or not to have a son
accepting the risk he or she can have cystic fibrosis (risk for the child, for the family)
• Third example was given by participant 6 (the first one among the lay interested people):
To take a risk decision in a dangerous situation lived in the mountain with a group of
friends: to descend with the sky looking from a surer place. (risk for the life, risk in the
sense of uncertainty of alternative)
• The fourth was raised by participant 4: To go to Madrid by bus in bad weather condition
(snow) (risk not to arrive and achieve our own goals)
• The fifth example was given by the second participant: To decide to make a transplant to
a Jehovah-witness (risk for the life of another man, risk for the stability of the clinical-
team). To be in a plane in which there was a problem with the landing gear (risk for his
life).
• The sixth example was proposed by the fifth participant: To take the responsibility to
manage by oneself an unexpected problem with an important client in a firm. (risk to fail
and to compromise the future of the profession)
• The seventh case was proposed by the ninth participant (the fourth among the lay
interested people): To undergo an operation with relevant side effects suspecting to
suffer a grave illness. (risk in the diagnosis, risk in the therapeutic process surgical
treatment)
The participants chose the example of “driving the car” by a great majority, after a long
process of argumentation. The only participant who disagreed about this choice declared
that even if that example wasn't the favourite one, it wouldn't be a problem at all to work with
it.
National Evaluation Report Neo Socratic Dialogue: Spain — 23
Arguments in favour of the example accepted by the group:
• It concerns a collective risk. It could be helpful to transfer the results to XTP problems.
• It is closest to the criteria for a suitable example (easy, comprehensible, diary, it is
possible to put oneself in the shoes of the example's giver)
• In the course of the election of the example a question emerged that was in other
occasion present in the dialogue: What is a risk?
The process of choosing the example
Arguments of some of the participants: personal preferences:
• Participant 7th: “All this examples concern risks in which we have taken a personal
decision, except that of the plane. It would be better to choose an example in which we
have had a decision. Preferences for the example of transplantation. We take a decision
that influences the team, the patient and us. Context nearer to XTP”.
• Example’s giver supported the own example: "To drive the car with the risk to be heavy
with sleep" because of the implication of other persons. This participant supported also
the example of transplantation.
• Participant 9th: supported the example of transplantation for its proximity to problems
related with ethics (personal decision, team decision, patient decision)
• Participant 2nd: chose the example of buying a motorbike because of its proximity to his
own life experience
• Participant 4th: supported the example of transplantation for the possible presence of a
judicial authorization.
• Participant 1st: supported the example because the collective risk in it implied has a
major connection with the XTP (individual benefit versus collective risk) even if in the
case of XTP it isn’t clear if we have a benefit at all.
• Participant 8th: chose the example of driving the car for the collective risk and she
supported also as second preference the example of buying the motorbike.
At the moment the preferences were so distributed:
• Motorbike: 2 votes
• Car: 3 votes
• Transplants: 4 votes
The facilitator suggested before having a vote to take into account the criteria of a suitable
example as well as the arguments exposed by the others. Would you like to change the
24 — National Evaluation Report Neo Socratic Dialogue: Spain
preference taking into account what we have learnt? Here there are some changes or new
preferences.
• Participant 6: It is better the example of the mountain because there is a process of
taking a decision in difficult situation of two alternatives. We don’t know in XTP what kind
of the decision is better. We know only that we cannot remain in that situation.
• Participant 2: There isn’t a perfect example. There are more suitable examples.
• Participant 9: decided to support the example of driving the car and to change her
precedent election.
In a final decision process all expressed their preferences: the results were 8 preferences for
the example of driving the car. Arguments in favour of the example accepted by the group:
• It concerns with a collective risk. It could be helpful to transfer the results to XTP
problems.
• It is as closest as ideal to the criteria for a suitable example (easy, comprehensible,
diary, it is possible to put oneself in the shoes of the example's giver)
National Evaluation Report Neo Socratic Dialogue: Spain — 25
Second session
The example was clarified by example’s giver and by the participants:
Towards the judgment
Should you undertake the risk in that situation? The example’s giver answered not having
asked such a question. The example giver acted more instinctively.
Context:
The participant who proposed the example said: “Since I have had my second son (two years ago), Ihave had problem by sleeping. I couldn't sleep all the time I needed, because of the young child. Twodays before the action I made, I knew I should go to a funeral of a colleague in Zamora (a city 300 kmfar away from my home) with a car that wasn't mine and that has recently been in a garage”.
Situation:
The participant who proposed the example said: “When I started, I was in a hurry because I shouldarrive at 9.00am in Zamora. There were other two persons with me, but they weren't able to drive. I feltemotionally bad, and I was tired. Nevertheless, at the moment of taking the decision, (that I shared withmy friends) I thought to be well, as often we believe in such circumstances. During the travel (that Ihaven't made before) I haven't had the experience of a specific moment in which I realised the risk wastoo high, as for instance, the sensation to fall slept or similar. I had fear about it but I had alsoconfidence in myself. The friends were talking to me during the travel and I didn’t make any stop in it”.
Problem:
To arrive in time for the funeral
Interest:
To k e e p a n e m o t i o n a l r e l a t i o n s h i p w i t h t h e f a m i l yTo accomplish a moral obligation
Risk:
To have an accident because of not having slept well
Benefit:
To keep proximity with the family
The affected by the action:
The driver, two friends of the example’s giver, the other person on the road.
Action:
Driving for 300 Km in bad conditions, not being able to keep all the attention required by driving.Example’s giver said: “I would act in the same way, because I haven’t had problem”.
Alternatives of action:
To l o o k f o r o t h e r p e r s o n a b l e t o d r i v eTo m a k e a r e s t d u r i n g t h e t r a v e lTo inform oneself about the street before to leave
26 — National Evaluation Report Neo Socratic Dialogue: Spain
Judgment
“The risk was to undertake, because there were the possibilities to control it, to come back
(in the sense to have some alternative at disposal)”
In this part some participants expressed dissent on the action taken by the example’s giver:
• Participant 4: It was an imprudent decision,
• Participant 1: The driver wasn’t aware of the risk and acted without having a conscience
of the risk
• Participant 2: The example giver was compelled by a sense of moral obligation
Reformulation of the judgment
Example’s giver said: “The risk was to undertake, because there was a moral obligation”.
In this part of the dialogue, the participants, instead of moving towards different form of
argumentation, worked empathically with the example. They agree that the risk was to
undertake because the example’s giver has had a moral obligation. The reasons to this
attitude were different.
The facilitator suggested some of them:
• Perhaps it has played a role to have suggested to detect the emotions the example
suggested. This has in part delayed a critical attitude as well the possibility to have a
dissent, as in the first part emerged in the group.
• The example’s giver expressed also difficulties: as having felt under pressure, by the
group when they expressed critical approaches.
• Problems of language: what does it mean “should” in Spanish? What does it mean “to
undertake a risk” in Spanish. "Should" was seen or as a necessary, factual condition,
instead of an exigency of an ethical justification, or as the expression of a singular moral
conscience. "Undertake" was interpreted as something in which there was a personal
moral involvement
One of the leaders in the group (the XTP researcher, participant 1) moved towards a
theoretical clarification. The participants worked specifying the factual aspect could justify
this proposition. The judgment was in the following way specified by the participants: “Yes,
the risk was to undertake, because there was a moral obligation”, under the condition of:
• not to have had a negative personal experience in the past (if a person hasn't had a
personal experience in which he/she had lived this peculiar risk or an analogous one,
he/she usually acts as if he/she would be able to face this situation)
National Evaluation Report Neo Socratic Dialogue: Spain — 27
• it didn’t' happen anything
• the risk was measurable
During the phase of discussion of the judgment and in the process of the justification was
presented some general themes did arise:
• The role that in the perception of a risk plays to have had a precedent experience.
• The role that can play the fact to being conscious or not of the risk and the factors that
influence this consciousness.
• The way of evaluating a risk, what kind of criteria do we have to evaluate a risk, to
graduate a risk, to quantify it? Are those criteria only individual, social, cultural and
relative?.
• The general question: what is a risk?
Third session
Moving from theoretical consideration to ethical consideration
Intervention of the moderator:
• Clarification of the utilization of the words and of the direction of our general questions in
order not to conduct the dialogue only towards a theoretical and empathic direction.
• Clarification of the differences between different kinds of justification: An action/decision
can be justified from a theoretical point of view (we improve our knowledge of it if we
detect the reasons, the causes and motivations that have played a role in that situation)
• An action/decision can also be justified in the sense that it is ethical correct, if there are
argument that make it ethical acceptable.
• In other words, the question wasn't why the example’s giver had acted in such a way, but
whether the arguments of the example’s giver to justify the decision were also ethically
relevant.
The facilitator provoked the group asking the following questions:
• Is to have a moral obligation an ethical criteria to undertake a risk?
• Is not to have an experience in a risk situation an ethical criteria to justify to undertake a
risk?
• Is the fact that we haven't measured a risk an ethical criteria to justify it?
The participants moved themselves from a dialogue of theoretical consideration to a
dialogue of ethical issues.
28 — National Evaluation Report Neo Socratic Dialogue: Spain
The group worked before in a general way underlying some aspects we have to take into
account to answer to our general question: which risk should we undertake?
Here there are the results of this part in which the participants marked the following
observations
• Participant 7: “We have to correlate risk and benefit. There should be a proportion between means
(risk) and ends (benefit). We shouldn't also forget that in doing so there is the problem of
evaluating a risk, as something that can be subjective, individual”.
This brought us to the general question: What kind of criteria do we use to evaluate a risk? Do we have
only individual social and cultural criteria to evaluate a risk?
• Participants 2 and 5: We have to clarify that relationship in the sense of a relationship between the
probability that something happens (statistical criteria) with that of its seriousness
• Participant 7: (not forgetting that) “the evaluation of the risk is a process”
• Participant 5: (to this last point) “we have to evaluate the risk in a short, medium and large time”
• Participant 7: “Another condition is that risks should affect the minor number of possible persons
involved, and that implies the smaller possible danger”.
• Participant 6: “We should control the risk, have the possibility to come back”
• Participant 1 commenting to participant 6: “If we could control a risk we will not have a risk. We
have to distinguish between the task we have to try to foresee, the risk with the impossibility to
have already a control of them that will avoid the same dimension of risk”.
The facilitator invited the participants to see those criteria in relation also to the example.
The XTP researcher, participant 1 above in Table 1, dissenting on the judgment of the
example’s giver answered in a different way to the question: “We shouldn't undertake those
risks, in which, even if the number of persons involved is limited, the risk is potentially very
dangerous”.
This was for the XTP researcher the answer to the general question in relation to the
example we had chosen.
Discussion of the group
Three participants, all of them interested in several issues of biotechnology (participants 7, 4
and 9), thought that the moral obligation plays a role, but that we have to add the criteria of
the relationship between risk and benefit. One of them thought also that not only a moral
obligation implies the assumption of risk. There are also labour responsibilities which can
imply the assumption of risks. This participant seemed to come back to the factual question:
National Evaluation Report Neo Socratic Dialogue: Spain — 29
if you decide to work in a certain way, you have to be consequent with that or with the
compromise you have made.
After a digression, this participant recognized that the answer we have made in the second
section have a theoretical relevance, but not an ethical one. We come back to the answer of
the XTP researcher, participant 1, and the group expressed, even if not in the form of
complete phrase some additions to that criteria, following the observations listed above.
Improving the judgment, the XTP researcher said: “We shouldn't 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”.
Another observation of the XTP researcher, participant 1, wouldn't be discussed by the
participants: taking into account the problem of evaluation suggested by that participant that
each one has its own ethics.
This led to the question: How to evaluate a risk when there are different perspectives in
play?
Fourth session
Coming back to XTP
Relevance of the dialogue to XTP (the most relevant argument of the participants):
• Participant 6: “We have considered different relevant aspects for XTP”
• Participant 2: “To find a consensus with persons who have different knowledge and
values”
• Participant 7: “The table 1 and the criteria as a point of departure”
General consideration of XTP
• Participant 2: “We should take into account the factor risk in the dimension of fear”.
• Participant 6: “We should take into account that there are also other risks (patient risk)”.
• Participant 2: “In the case XTP will function the benefit for the society will be great”.
• Participant 1: “We should also take into account the animal rights and the fact that some
allotransplants are possible thanks to organs from healthy persons”.
Difficulties in the dialogue
30 — National Evaluation Report Neo Socratic Dialogue: Spain
• Participant 5: “I don't see clearly the connection between the example and the criteria we
have reached”.
• Participant 1: “We have had difficulties when we have clarified the different meaning of
being able to and to have to”.
• Participant 3 and example’s giver: “In the case of our example we cannot apply the
criteria that we have found because we know the risk, in XTP we don't know the risk”.
• Participant 8: “The judgment isn't an answer to the question because we have worked in
another direction”.
Other open questions
• Participant 2: “Who estimates the risk?”
• Participant 7: “The theme of subjectivity in the process of evaluation of a risk as central”.
Second Dialogue
Theme: Which risks to take?
Question: Which risks are we allowed to undertake?
First session
Towards the example
Examples:
• Participant 8 gave the first example: To drive by car to Cadiz, after having suffered few
months ago an accident in which some friends have had serious consequences (risk
having an accident, fear about it)
• Participant 1: To choose to utilise private transport instead of public one after having had
a dialysis session and being tired (desire to arrive in a shorter time, risk to drive in a bad
condition, balance risk and benefit)
• Participant 3: To exercise the legal profession in which I was working or to accept a grant
for the investigation at the University (risk and incertitude, balance between risk and
benefit) a change in my life (choosing among different profession)
• Participant 4: To undertake the risk to undergo an amniocentesis during the pregnancy
(risk for the baby, mother (emotional))
• Participant 5: During a research with adenovirus a person involved, a technician refused
to participate in the experiment, because of the risk involved in using his technical
instrument. To decide to follow or not this research -decision of research's chief (to
undertake the risk involved in the trial, different interests in the participants)-
National Evaluation Report Neo Socratic Dialogue: Spain — 31
• Participant 9: To continue with a job or to go abroad to make new experiences (risk to
loose security, benefit to make new experiences). Choosing among a profession and a
way of life.
• Participant 2: To submit oneself to a transplant of heart and kidney (risk to die)
• Participant 7: To come back from EU to Spain after having received a proposal of job
• Participant 10: To accept a research grant to work on HIV in a possible dangerous
context (a laboratory that wasn't conformed with the actual norm of risk, because of the
lack of funds) (risk for the health, risk by not having the grant)
• Participant 11: To go to Madrid to make a master or to remain in the place in which I lived
to prepare a working project with good possibilities, possible new patent (risk in the
uncertainty)
• Participant 6: To drive by motorbike. To undertake a personal risk that can be also
provoked by other persons and that can affect others persons (relatives, other drivers,
etc.)
Choosing the example
The participants chose the example number 9, raised by participant number 10, research
grant to work on HIV, with great majority (nine person chose this example as the first
preferences, two others chose it as a possible interesting example, no one expressed refusal
to work with such an example), after a long lasting process of argumentation in which the
participants, taking into account the arguments of the others, changed their own opinion.
Arguments in favour of the example accepted by the group:
• It concerns with a collective risk and has also a personal relevance. There is an analogy
between the problem of infectious disease in HIV patient and a possible epidemics
caused by XTP.
• With regard to the example of amniocentesis which reached some preferences, it was
argued that the example of the research grant does not present the involvement of other
ethical discussion as, for instance, the problem of abortion, which might disturb the
course of the dialogue.
• With this example it is possible to assess at a certain degree the probability of the risk; it
isn't only a question of a way of living. The example’s giver could evaluate the risk to
contract HIV.
The process of choosing the example
• Participant 3: initially chose participant 5’s example and asked for the risk in that
situation. The answer of participant 5 was: "There isn't scientific evidence that
adenovirus can provoke a serious illness. Nevertheless the laboratory didn't respect the
32 — National Evaluation Report Neo Socratic Dialogue: Spain
minimal conditions required by the law to control the risk". (Conflict between legal
prescription and scientific interests)
• Participant 8: supported the example of participant 3 because the decision implies a
change of life; the decision implies a good argumentation; it is a decision that affects
other subjects and that we can understand without difficulty; it has also a relationship to
the XTP, from the point of view of the patient.
• Participant 3: After having listened to participant 8, participant 3 changed his opinion.
The best example is that of participant 10. It refers to a risk that is analogue to that of
XTP, HIV infections and collective risk, and it concerns also a vital decision.
• Participant 5: The examples that are too personal or vital are not adequate. You cannot
evaluate the consequences and the results of your decisions. Was it better or not to work
in a sector or in another one? How could we answer to this question? You cannot
evaluate the benefit. The adequate examples are those of participant 2, participant 4 and
participant 10 because it is possible to quantify the risk and evaluate the benefit.
• Participant 4: agreed with participant 5, but added the example of participant 1 and
expressed doubt on the example of participant 2. It is too individual and personal. It
doesn't seem to look to a collective risk.
• Participant 10: preferred the example of participant 4 for the risk for the child and for the
family.
During this discussion some questions were raised:
• Participant 9 stated that there are different perspectives in XTP, for instance that of the
patient, that of the researcher. The choosing of an example varies taking into account
the preferences of the participants. Which are our criteria?
The facilitator suggested that the criteria depend on the participants and not on the facilitator.
Nevertheless an example that has only consequences for an individual could bring the group
to an analysis not so interesting for XTP. In any case the decision should be a decision of the
group.
• Participant 7: “What does it mean "vital"?”. This participant had problem for
understanding the arguments of the participant 5. "Vital" can mean something personal,
that affects a way of living, as well as something related to question of life and death.
The argument of participant 5 may be concerned with the first sense of vital.
There was also a brief clarification of the possible consequences of the example of
participant 2 for a collective risk.
Provisional preferences results:
National Evaluation Report Neo Socratic Dialogue: Spain — 33
• Participant 5, 1 vote
• Participant 7, 1 vote
• Participant 4, 2 votes
• Participant 10, 3 votes
• Participant 3, 1 vote
• Participant 1, 1 vote
After having listened to the arguments of the others, there was a final round for choosing the
example.
The example of participant 10, research grant for work on HIV, was chosen:
Arguments in favour of this example, accepted by the group:
• It concerns with a collective risk and has also a personal relevance. There is an analogy
of the problem of infectious disease in HIV patients and a possible epidemic with XTP.
• Considering the example of participant 4 who has reached some preferences, the
example of participant 10 avoids the risk to involve other ethical discussion as, for
instance, the problem of abortion, which might disturb the course of the dialogue.
• It is possible to measure at a certain degree the probability of the risk; it isn't only a
question of a way of living since it should be possible to evaluate the risk to contract HIV.
34 — National Evaluation Report Neo Socratic Dialogue: Spain
Second session
The example clarified by the participants and by the example’s giver.
Context
The possibility to accept a grant of research to work in the field of HIV.
Situation
Example’s giver said: “I could choose among different possibilities. I was working and I was reflectingon what to do; to begin a master, to research in the cytogenetics field, or making other things. Toaccept this grant seemed to me the best option. Nevertheless the place in where I have to work wasn'ta sure place. It was a restructured patient’s room in which the conditions of security to perform theresearch were lacking. (I knew the way of transmitting HIV and the norm of security required). I haven'tthe possibility to change these facts, even if I had spoken with the responsible of the research. I talkedwith the other researchers as well as with my partner and family. The first one, to know the situation ofrisk, the second one to share (in the sense of counseling and supporting) my personal decisionprocess. My partner left me the responsibility of the decision.
Problem
What is the best option?
Risk
High risk (probability) of having an accident in the laboratory. Infection of HIV that could affect me andother persons (I was working with infected blood). Not to achieve a professional satisfaction, and abetter economic situation. Other illnesses that are possible to transmit with blood that I didn't know.Risk connected to a possible denounce to the authority.
Benefit
To obtain this grant. To improve the own economic and professional situation.
Social benefit
To work in the field of HIV is perceived by society as good and worthy.Motivation (This point was mentioned by the group but not deepened under the suggestion of thefacilitator)Maybe it was a question of professional and private satisfaction, joined to the economic advantage ofthe grant.
People affected by the action
The partner, the family and friends. Other persons: patients, persons who lived in contact withexample’s giver, persons with whom the example’s giver was working.
Action
To accept the grant trying to negotiate some conditions of security. Failing in this effort the participant(example giver) did accept the risk.
Alternatives of action
To accept the grant and then to deny to work in such a condition. To negotiate with the team betterconditions for working. To denounce to the authority the lack of security norm. To speak with otherpersons, looking for other responsibilities.
National Evaluation Report Neo Socratic Dialogue: Spain — 35
Towards the judgment
Were you allowed to undertake the risk in that situation?
Judgment that wasn't reformulated because the example giver agreed on it.
Example’s giver said: “Yes, because I considered myself able to reduce the risks, assuming
additional preventive measures (regarding blood, wound, gush)”.
Arguments of the participants
In a round session, the participants, accepting that the answer was an affirmative one,
formulated different arguments. The facilitator noted their judgments on a personal paper
taking into account that not everyone was able to express in a synthetic form the
argumentation. The following answers are a summary of the argumentation.
“Yes, it was allowed to undertake the risk, because…
• Participant 5: “Even if there could be damage to others, taking into account the previous
knowledge and the expected benefit, the damage seems to be under control as well as
minimized”.
• Participant 4: “Taking into account risk and benefit, as well as the measures adopted to
reduce them, there was a low probability that other persons were affected”.
• Participant 1: “The fact that I was myself undertaking a risk, together joined with the
attention that I have to pay in my work, made it unlikely that the other were damaged”.
• Participant 11: “The own risk as well as the risk to affect other persons was lower then
the benefit (professional benefit)”.
• Participant 7: “There was an autonomous decision and no conflict of values”.
• Participant 8: “The example giver was acting according to own values” (Participant 8
would have defend to take more into account the emotional component).
• Participant 6: “The choice was accompanied by increasing the measure of security and
accepting the risk implied in the own research”.
• Participant 9: “The probability of damage was low; there were additional measures of
security; the other professionals were working in the same conditions; the possible
damage to other persons was under control; there was more a personal risk than a
collective one”.
• Participant 2: “Benefit was greater than risks. Infections were under control”.
• Participant 10: “There was a previous knowledge of the risk and an assumption of
additional cautions.”
• Participant 3: “Benefit was major than risk”.
36 — National Evaluation Report Neo Socratic Dialogue: Spain
Third session
From the arguments of the example to an answer to our general question
The facilitator collected those arguments under the shape of a general theme, because in
the precedent phase it wasn't possible to describe them in an explicit form, taking into
account the difficulties of some participants to express clearly and synthetically in a phrase
his/her argument and the time at disposal. Here there is the table at which the participants
have had the possibility to make additions:
Factors (expressed by the participants in their different argumentation) that have to take into account toestimate if it is allowed or not to undertake a risk as:
• Knowledge of risk
• Influence of the context (the way of working in a specific field)
• Autonomy of decision
• Control of the damage
• Others persons affected by the actions
• Relation between benefit and risk (quality of risk, quantity of risk, uncertainty)
• Values are not in conflict
• Emotional interest
• To be involved in the research
The facilitator suggested to take into account those criteria that have been reached from our
example, in order to answer our general question (not forgetting the sense of being allowed
to). Here the participants worked with concrete and simple phrase, trying to improve what
they were writing and opening new questions.
Which risks are we allowed to undertake? (or Which risks are them allowed to undertake?). We areallowed to undertake those risks in which… (It is allowed to undertake those risks, in which…)
• Participant 4: “The own benefits as well as that for others prevail over the damages to be feared”.
• Participant 5: “Existing knowledge of the risk, the relationship between risk and benefit is clearlyfavourable towards the benefit”.
• Participant 4: “In the first phrase there is the dimension of uncertainty, in the second the questionof the knowledge. In the second phrase it is implicit that I don't act if I don't know the risk. In thefirst one there is the dimension of uncertainty. It is more open”.
• Participant 3: “The second phrase is too strict. We should take into account the dimension ofuncertainty”.
• Participant 5: answered to the objection clarifying that the knowledge is always reasonable. Newformulation: “Existing a reasonable knowledge of the risk, the relationship between risk and benefitis clearly favourable to the benefit”.
• Participant 4: suggested that we could put in the second phrase the dimension of the others thatwas present in the first phrase.
• Participant 1: suggested the rephrase in the following form: “Existing a reasonable knowledge ofthe risk, the relationship between risk and benefit, is clearly favourable to the own benefit or to thatfor others”.
• Participant 10: He specified in the following way: “Existing a reasonable knowledge of the risk, therelationship between risk and benefit is clearly favourable to the own benefit as well as that forothers”.
National Evaluation Report Neo Socratic Dialogue: Spain — 37
relationship between risk and benefit is clearly favourable to the own benefit as well as that forothers”.
• Participant 4: stated that we had to clarify the meaning of "to be feared" (phrase 1): “It issomething that we don't know, we suspect that something can happen but we haven't a scientificbase”. If participant 5 meant with "reasonable knowledge" the same, there had no problem toaccept the revised version. Moreover, this participant suggested to write instead of "own" and "forothers", “individual” and “collective” by saying: “Existing a reasonable knowledge of the risk, therelationship between risk and benefit, is clearly favourable to the individual and collective benefit”.
• Participant 5: “To be feared is something we fear about. A term more subjective than reasonableknowledge”.
The group agreed with the last formulation of participant 4 that summarized that of
participant 5 and the others participants. The group moved to the question of "when is
knowledge reasonable".
Towards a theme connected with the answer of our criteria
When is knowledge reasonable?
This topic was addressed to clarify the meaning of reasonable, looking at the example and not
forgetting the direction of our question:
• Participant 1: “We have sufficient information or data to take the necessary cautions to avoid the
risk (the knowledge of example’s giver of the reason of the HIV infection)”.
• Participant 11: “With this answer we are working at the second question proposed in the dialogue:
not that risk we are allowed to undertake, but those risks we should avoid”.
• Participant 5 addressing to participant 11: “We are answering to our question, but in a positive
way”.
• Participant 11: “The arguments we are using are suitable for both questions. The criteria we have
mentioned is valid for both questions, if we correct the relationship risk benefit in the sense of
avoid a risk”.
Coming back to the question of reasonability
• Participant 2: “We have sufficient data with which we can control the possible damages”.
• Participant 5: “I think that instead of "control" we should say "predict" the possible damages”.
• Participant 4: “The hypothesis should be predictable in the sense that it is scientifically
defensible (in the case of the example, the kind of knowledge we have on the way of transmission
of HIV)”.
• Participant 9: “We should add also what is unpredictable”.
• Participant 5: “We move always in a certain context of uncertainty”.
Different aspects of the uncertainty: Uncertainty as something we cannot foresee (an accident);
uncertainty as probable in a scientific investigation.
• Participant 6: “Nevertheless we need some criteria to evaluate the risk and the degree of
uncertainty we can accept. These criteria are scientific but also social”.
38 — National Evaluation Report Neo Socratic Dialogue: Spain
uncertainty we can accept. These criteria are scientific but also social”.
• Participant 11: “The criteria are more individual”.
We open the further question: What criteria do we have to evaluate a risk? How and who evaluate a
risk?
• Participant 5: “A reasonable knowledge can be understood in three sense
a) If A then B (empirical investigation)
b) If A then B (There is a theory that, even if we haven’t had an empirical evidence of
the relation "if A then B" justify its possibilities)
c) B happens in an unpredictable way
A knowledge is reasonable only if a) or b)”.
• Participant 7: “When we evaluate a risk we have also to imply a certain confidence in our
evaluation: the problem of subjectivity”.
At the end of the dialogue participant 8 suggested not to use reasonable knowledge, but to use the
information we have at disposal at the moment. We haven't time to come back to the phrase, but it
seems that it is valid, under the condition that we have to clarify further the aspect of reasonability.
End of the dialogue and final results
“Which risks are allowed to undertake? 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”.
New questions to search for answering our general questions:
• Who is able and how is possible to evaluate a reasonable knowledge?
• What role the confidence does play in this process?
• How evaluate and who does evaluate a risk?
Dimension of risk:
• Uncertainty: Uncertainty of first type: something unattended can happen: unforeseeable
• Probability: The probability that something happens. Uncertainty second type. Probability
and reasonable risk (reasonable knowledge of a risk, reasonableness in undertaking a
risk). The problem of evaluation of the reasonable in the theoretic as well as in the
practical dimension.
National Evaluation Report Neo Socratic Dialogue: Spain — 39
• Seriousness: The seriousness of the event (the problem of an evaluation-subjective and
objective criteria, the dimension of fear).
Fourth Session
Moving to XTP
Proposal made by participant 4:”The answer to the question who does evaluate and how
evaluate the risk in XTP is different if we take into account the different risks. For instance in
the risk of death for a patient it should be the patient who does evaluate whether to confront
or not the risk; in the case of a pandemic risk it should be a committee of experts to do such
an evaluation, in the case of the allocation of resources it should be necessary to involve the
society in a process more and more democratic (…)”.
Who should evaluate a risk?
• Participant 1: “It should be the patient (risk of life)”.
• Participant 2: “The patient is not the only actor that evaluates the risk, we don't know the
reaction of the transplant and the physiology”.
• Participant 8: “It should be the patient to evaluate the risk, with all the uncertainty we
have”.
• Participant 2: “It is necessary to inform the family”.
• Participant 3: “If we have avoided the risk of a pandemic, it is a question of the patient.
But if this is not the case, we have also to say something. The question is how to do it”.
• Participant 1: “I agree with participant 3. The experts decide if there is or not a risk and
not only for an epidemic”.
• Participant 3: “There are two different way of uncertainty: foreseeable and not
foreseeable”.
Who does evaluate the risk the technicians are undertaking?
• Facilitator: “The expert can say if there are or not a risk, but in order to have this
knowledge of risks are we already assuming a risk? What do you think about it?”
• Participant 10: “Who does evaluate the risk which has to undertake the experts?”
• Participant 4: “Not only the researchers who work in a specific research program,
because they are directly involved. We have to imply more actors in the decisional
process (other experts, ethics, politics, and law experts, etc.)”.
• Participant 1: “The experts shouldn't have any interest in the theme (other experts)”.
40 — National Evaluation Report Neo Socratic Dialogue: Spain
This last consideration moved the group to a dissent. It was not clear if this last criteria (not
to have any interest in the research) was acceptable.
4.2.1 Transfer from the dialogue to the XTP issue
The main ideas of the last part of both dialogues, called as “transfer to XTP”, are
summarized in this section. All the quotations, cited in the original language, belong to this
last part.
4.2.1.1 NSD1
The example chosen by the participants in the first dialogue was well considered by the
audience because being a high-risk activity: to drive in the state of somnolence, which is a
very dangerous activity.
There exists a risk not only for the person who drives the car, but also to the rest of the
passengers and other people who are driving on the same road. In case of an accident, not
only the driver might get hurt, but also other people in the car and other drivers who are
using the same road at that moment.
In this example, the decision is taken by one person, the driver, but the possible harm affects
other people. It is a situation similar to xenotransplantation. The decision maker is the
patient, but in case of infections, the damage could affect his or her relatives and other close
persons. These persons might get harmed but they did not participate in the decision.
The participants discussed about the way how to evaluate the probability of a risk, its
seriousness and the possibility of controlling alternative outcomes of the decision taken.
One of the main problems that must be faced is to know the probability of the risk. This is, to
quantify the probability of an outcome from a concrete action. If this probability is known, the
decision maker has more information and this is an extra help in order to take a right
decision. The following quotations show a discussion among the participants when they deal
with the unknown probability of the risks in xenotransplants. The researcher on XTP says
that, nowadays, there are not enough evidences to prove the risk of infection.
Yo creo en relación con los xenotrasplantes, antes lo comentábamos en el descanso, es que no se puede
aplicar tanto el ejemplo, porque en el ejemplo sí que se conocen los riesgos que puedes asumir, y en el caso de
xenotrasplantes es más difícil tomar una decisión porque tampoco conoces los riesgos.
Hay riesgos que se conocen...
En el caso del coche sí, sabes que hay un riesgo, porque (ININTELIGIBLE) un accidente de tráfico, y en el caso
de los xenotrasplantes tampoco se conocen los riesgos, lo que puede ocurrir realmente.
¿Estáis de acuerdo con esto?
National Evaluation Report Neo Socratic Dialogue: Spain — 41
¿Que no se conocen los riesgos?
Que en el accidente... que en el caso del ejemplo que hemos planteado, el riesgo está bien conocido y en el
caso del xenotrasplante el riesgo no está conocido... no se sabe de ninguna forma lo que podía hacer, es algo
totalmente desconocido.
¿En el caso del xenotrasplante está preguntado?
Sí, es una pregunta.
Si analizamos... si nos guiamos de la evidencia, al día de hoy no tenemos ningún riesgo, es decir, se está
hablando de la evidencia, cuando digo la evidencia es lo que se ha estudiado, es decir, los modelos que aquí... yo
creo que el matiz estaría en... me parecía muy importante cuando se intentaba... digamos, ya se han intentado, se
está intentando reproducir en el laboratorio todas aquellas potenciales circunstancias que pueden realmente
producirse si algún día llegamos a trasplantar órganos de animales, y en este caso, de cerdos que es el animal con
el que estamos trabajando estos días, y a día de hoy, no tenemos ninguna evidencia de que exista ningún riesgo.
Another relevant factor is to know the seriousness of a risk. If this seriousness is well known,
the decision maker has more information about the consequences.
It is important also to have information about the different results which can appear after
taking risks. In the case of xenotransplantation, the results of the fact are not well known yet.
The uncertainty is very high. This argument emerges in the following discussion among the
participants.
El riesgo, es que... vamos a ver, una cosa es que yo creo que el riesgo en este caso... aquí ya entramos en
matices en un ambiente más médico, en este caso el riesgo, cuando ya hablamos de un riesgo, aquí sí que
matizamos lo que decíamos antes, yo por eso también mis propuestas las he llevado en ese camino, porque el
gran debate que ha existido... es decir, una cosa que de siempre se ha considerado aceptable, cualquier
intervención conlleva un riesgo, Carmen nos explicaba un ejemplo yo creo muy claro de una situación personal de
ella, pero claro, hubo un riesgo individual que es la persona la que tiene que decidir en su momento y en función de
sus circunstancias si lo acepta o no, el problema potencial del xenotrasplante es que existía un riesgo... o se ha
considerado, teóricamente siempre porque no existe ninguna evidencia, que es lo que decía, de que pudiese ser
así, pero desde un punto de vista teórico y un poco como lo que he dicho también anteriormente, siguiendo el
modelo de lo que ha pasado con el SIDA, de que una infección procedente de un cerdo pudiese infectar a través de
un paciente y a partir de ahí extenderse a todo el resto de la población, ese ha sido el gran riesgo desde el punto
de vista de preocupación y yo creo que lo que ha parado y lo que paró el ensayo clínico en humanos fue por este
riesgo potencial, pues bien, a raíz de los últimos cuatro años, este riesgo potencial de transmisión de infecciones
del cerdo a los receptores, se ha investigado en diversos modelos a animales y al día de hoy no existe ninguna
evidencia de que esta transmisión de infecciones exista, por lo cual el riesgo éste, el riesgo del que estamos
hablando de lo que es la transmisión a día de hoy, este riesgo en concreto no existe, lo cual no quiere decir que
pase, estamos en lo de siempre, es decir...
Hasta el momento.
...hasta que tengamos la experiencia, los modelos, lo que se ha hecho ahora, tenemos que decir que este riesgo
no existe, lo que pasa que nadie... el riesgo cero tampoco va a existir nunca, ni tampoco nadie va a poder nunca
decir que no existe ningún riesgo.
(…)
Para mí es mucho más difícil cuantificar un riesgo cuando, por ejemplo, no se tiene una estadística de casos que
han ocurrido, porque hemos hablado antes de que te puedes basar en la experiencia para tomar una decisión o
42 — National Evaluation Report Neo Socratic Dialogue: Spain
incluso para valorar un riesgo posible, hemos hablado de estadísticas, en el caso de los xenotrasplantes como es
una situación nueva es difícil contar con esa información previa para tomar una decisión.
To sum up, there are three factors which must be taken into account: the probability of the
risk, the seriousness of the risk and the control of the different results.
Benefits and risks of a concrete action must be balanced in order to take a better decision.
All the participants reached a consensus on this idea.
But the difficulty appears when people try to value a risk. This value is often subjective,
because it depends on their personal point of view. Some participants pointed out that the
own experiences can help in the process. If a similar situation has appeared in the past, it is
easier to value the risk in order to take a decision. In the following quotations one participant
suggests that the process of valuing a risk depends on the personal situation of the patient
who needs a transplant, among other factors.
El diálogo como método me parece muy interesante pero la visión de cada persona del riesgo, no sólo en la
valoración externa sino la valoración individual, ya se ha comentado varias veces, es completamente diferente de
unas personas a otras, y eso está demostrado en las encuestas de población, las contestaciones dependen
exactamente de la relación que tengas con la enfermedad, una persona sana como tiene el problema lejano
contesta una cosa, una persona que tiene un familiar enfermo contesta otra cosa, la persona que está enferma
contesta otra cosa, la persona que está en cuidados intensivos en una situación muy grave, esperando por el
trasplante cardiaco, contesta otra cosa completamente diferente, o sea, va a ser imposible...
Estamos en un marco, pero el marco del paciente.
Sí, pero el riesgo o la valoración de un riesgo, el riesgo que cada uno es capaz de asumir y lo que le importaría
que la sociedad asuma es completamente diferente en tanto en cuanto la enfermedad le afecte a él o a alguien
relacionado, esto va a ser difícil de evaluar. Por eso me parece que el diálogo de este tipo, conducido entre
personas con diferentes capacidades de implicación o de información es fundamental, es un buen instrumento.
One extra difficulty is the task of calculating the benefit of an action. If the decision maker
does not know the value of risk and benefit, it is very difficult to balance them. In this case,
there is no enough information to decide. The following quotations reflect a discussion about
the task of calculating the benefit of xenotransplants, individual benefit versus collective risk.
Yo lo que pienso fundamentalmente es el tema de la subjetividad que hemos dicho desde un principio, a la hora
de medir el riesgo, como comentabas antes, no es lo mismo el riesgo que ve el paciente que el riesgo que puede
ver el resto de la sociedad, o la familia o el resto de la sociedad, lo primero porque los beneficios para unos son
claros, para otros son relativos y para los otros no les afectan en absoluto, entonces, es lo que hablábamos del
balance riesgo-beneficio, en el ejemplo nuestro estaba muy claro el riesgo, la probabilidad podía ser mas o menos
alta pero el riesgo estaba claro.
¿El riesgo para nosotros?
Y el beneficio, estaba muy claro, podíamos estar más o menos de acuerdo con el beneficio, pero para todos era
el mismo beneficio y para todos era el mismo riesgo. En el caso de los xenotrasplantes, yo veo que el problema
puede ser que entre el desconocimiento y luego aparte la distinta posición en un determinado momento, ni los
beneficios sean comunes ni los riesgos sean comunes, lo cual hace todavía más complicado el problema.
National Evaluation Report Neo Socratic Dialogue: Spain — 43
Time is another factor that was pointed out by the participants. Sometimes, risk in a concrete
decision is not considered in long term. The decision maker only considers the
consequences in short term. But it may be that these consequences turn out to have bad
results or unwanted damages in the long term. It may also be that the decision maker does
not take into account a different scenario which may appear in the future.
The possibility of going backwards if an unwanted damage does occur must be taken into
account. The decision maker must consider the possibility to go back to the starting point of
the decision process if the decision has had unwanted consequences. If the consequences
of the decision were irrevocable, the situation would be considered of high risk.
An approach or judgement based on grounds of ethics and morality can be considered as
very unstable when people have to decide in a risky environment. Ethics or morality is a
highly variable concept among a group of persons, so it is possible to find several
justifications depending on who is making the decision. One action or decision may be
justified for one person, but it may be a mistake for another. So consensus was not reached
in the group about the significance of the ethical or moral approach to decide in a risky
environment.
4.2.1.2 NSD2
During the second dialogue, the example cited in 4.1 was considered adequate by the
participants because of its similarity to the xenotransplantation case.
There is only one decision maker, the person who accepts the job in the laboratory even
though the working conditions are precarious. In the transplant case, there also is only one
decision maker, the patient. Only him or her has to decide if they want to receive an organ of
animal origin. In the following quotations some participants discuss about those persons who
take part in the decision of accepting a grant in a laboratory without enough security
measures. This situation was the chosen example in the NSD2.
-Por ejemplo, la cuestión... los resultados no son sólo las cosas que hemos escrito, los criterios, las normas, que
sería ese juicio, sino también las preguntas, el quién y cómo evalúa los riesgos, ¿tiene sentido esa pregunta?, ¿es
una pregunta que matiza?, en la cuestión de los riesgos de los xenotrasplantes ¿está claro quién y cómo se
evalúan los riesgos? En nuestro caso tampoco estaba... sin miedo, se pueden decir también cosas equivocadas.
Yo creo que en el caso concreto sí que había un alguien y un cómo se evaluó la razonabilidad, ese fui yo, y de la
forma que lo hice en ese momento, o sea, que en el caso concreto sí que hubo un quién y un cómo...
Hay un cómo y no lo habéis apuntado en el curso de discusión, en el cómo, no es que estabas tú sólo, estaba tu
familia, tu pareja y los otros que trabajaban, es decir, que no era... habías incluido en tu proceso de toma
decisional, de una u otra forma, otros actores, porque eso es lo que has dicho tú...
Sí... pero el que los evalúa soy yo, o sea, ellos aportan más datos, más información a la hora de evaluar esta
razonabilidad, ellos aportan más información, información de cómo a ellos les afecta, cómo a ellos les podría
afectar, cómo... pero al final, el que lo evalúa es uno, el que toma la decisión.
44 — National Evaluation Report Neo Socratic Dialogue: Spain
Es decir... es curioso como después de haber hablado y no hemos tocado ese tema del proceso decisional, que
era otro tema que se podía tocar, por ejemplo, por lo que está escrito allí, uno podría también entender que los
otros sí, es decir, los otros que trabajan contigo, te han dado más datos, también tu familia, en el caso de la pareja
uno podría también pensar “bueno, yo te he expuesto la situación, hemos hablado, hemos considerado y he
pensado teniendo en cuenta esto...”, es decir, un proceso decisional en que va a tener un papel importante también
otras personas. Uno también lo puede pensar así.
Sí.
¿Cómo lo ves tú?
En el proceso sí van influyendo determinadas... otras personas con un grado mayor o menor de influencia, pero
excepto quizás la pareja, en el caso concreto sí que no fue ningún consenso, no fue una evaluación común, pero
que podría haberse dado el caso de que fuese una evaluación común, es la única restricción a quién y cómo, pero
al final el “cómo” sí que incluye a todos estos... a estas consultas, a estas nuevas informaciones y nuevas
opiniones, pero el “quién” no las incluye. Yo creo que en el “cómo” sí que las puede incluir, ¿cómo? consultando,
valorando las distintas opciones y opiniones, pero al final el “quién” sí que es... fui yo en ese caso.
The benefit from the job is also personal because the salary, the accumulated experience as
well as the professional recognition are advantages or benefits for the decision maker. In the
xenotransplant case, the benefit is personal, too, because it is the patient who benefits.
The risk of infection with HIV in the lab can have several effects. If it is only the decision
maker who gets infected, the disadvantages from the decision affect only this one person.
But if the decision maker infects other people, then the disadvantages are on a social level.
The affected parts can be the people with whom the decision makers maintain a close
relationship, like family, friends or partner. As we know, HIV is mostly transmitted through
interchange of blood, semen or vaginal fluids. During NSD2, one participant explained the
differences between the known risks of researching on HIV and the unknown risks in
xenotransplants.
-Cuando se habla de los riesgos en los xenotrasplantes casi la cabeza se va al riesgo de la epidemia, de la
pandemia, un riesgo para lo colectividad, para los demás, no sólo para un beneficio individual.
(…)
-Es que justo era sobre ese punto. Yo lo que pienso es que aquí hay dos posibilidades, si en un momento dado
tenemos una cierta garantía, o una garantía científicamente importante de que no se va a transmitir pandemias, yo
también estoy en que el criterio básico es el del paciente, puede someterse a un riesgo elevadísimo si con eso
espera salvar su vida, es decir, ya luego el requisito... siempre que se le informe de que el riesgo es mínimo, que
se dan las condiciones... pero si estamos en una situación como la actual, donde no hay evidencia científica de que
no haya transmisión de pandemias al resto de la población, “¡oiga, que yo me pongo en riesgo!”, también tendré
que consentir de alguna forma, no puede consentir sólo el paciente, aquí yo creo que en la medida en que el riesgo
es global, yo... igual no yo personalmente, pero representado por alguien también tendré alguna palabra, porque si
se genera un nuevo SIDA, que ya está constatado científicamente que es de transmisión de animal a humano, vía
el xenotrasplante, que al fin y al cabo ¿qué es?, pues una ruptura de la barrera interespecies, pues una pandemia
de esas características pone en riesgo a todo el mundo, no sólo al paciente en primera persona, luego... yo no sé
cómo habrá que hacerlo, si a través de cuerpos, como decía Blanca, organismos específicos, etc., pero mientras
haya un riesgo... habrá que ver la magnitud del riesgo, por eso antes discutíamos tanto el nivel de incertidumbre,
porque claro, ahí está la “madre del cordero” aquí, en cuál es la magnitud de incertidumbre a partir de la cual
National Evaluation Report Neo Socratic Dialogue: Spain — 45
consideramos que el riesgo es razonable asumirlo o no, y por eso... pero quiero decir que mientras haya un riesgo
científicamente contrastado como es ahora, pues ahora en laboratorio se ha contrastado que cabría la posibilidad
de que retrovirus porcinos pasasen a humanos, entonces mientras exista esa evidencia, tendremos que consentir
todos ya, otra cosa es que lleguemos a un punto en el que se elimine esa incertidumbre, y que las investigaciones
demuestren que es una incertidumbre infundada y entonces el rol para mí es el del paciente.
If the transplantation of a pig organ causes infections or transmission of disease from the
animal to humans, then the problem can be individual or collective. If the infection turns
epidemic, the disadvantage can affect all of society, and not only the patient and its
immediate surroundings. Therefore, the situation of the selected example and the one of
xenotransplants is similar.
There is an important difference between the two, which is the knowledge about the existing
risk. In the case of HIV, we know the ways of transmission of the virus as well as the
seriousness of the consequences. Also, there are some treatments available for AIDS
patients. This means that in spite of the risk, the problems are well known and we have a
therapy available to transform AIDS into a chronic disease, at least in the industrialised
countries.
However, we do not know the possible consequences from the transmission of pig viruses.
We do not know about the diseases which this might cause nor would we have a specific
treatment available. This means, that in the case of xenotransplantation neither do we know
the probability of possible problems nor their seriousness. This makes the case of
xenotransplants more uncertain. These ideas are reflected in the following quotations.
Una pregunta para Asier, cuando hablaba de la incertidumbre, estamos hablando de incertidumbre como la... he
apuntado aquí, imprevisibilidad de las consecuencias, ¿nos estamos refiriendo a eso?, que aceptamos esa
incertidumbre como... vamos, lo he definido así, no sé, como asumir esos riesgos, como asumir esas supuestas
imprevisibilidades de las consecuencias posibles o margen de lo posible, ¿es a eso a lo que te referías como
incertidumbre?
Aquí cuando hablo de incertidumbre, precisamente es que aquí estamos ante algo incierto, incluso en la
posibilidad de que se materialice, es decir, es incierto incluso que se pueda generar una pandemia, aquí ya no es
incierto a nivel de probabilidad, hay un 10, un 20 ó un 30, sino es que puede que sea incierto incluso el objeto al
que nos referimos, en el ejemplo que poníamos con José, era incierto que contrajese el SIDA, puede tener un 2%,
pero una magnitud graduable, era un nivel de “incerteza” que podíamos graduar, pero es que aquí es incierto
incluso a qué nos... ¿es real o es irreal?, a eso me refiero aquí con incierto, a nivel de la pandemia, y es lo que me
parece que es lo que científicamente hay que despejar antes de pasar al paciente y luego ya, luego yo soy
partidario de que la voz la tiene que tener el paciente, pero claro, despejando eso también eliminamos un nivel de
incertidumbre para el paciente, porque si le estás ofreciendo una terapéutica que él puede pensar que es válida y
que es puro “cobayismo”.
The judgements and arguments in the second dialogue were up to a point similar to the ones
expressed by the participants in the first dialogue. However, the participants were more apt
in expressing their personal opinions.
46 — National Evaluation Report Neo Socratic Dialogue: Spain
A new concept which was introduced was the level of reasonability of the risk. Some of the
participants tried to explain the concept of “reasonable risk", but their intents of defining the
term lead to communication problems within the group.
According to the opinion of the participants who proposed the term, we can consider a risk to
be “reasonable” whenever
• there is sufficient information available to avoid the risk
• there is sufficient information to control possible disadvantages or damages
In the second dialogue, one participant propounded the idea of one type of risks which would
be commonly accepted by a social group. These risks are relatively frequent and society has
defined ways of collective behaviour, common to all individuals, in order to deal with them.
Some examples of those risks appear in activities like driving a car, working in the
construction sector, etc. This participant called them as “institutionalised risks”.
The risk, taken from the example, of working (here: doing research) under conditions of
relative lack of safety is a common one in our society, according to several of the
participants. This is a risk which turns up frequently, which is why society, in the end, came to
accept it as part of the process of looking for and deciding to accept an employment (here: in
the research sector).
4.3 Which coalitions as well as conflicts of interests did exist ordevelop?
Two participants in the first dialogue had wide knowledge about xenotransplantation because
they had published some documents and carried out several research projects. These two
participants had more information on assessing the risk in xenotransplantation.
Despite this wider knowledge in the central issue, their participation in the dialogue was
similar to the rest of the audience. On the other hand, it can be said that they were more
cautious than the rest of the participants, may be because of their previous research
experience.
In the second Neo Socratic dialogue, there were two participants who held similar ideas and
arguments about xenotransplantation. They were the two representatives of the patient
associations. Both had received an organ some years ago, so their link with transplantation
was very strong.
These two persons did not have a wide knowledge about the technical aspects of transplants
of animal organs, but they supported the arguments in favour of increasing the research on
National Evaluation Report Neo Socratic Dialogue: Spain — 47
xenotransplantation. They considered that this biomedical development offered the greatest
life expectancies for patients on the waiting lists.
Almost all the participants had the same knowledge about xenotransplantation in the second
dialogue. This fact may have been preventing any kind of coalition between the participants.
4.4 Which problems did arise?
There are no many actors involved in the xenotransplantation issue in Spain. Moreover, this
topic has not raised a great debate and interest among our citizenship as it has been already
stated in the Baseline Evaluation phase and in previous sections. It has not been easy to
attract the well trained and knowledgeable people on xenotransplantation for several
reasons. One of the main problems was the disponibility of time, as several invited persons
had to cancel their participation in the last minutes by agenda problems. On the other hand,
the attendants and active participants expressed views that more time would have been
necessary for extending the dialogue in order to reach more fruitful results. We found that
there is a paradoxical situation with respect to time availability criteria.
Thus, a problem reflected in the interviews and questionnaires was the lack of time and the
task of choosing the example, activity which takes up too much time, as some participants
explained. Each NSD was allocated six hours time for development, though only the last one
was devoted to the transfer phase. According to the opinions collected from the ex-post
questionnaires and the telephone interviews, the participants requested more time for this
last phase in order to enable the drawing of conclusions related to the specific case of
xenotransplantation. Many have also suggested the organizer to propose the examples in
order to short time in the initial phase. This argument probably runs against the same nature
of the NSD. Those raising this argument thought that it should favour the election of an
adequate example in order to make easy the correct development of the NSD. These ideas
were reflected in the telephone interviews, as can be seen in these quotations:
• NSD1, participant 1, xtp researcher: “¿Lo más negativo? Pues bueno, yo creo que lo más negativo tal vez
pienso que lo que habría que intentar o habría que buscar... a ver, aspecto negativo es que habría que trabajar
mucho más, la única cosa que no me gustó, porque continúo pensando que lo más difícil para mí es la
elección del ejemplo que vayas a discutir, es decir, yo creo que ese ejemplo no tiene seguramente... o no hay
que... los que trabajáis en este campo tenéis a lo mejor discutir... habría que intentar no dejarlo como una cosa
abierta que propongan las personas que estén allí, lo cual... o sea, si tú tienes que elegir entre lo que pueda
ser de allí, claro siempre tienes que asumes el riesgo que tienes que acabar eligiendo sobre temas que no son
muy... puedes acabar discutiendo sobre aspectos que igual no son... no sé hasta qué punto son muy reales, y
a lo mejor... lo que yo creo que a lo mejor los que trabajáis, los que organizáis el diálogo, pues tendríais que
proponer una... a ver, no digo que lo elijáis vosotros, pero sí trabajarlo mucho antes, es decir, traer un trabajo,
buscar qué ejemplos pueden ser los más indicados, y hacer una lista... lo cual no quiere decir que lo elijáis ni
mucho menos vosotros, pero hacer una presentación y entonces que el resto de gente sea la que lo elija”
48 — National Evaluation Report Neo Socratic Dialogue: Spain
Summary: most difficult problem is to work more (in the dialogue) and in particular in relation to the
election of the example.
• NSD2, participant 3, interested in bioethics: “Hombre yo creo que a nivel de diálogo la clave para que
realmente el diálogo sea útil es que el ejemplo, o el problema sobre el que se está discutiendo, en este caso
nosotros hablábamos de la experiencia de un compañero, sea realmente adecuada, es decir, sea la idónea, y
yo creo que realmente ahí en “dar el clavo” como quien dice, es lo fundamental. Si no, yo creo que te pierdes
en disquisiciones, en cuestiones paralelas, que pueden que no tengan nada que ver con el problema”
Summary: it is essential a good election of the example, otherwise there are risks of loosing the point,
of discussing unrelated things.
Another problem was the different dynamics operating during the performance of the two
dialogues. The NSD1 was much less fluent than the NSD2 as repeatedly outline along this
report. We are inclined to propose that these differences result from the composition of the
two groups as detailed under section 3.1. We have termed the first group as “positivist”,
while the second group was integrated by people more advised and interested on ethical
aspects. These second group participants would feel easier to comment around the ethical
dimension introduced in the dialogue. The facilitator also had an easier task in driving them
to express ideas following a nice track for the flow of ideas and arguments, would them be
shared or not by the others. This lack of fluency has been reflected in comments from the
telephone interviews:
• NSD1, participant 6, student of biotechnology: “Y ¿lo más negativo? Como negativo yo creo que igual sí que
hubo o pudo haber personas que no hablaron todo lo que debieran, porque igual no sabían muy bien lo que
tenían que decir o cómo tenía que conducirse el... claro, es que yo lo que no veía muy claro es si había un
guión o no había un guión, si había que decir lo que uno pensaba o si había que enfocarlo...”
Summary: the most negative was the absence of fluency. Difficulties to detect the existence of a
(hidden) script.
Another criticism arising from the questionnaires and interviews concerned the difficulty to
transfer the outcomes of the dialogue to the xenotransplantation issue, what has been
referred as “transfer phase”. The possibility to extrapolate the conclusions from the dialogues
to the issue of xenotransplants was not easily attained, the result from the NSD2 being
slightly more satisfactory. Some participants pointed out to this problem in the interviews:
• NSD1, participant 5, participant interested in biotechnology: “A mí el método me parece muy bueno y creo que
es una forma de sacar muchas cosas de la gente de forma no directa, sino un poco indirecta, y que la gente
se expresa abiertamente, eso de alguna forma induce al resto de los participantes a que hablen en muchas
ocasiones, de que relacionen unas ideas con otras..., pero yo por parte del moderador, igual estoy confundida
y eso no tiene que ser así, pero por parte del moderador iría como sacando conclusiones de vez en cuando,
iría como reorientando un poco lo que es el mecanismo, no los contenidos, ni modificar las conclusiones de la
gente ni nada, pero sí un poco ordenando, porque a mí me pareció eso, como un poco desordenado”
National Evaluation Report Neo Socratic Dialogue: Spain — 49
Summary: the method seems good to open heart and minds of people but there is a great distance
between the example and the topic. Intermediary steps may help.
• NSD1, participant 3, health jounalist: “¿Lo más negativo?... porque... que yo creo que no se llega a ninguna
conclusión”
Summary: the most negative?, because, I believe there was no possible to reach a conclusion.
4.5 Was the process managed efficiently?
The first dialogue was led by the facilitator and moderator Mr. Paolo Dordoni with
unquestionable success, despite of initial difficulties. The dialogue between the participants
did not start off smoothly. Some persons were reluctant to show their own points of view at
the beginning of the session.
There is one question related to the work of the moderator in the ex-post questionnaire. This
question aims to unfold the opinions of the participants about the moderation of the Neo
Socratic dialogue. The answers of both dialogues are shown in Tables 8 and 9.
Table 8: Assessment of the facilitator’s interventions
The facilitator …
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t
agre
e
I don
’t ag
ree
Mea
n
Std
. Dev
i atio
n
1. Integrated all positions well13
(4/9)6
(4/2)1,32
(1,50/1,18)0,48
(0,53/0,40)
2. Included all participants in the dialogue12
(2/10)7
(6/1)1,37
(1,75/1,09)0,50
(0,46/0,30)
3. Reacted appropriately on conflicts8
(3/5)9
(4/5)2
(1/1)1,68
(1,75/1,64)0,67
(0,71/0,67)
4. Promoted a good atmosphere12
(3/9)7
(5/2)1,37
(1,63/1,18)0,50
(0,52/0,40)
5. Summarized the contents well12
(5/7)7
(3/4)1,37
(1,38/1,36)0,50
(0,52/0,50)
6. Kept an overview12
(3/9)7
(5/2)1,37
(1,63/1,18)0,50
(0,52/0,40)
7. Focused the discussion on the issue11
(2/9)8
(6/2)1,42
(1,75/1,18)0,51
(0,46/0,40)
8. Focused the discussion on the essentialissues
6(2/4)
11(4/7)
2(2/0)
1,79(2,00/1,64)
0,63(0,76/0,50)
9. Determined the course of discussion tostrongly
1(0/1)
2(1/1)
15(6/9)
1(1/0)
2,84(3,00/2,73)
0,60(0,53/0,65)
(Source: CSIC-Survey 2003)
The participants in both NSD highly praised the capacity of the facilitator in integrating all
positions and visions. By a separate analysis of the ratings, it can be seen that the most
50 — National Evaluation Report Neo Socratic Dialogue: Spain
appreciated quality by the first group was “Summarized the contents well” while “Included all
participants in the dialogue” was the one highly valued by the participants in the second
NSD. In any case, ratings were always quite high, with values between 1 and 2
corresponding to “I agree very much” and “I rather agree”, what is a very strong indication of
the high level of appraisal reached by the participants on the qualities of the facilitator
intervention.
To reinforce the argument of the relevance of the different composition and attitudes
between the two NSD groups, it is worth to note the higher appraisal reached by items 2, 4,
6 and 7 in the second group. These items relate quite significantly to the dynamics of the
dialogue evaluation and the atmosphere surrounding it. As has been continuously stated,
NSD1 was largely less fluent and developed through a less friendly atmosphere. This may
be reason why items like “Included all participants in the dialogue”, “Promoted a good
atmosphere” as well as “Kept an overview” and “Focused the discussion on the issue” have
been less valued by the participants of the first dialogue. These results offer, in our opinion,
support for arguing on the validity of the analysis based on a qualitative, quasi-ethnologic,
approach.
Table 9: Assessment of the facilitator’s characteristics
The facilitator was...
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t
agre
e
I don
’t ag
ree
Mea
n
Std
. Dev
iatio
n
Overall I was satisfied with the moderation11
(2/9)8
(6/2)1,42
(1,75/1,18)0,51
(0,46/0,40)
1. Well prepared14
(5/9)5
(3/2)1,26
(1,38/1,18)0,45
(0,52/0,40)
2. Patient12
(7/5)7
(1/6)1,37
(1,13/1,55)0,50
(0,35/0,52)
3. Fair11
(4/7)8
(4/4)1,42
(1,50/1,36)0,51
(0,53/0,50)
4. Interested13
(5/8)6
(3/3)1,32
(1,38/1,27)0,48
(0,52/0,47)
5. Competent in respect to content11
(4/7)8
(4/4)1,42
(1,50/1,36)0,51
(0,53/0,50)
6. Congenial15
(6/9)4
(2/2)1,21
(1,25/1,18)0,42
(0,46/0,40)
7. Neutral10
(4/6)9
(4/5)1,47
(1,50/1,45)0,51
(0,53/0,52)
8. Confident12
(6/6)7
(2/5)1,37
(1,25/1,45)0,50
(0,46/0,52)
9. Dominant2
(0/2)11
(4/7)6
(4/2)3,21
(3,50/3,00)0,63
(0,53/0,63)
(Source: CSIC-Survey 2003)
National Evaluation Report Neo Socratic Dialogue: Spain — 51
With respect to the opinion on the personal characteristics of the facilitator, the participants
valued more positively “Congenial” followed by “Well prepared”. The scores varied between
1,21 and 1,47.
Both groups shared a high positive opinion on the characteristics of the facilitator (see Table
9) where the mean scores for the positive aspects ranged between 1,21 and 1,27, while the
negative character was commonly receiving a rejection. It must be stressed that in this
evaluation of the personal characteristics of the facilitator, items linked to the human values
and behaviour of the facilitator like “Patient”, “Confident” and “Dominant” (this one as
assessed by the level of rejection) received better appraisals from the participants of the first
dialogue. This may reflect the appreciation of the “more difficult” participants for the capacity
of the facilitator to pass over the difficulties posed by themselves and drive the exercise to an
end. Nevertheless, the most positive declaration emerged from participants in dialogue 2.
Some examples are:
• NSD2, participant 5: “Como positivo, sin duda, el papel del moderador que lo hizo de una manera creo que
brillante y cauta al mismo tiempo, y respetuosa en general, me pareció el conductor del debate”
Summary: “As positive, without any doubt, the role of the moderator who performed the work both
brilliantly and carefully, being also able to respect the divergences. He was a real driver of the debate”.
• NSD2, participant 8: “Pues, una solidaridad entre todos los participantes, y quizás el ambiente que surgió
durante... que fue como... no sé, muy distendido y amigable entre todos. Y la moderación muy bien llevada”
Summary: “important points: solidarity, friendly and smooth ambiance. A very well done work by the
facilitator”.
The most frequent comment in the open questions about the moderation of the dialogue
dealt with the capability of the moderator to integrate all the participants' opinions. On the
other hand, some participants expressed criticism about the slowness during the
development of the dialogue. Some persons thought that the dialogue was too slow in some
parts.
• NSD1, expost questionnaire: “Ha sido un poco lento en determinados momentos. El ritmo podía haber sido
más dinámico”
• Summary: “too slow in some moments. The rythm should have been more dynamic”.
• NSD1, expost questionnaire: “Ha habido un momento en el que se produjo un atasco en el discurso, se
reiteraba sobre el mismo punto y no se avanzaba”
• Summary: “There have been moments of dialogue blockage, points become components of a
reiterative dialogue and there were no advances”.
52 — National Evaluation Report Neo Socratic Dialogue: Spain
The second dialogue was more fluent than the first one. All participants had the same level
of knowledge about xenotransplantation, so they did not feel uncomfortable while expressing
their opinions.
In the open question about moderation, the most positive comment was about the ability of
the moderator to integrate the different thoughts of the participants and to drive the dialogue
to a common point. The audience valued positively the opportunity to express their own
points of view, despite the wide diversity of the group. These opinions from the
questionnaires support such arguments:
• NSD2, expost questionnaire: “Haber llegado a un consenso tan rápido, con personas de diferentes
profesiones”
Summary: “To have reached a fast consensus with so many different professions”.
• NSD2, expost questionnaire: “Integración de todos los miembros del diálogo y marcar las conclusiones”
Summary: “Integration of all members of the dialogue and ability to draw conclusions”.
• NSD2, expost questionnaire: “Facilita, de forma estructurada, la puesta en común de varias opiniones, y partir
de una experiencia personal, llegar a conclusiones sobre un tema tan candente”
Summary: “It makes easy, in a structured way the share of common opinions, and to start from a
personal experiences to arrive to conclusions on such a hot topic”.
On the other hand, lack of time was one the negative points in the development of the
second Neo Socratic dialogue. This lack of time limited the opportunity to discuss some
issues in depth. The participants also asked for higher personal implication of the moderator
in the issue of xenotransplantation. This implication could have facilitated, in their opinion,
the comprehension of some concepts exposed in the dialogue as participants said. The lack
of time is reflected in some quotations from the questionnaires:
• NSD2, expost questionnaire: “Creo que la duración del evento debería ser mayor para poder dialogar sobre
cuestiones que han surgido y no se han podido tocar”
Summary: “I believe that the event should last longer in order to make possible the dialogue on issues
raised which could not be discussed”.
• NSD2, expost questionnaire: “Cuando llegábamos a un tema particularmente interesante, como había que
abarcar tanto es tan poco tiempo, había que pasar el tema por encima”
Summary: “When reaching particularly relevant topic, owing to the many issues to deal with in quite
short time, it was not possible to touch on it in depth”.
National Evaluation Report Neo Socratic Dialogue: Spain — 53
5. Output
5.1 Which results did the Neo Socratic Dialogue have?
As an additional outcome of the satisfaction attained by the participants in the NSD, they
were asked about their thought on the possible relevance of the dialogue results for their
personal or professional career and activity. The results are shown in Table 10.
Table 10: Assessment of the usefulness of the results of the NSD
Ver
y us
eful
Rat
her
usef
ul
Rat
her
not
usef
ul
Not
use
ful
Mis
sing
dat
a
Mea
n
Std
. Dev
i atio
n
If you think about theresults, the NSDparticularly had concerningXTP - To what extent doyou think are these resultsuseful for your professionalor voluntary work?
3(0/3)
14(7/7)
2(1/1)
0(0/0)
0(0/0)
1,95(2,13/1,82)
0,52(0,35/0,60)
(Source: CSIC-Survey 2003)
About the 90% of the sum of participants in the two dialogues stated that the results were
seemingly “Very useful” and “Rather useful”, living rise to a mean of 1,95.
The participants attending the second NSD appeared as being more satisfied (mean 1,82), a
figure closer to the option “Very useful”. The attendants to the first NSD expressed opinions
which averaged 2,13. It is also worth of noting that the assessment of the participants in the
first dialogue emerged as more homogeneous as judged from its lower typical deviation.
The first dialogue finished with two judgements about decisions in a risk environment. The
judgements, approximately, were:
• "A risk must not be assumed, although it only affects a reduced number of people, if its
consequences are very serious".
• "The ethical acceptability of a risk will depend on its probability and the seriousness of
the consequences that the decision implies".
These are the main conclusions, almost unanimously adopted by the participants.
The second dialogue ended by agreeing on two judgements in relation to the decision
making process in environments and situations under risk. The judgements were the
following:
54 — National Evaluation Report Neo Socratic Dialogue: Spain
• "We can assume those risks whose benefits, for ourselves and for third parties
dominate, are greater than any possible disadvantages or damages"
• "We can assume those risks in which the benefits are clearly surpassing the possible
risks and there is a reasonable level of knowledge about the relationships between risk
and benefit".
Both judgements were the result of the opinions and contributions of all participants, though
the latter of the two was the most appreciated.
5.2 Was consensus reached? If not, why not?
Some of the participants subscribed to one of the two phrases given in 5.1., some of them to
the other. It was not possible to reach complete consensus. In addition, each participant
expressed slightly different views.
The most problematic issue for reaching consensus was ethics. Some of the participants
were reluctant to include ethics as one of the decisive factors for decision making under risk.
Ethics depends to a very high degree on each individual, which is why some participants did
not think it was a good idea to include it in the two judgements given in 5.1.
The following quotations of NSD1 show comments on the subjectivity associated to the
process of taking decisions on issues where there are emerging risks for individuals:
“Un poco vuelvo al tema de la subjetividad y la dificultad. Quiero decir que cuando realmente se intenta o, sobre
todo yo intento pensar, quizás estoy muy mediatizado porque lógicamente hasta ahora... llevo participando, llevo ya
muchos años participando en reuniones discutiendo estos temas a diversos niveles, y un poco la primera
conclusión a la que todo el mundo llega es que los riesgos individuales es una decisión de la libertad de la persona,
es decir, todo lo que sea propio, hay que garantizar que esa persona tenga toda la información sobre, lo que
decíamos información disponible sobre cuáles son sus potenciales riesgos, qué le puede pasar, qué beneficios va a
tocar, etc., y ahí la persona tiene un derecho, finalmente es la que va a tener que decidir si acepta o no acepta,
suponiendo que la información y lo que se le informe a él, y además está muy claro que no tiene que ser... que es
una información que tienen que dar no las personas que vayan a realizar el xenotrasplante, porque es una
información subjetiva, y todos los que somos médicos sabemos que por mucha información, tú puedes llegar a
influir claramente en la decisión que tome un paciente en función de cómo le plantees un problema, o sea, quiero
decir que tiene que ser dada incluso por personas ajenas, tienen que participar claramente personas ajenas a lo
que es el campo éste, para que la opinión y la decisión del paciente sea lo más libre posible y, por descontado, que
en el último momento el paciente tiene derecho a renunciar siempre de participar en una situación de este tipo”
Summary: Subjectivity and difficulty are the main topics. Individual risks are decisions based on the
freedom of the individual. The patient’s decision must be influenced by advices provided by persons
external to the issue”.
In the second dialogue, the issue of taking decision was also touched upon, an issue which
depends on the individual values and may vary from one person to another one:
National Evaluation Report Neo Socratic Dialogue: Spain — 55
-Sí... pero el que los evalúa soy yo, o sea, ellos aportan más datos, más información a la hora de evaluar esta
razonabilidad, ellos aportan más información, información de cómo a ellos les afecta, cómo a ellos les podría
afectar, cómo... pero al final, el que lo evalúa es uno, el que toma la decisión.
- Es decir... es curioso como después de haber hablado y no hemos tocado ese tema del proceso decisional, que
era otro tema que se podía tocar, por ejemplo, por lo que está escrito allí, uno podría también entender que los
otros sí, es decir, los otros que trabajan contigo, te han dado más datos, también tu familia, en el caso de la pareja
uno podría también pensar “bueno, yo te he expuesto la situación, hemos hablado, hemos considerado y he
pensado teniendo en cuenta esto...”, es decir, un proceso decisional en que va a tener un papel importante también
otras personas. Uno también, lo puede pensar así.
(…)
-Yo insisto que los criterios que tienen a su alcance los ponen en conocimiento de la persona al ser trasplantada, y
de la familia directa, eso de “tú sí ó tú no”, yo creo que está bien claro, si no lo haces te mueres y si lo haces
también te puedes morir...
-Pero siempre es la persona quien lo decide.
Summary: Data are given by others but the final decision rests on the person directly involved.
In the second dialogue, all of the participants gave support to both of the phrases given
above, even though some of them showed certain differences of opinion.
The most problematic issue here was “reasonable risk”. Some participants were doubtful
about when a risk could be qualified as reasonable, given that this is a very subjective
concept and depends entirely on each individual.
5.3. Was it possible to mark dissent?
There were no marked dissensions in both dialogues with a few exceptions related to small
nuances introduced by the participants to the final judgements. To enter into more details
about the shades see sections 4.1 and 4.2.
5.4. Was it possible to formulate policy options?
Some of the participants of the first Neo Socratic dialogue had difficulties in applying the
judgements to the xenotransplantation case, when it came to defining a line of action with
respect to this technology. The following quotations reflect a part in the NSD1 when a
participant expressed doubts about the possibility to apply judgements to the case of
xenotransplants:
Sí, sí, te comento. Para que se haya llegado al final sí creo que puede tener algo más que ver con el tema de los
xenotrasplantes, yo lo que no veo tanto, quizás es mi percepción y quizá soy yo, es la conexión entre el ejemplo
principal... o sea, hay algún punto que sí, pero hay otra serie de puntos que no los veo que se aproximen a esto,
sinceramente no veo tanto la conexión entre a lo que queríamos llegar y el ejemplo primero ¿sabes?, o sea, el
primer ejemplo es que lo veo como el caso que pusimos práctico, como que las cosas no han quedado tan
56 — National Evaluation Report Neo Socratic Dialogue: Spain
concretas, aquí yo creo que ya se ha concretado algo más, pero ahí, las definiciones o los puntos que se han dado,
o a las conclusiones que se han llegado las veo como más dispersas...
¿Los juicios?
Esa es mi opinión que puede ser completamente equivocada, pero es así como lo percibo. Creo que estamos
respondiendo a la pregunta, desde mi punto de vista, con respuestas tampoco concretas, demasiado... con
connotaciones muy diferentes para cada uno de nosotros, entonces es un poco difícil, desde mi punto de vista,
concretar, porque el significado que yo pueda dar a una palabra o a una frase igual es distinto al que otra persona
pueda tener, entonces a mí me parece un poco complicado llegar a tener unas respuestas tan concretas, ahí ya
veo cosas más concretas, aunque no estén acotadas, aunque no sean... pero sí que ya entran dentro de algo que
sí se puede “tangibilizar” más, que es más tangible.
Es más una consideración en torno a diálogo mismo y a lo que se ha dicho en el diálogo más que a los
xenotrasplantes ¿no?, más bien tu punto de vista...
Sí, es como yo lo percibo pero que puedo estar completamente equivocada, no lo sé, es como yo lo estoy
percibiendo o como a mí me está llegando, que lo veo... no sé, estoy un poco perdida en el sentido de que creo
que las respuestas que se dan son demasiado genéricas para mí personalmente, hasta el final no están
respondiendo demasiado a la pregunta, las del ejemplo.
¿Los juicios?
Sí, los juicios, y después trasladarlos al ejemplo que el caso que estamos viendo que no lo veo tan acorde, o tan
fácilmente trasladable.
(Summary: -From my personal perception, likely due to my limitations, I do not see the link between theexample, in broad terms, and the final outcome.
-Do you mean the judgements?
-This is my point of view. The answer to a main question with fuzzy answers, different meanings andcontexts makes difficult to arrive to concrete a question.
-Your opinion concerns to the dialogue in general and to the specific points of the dialogue instead of thespecific issue of xenotransplantation.
-Yes, this is my personal impression. The answers are too broad for entering into the specific issue.
-Judgements?
-Yes, how to translate judgements to the case we are dealing with).
Let’s analyse the judgements, as they apply to xenotransplants, one by one:
• “A risk must not be assumed, although it only affects a reduced number of people, if its
c o n s e q u e n c e s a r e v e r y s e r i o u s ”
With respect to infections, in the case of xenotransplants, the number of potentially
affected people could be very high, depending on the seriousness of the infection. The
affected parts could be the patient him or herself, but they also could be all of society, in
c a s e o f a n e p i d e m i c .
Up to now, it is still unclear how serious a transmitted infection could be. All of the
experiments done in order to determine the risk of infection have shown the absence of
transmission of illnesses. The medical doctors present in the dialogue reminded the
audience that for some time now implants of cardiac valves taken from pigs have been
used without any problem in terms of infections.
National Evaluation Report Neo Socratic Dialogue: Spain — 57
• “The ethical acceptability of a risk will depend on its probability and the seriousness of
t h e c o n s e q u e n c e s t h a t t h e d e c i s i o n i m p l i e s ”
Here, the probability of infections in the case of xenotransplants is unknown. This means
that the judgement can only be applied to transplants of pig organs.
In the second dialogue, there was more time for transferring the judgements selected by the
participants to the xenotransplant case. In the first dialogue, there was almost no time to do
this, which is why in the second dialogue, more time was given to this question.
• "We can assume those risks whose benefits, for ourselves and for third parties
dominate, are greater than any possible disadvantages or damages"
The benefits from xenotransplants are for the patient who receives an organ, because
this operation might save their life. However, there are no direct benefits for others, like
f r i e n d s , f a m i l y o r t h e r e s t o f s o c i e t y.
Currently, there are no data about the probability of infections, which could lead to the
conclusion that –in principle– there are only benefits. On the other hand, a majority of
researcher is convinced that there is a possibility of infection, or even of infections
t u r n i n g e p i d e m i c a n d a ff e c t i n g a l l o f s o c i e t y.
In that latter case, the possible damage would be higher than any benefit, given that the
benefits are for the treated patient only.
• "We can assume those risks in which the benefits are clearly surpassing the possible
risks and there is a reasonable level of knowledge about the relationship between risk
a n d b e n e f i t " .
This judgement is similar to the preceding one, which means it presents similar
limitations. It is difficult to establish a risk-benefit relationship which could serve as basis
for decision making, given that the exact probabilities of epidemic infections as a result
o f x e n o t r a n s p l a n t s a r e s t i l l u n k n o w n .
The participants were divided on the issue of a decision about proceeding with a
xenotransplant or not. Some believe this is up to the patient, while others said that this
d e c i s i o n m u s t b e t a k e n b y a g r o u p o f e x p e r t s .
Within this group of experts, people not connected to xenotransplantation research
would have to be included, in order to make sure that the opinion of individuals which do
not have any direct interest in xenotransplants counts in the moment of taking a
decision.
58 — National Evaluation Report Neo Socratic Dialogue: Spain
5.5. Which experiences did participants make?
In the ex-post questionnaire, there is one question about the conduct of the participants as a
group and which refers to the common experience during the development of the dialogue.
Table 11 shows the results about the group’s activities.
Table 11: Assessment of the group’s activities
The group
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t
agre
e
I don
’t ag
ree
Mea
n
Std
. Dev
iatio
n
1. Allowed everybody to speak18
(7/11)1
(1/0)1,05
(1,13/1,00)0,23
(0,35/0)
2. Allowed different opinions11
(3/8)8
(5/3)1,42
(1,63/1,27)0,51
(0,52/0,47)
3. Had a good atmosphere18
(7/11)1
(1/0)1,05
(1,13/1,00)0,23
(0,35/0)
4. Cooperated well10
(3/7)8
(5/3)1
(0/1)1,53
(1,63/1,45)0,61
(0,52/0,69)
5. All in all I was satisfied with thegroup
11(3/8)
8(5/3)
1,42(1,63/1,27)
0,51(0,52/0,47)
6. Worked concentrated8
(3/5)10
(4/6)1
(1/0)1,63
(1,75/1,55)0,60
(0,71/0,52)
7. Led a high level conversation4
(0/4)14
(7/7)1
(1/0)1,84
(2,13/1,64)0,50
(0,35/0,50)
8. Worked to the point11
(5/6)8
(3/5)1,42
(1,38/1,45)0,51
(0,52/0,52)
9. Remained the overview9
(3/6)10
(5/5)1,53
(1,63/1,45)0,51
(0,52/0,52)
10. Reached at acceptable results9
(2/7)7
(4/3)3
(2/1)1,68
(2,00/1,45)0,75
(0,76/0,69)
(Source: CSIC-Survey 2003)
Items like “Allowed everybody to speak” and “Had a good atmosphere” were the most valued
activities, while item “Led a high level conversation” received the lowest appreciation. In any
case, all assessments were quite close, ranging between 1 and 2, which correspond to “I
agree very much” and “I rather agree”.
With regard to the global assessment corresponding to statement number 5: “All in all I was
satisfied with the group”, important differences are seen between the two dialogues. In the
first dialogue only 38% of the participants gave the maximum rating, while 73% of the
participants in the second NSD gave this rate. There seems that the members of the second
NSD group reached a higher degree of self satisfaction in conducting the exercise.
In this same context and on the grounds expressed repeatedly on the more favourable
attitude shown by the participants in the second dialogue, items “Allowed different opinions”,
National Evaluation Report Neo Socratic Dialogue: Spain — 59
“All in all I was satisfied with the group” and “Reached at acceptable results” were better
assessed by the participants: a more fluent dialogue and a greater true devoted to the
transfer phase may have been underlying the good appraisal on these items given by the
group of NSD2.
Table 12: Assessment of group characteristics
The group was
I agr
ee v
ery
muc
h
I rat
her
agre
e
I rat
her
don’
t
agre
e
I don
’t ag
ree
Mea
n
Std
. Dev
iatio
n
1. Interested12
(2/10)7
(6/1)1,37
(1,75/1,09)0,50
(0,46/0,30)
2. Open14
(6/8)5
(2/3)1,26
(1,25/1,27)0,45
(0,46/0,47)
3. Fair16
(6/10)3
(2/1)1,16
(1,25/1,09)0,37
(0,46/0,30)
4. Competent10
(4/6)9
(4/5)1,47
(1,50/1,45)0,51
(0,53/0,52)
5. Well composed6
(1/5)10
(6/4)3
(1/2)1,84
(2,00/1,73)0,69
(0,53/0,79)
6. Heterogeneous9
(2/7)9
(5/4)1
(1/0)1,58
(1,88/1,36)0,61
(0,64/0,50)
7. Pushy5
(1/4)12
(6/6)2
(1/1)1,84
(2,00/1,73)0,60
(0,53/0,65)
(Source: CSIC-survey 2003)
Table 12 gathers the opinions of the participants about the personal characteristics of both
groups in the NSD. The most appreciated quality was “Fair” followed by “Open”. The last
positions belonged to “Well composed” and “Pushy”, both with the same numerical value.
There are, nevertheless, significant differences between the two NSD in some
characteristics. Option “Interested” received a mean value of 1,75 in the first NSD and 1,09
in the second. The second group was self-assessed as being more interested in the exercise
performance. Similar results were obtained with respect to options “Well composed”, and
“Heterogeneus”. All these items received better appraisals from the members of the second
NSD group.
We argue again on the differences in the composition of both groups to explain the
evaluation data. With regard to item “Pushy”, it should be indicated that the evaluation on
this item has to be discarded because a poor translation to it in Spanish. It was translated
according to a meaning closer to ambitions (“Demanding”) than to “Agressive”.
60 — National Evaluation Report Neo Socratic Dialogue: Spain
The group thought the conduct of the participants was productive. The most extended
comment in the open questions of the questionnaire was that an open and tolerant
environment was created which allowed respect for all ideas, a situation which is often
impossible to achieve in conventional debates.
In general, the satisfaction with group conduct was higher in the second dialogue than in the
first one. In the open question on group conduct, the issue most mentioned was the
possibility of formulating common judgements agreed on by everyone, in spite of the high
intellectual and professional diversity of the group.
Another important point was the environment of respect and tolerance maintained
throughout the meetings, during which all of the opinions could be heard and included in the
final conclusions.
Summing up, we can observe that the second dialogue worked more fluently than the first
one, especially since the moderator needed to put in less effort in animating the participants
to express their opinions.
The responses to the question on satisfaction with the group in the ex-post questionnaire
and in the telephone interviews give rise to the following items:
• NSD2, expost questionnaire: “He tenido oportunidad de conocer a distintas personas”
“I have had the opportunity to meet a variety of persons”.
• NSD2, expost questionnaire: “Existía gran variedad de opiniones y personas, lo que ha permitido
enriquecernos como personas. Al final se ha llegado a puntos clave entre todos, de forma constructiva”
“There was a great variety of opinions and individuals, what has made us to get more rich as
human beings. To the end, we have achieved a constructive result on some key points with the
involvement of all”.
• NSD2, expost questionnaire: “Ha permitido un excelente ambiente de trabajo y ha dado lugar a la
búsqueda de consenso mediante una actitud abierta y flexible de todos los miembros”
“The dialogue has allowed a very good working ambiance and to the search of a consensus by
means of an open and flexible attitude of all the members”.
• NSD2, expost questionnaire: “Se expresaron las ideas libremente sin que nadie se sintiese atacado
personalmente. La participación ha sido más alta de lo esperado, siendo el número de participantes
idóneo”
“Ideas were expressed with freedom, nobody could feel being attacked personally. Active
participation was higher than expected and the number of participants deemed suitable”.
National Evaluation Report Neo Socratic Dialogue: Spain — 61
5.6. Were their expectations/motives/goals fulfilled?
All of the participants in the dialogue assure that it fulfilled most or all of their expectations,
according to the respective question from the questionnaire.
Data on the question about the general expectations of the NSD is collected in Table 13, see
below. The assessment on this point was pretty satisfactory as about 63% of the participants
scored their expectations as having been “Surpassed” or “Met”, yielding an average of 2,16.
It is important to point out that no one of the participants singled out the option “Rather did
not met” or “Did not met”, an indication of the degree of satisfaction of both dialogue
participants with respect to the results.
As can be seen from Table 13, the members of the second NSD expressed a better
appreciation of the experience (mean 1,82) than those intervening in the first NSD (mean
2,63). The first value runs close to “Met” option, while the mean value of the first NSD
approaches the option “Rather met”. With respect to t he typical deviation there are not
significant differences between the two, though it was slightly higher in the second NSD.
The better outcomes on the expectations of the opinions of NSD2 do seem to fit with all the
previous arguments on the composition characteristics of the groups as shown in section
3.1.
Table 13: Realization of expectations
Sur
pass
ed
Met
Rat
her
met
Rat
her
did
not
mee
t
Did
not
mee
t
Mea
n
Std
. Dev
iatio
n
Altogether the NSDsurpassed, met, rather met,rather did not meet, did notmeet my expectations
4(0/4)
8(3/5)
7(5/2)
0(0/0)
0(0/0)
2,16(2,63/1,82)
0,76(0,52/0,75)
(Source: CSIC-Survey 2003)
5.6.1. How do participants explain their assessment?
In order to get a detailed picture about peoples’ experiences we asked them at the end of the
NSD several questions what they gained from the dialogue, as Table 14 shows. These
questions were related to the items of expectations used in the ex-ante questionnaire.
62 — National Evaluation Report Neo Socratic Dialogue: Spain
Table 14: Assessment of the outcomes of the NSD
The NSD: 1= I
agre
eve
ry 2 3 4
5 =
Ido
n’t
Mea
n
Std
.D
evia
tion
1. Allowed me, to get to know adifferent form of discussion
155/10
43/1
1,21(1,38/1,09)
0,42(0,52/0,30)
2. Allowed a dialogue equal to allparticipants
177/10
21/1
1,11(1,13/1,09)
0,32(0,35/0,30)
3. Provided an open atmosphere12
2/10
76/1
1,37(1,75/1,09)
0,50(0,46/0,30)
4. Conveyed the instrument NSD18
7/11
11/0
1,05(1,13/1,00)
0,23(0,35/0)
5. Showed, that other participantshad also an interest in the topic
83/5
105/5
10/1
1,63(1,63/1,64)
0,60(0,52/0,67)
6. Allowed a high level conversation5
1/4
125/7
22/0
1,84(2,13/1,64)
0,60(0,64/0,50)
7. Contributed to learning to knowother people and their standpoint
167/9
31/2
1,16(1,13/1,18)
0,37(0,35/0,40)
8. Provided a clearly structureddiscussion
71/6
94/5
22/0
11/0
1,84(2,38/1,45)
0,83(0,92/0,52)
9. Provided time to think about anethical problem
94/5
84/4
10/1
10/1
1,68(1,50/1,82)
0,82(0,53/0,98)
10. Allowed that other participantsreferred to my arguments
41/3
84/4
63/3
10/1
2,23(2,25/2,18)
0,85(0,71/0,98)
11. Allowed that other participantslisten to me and try to understand
73/4
104/6
21/1
1,74(1,75/1,73)
0,65(0,71/0,65)
12. Brought an exciting discussion withregards to content
61/5
104/6
22/0
11/0
1,89(2,38/1,55)
0,81(0,92/0,52)
13. Brought about tolerance to myopinion
115/6
62/4
11/0
10/1
1,58(1,50/1,64)
0,84(0,76/0,92)
14. Helped me to better understandother participants’ position
72/5
116/5
10/1
1,68(1,75/1,64)
0,58(0,46/0,67)
15. Helped my to develop mycommunicative skills
72/5
95/4
21/1
10/1
1,84(1,88/1,82)
0,58(0,64/0,98)
16. Allowed me to convince others withmy point of view
52/3
95/4
51/4
3,00(2,88/3,09)
0,75(0,64/0,83)
17. Gave me new insights into theethics of XTP
62/4
52/3
42/2
42/2
2,32(2,50/2,18)
1,16(1,20/1,17)
National Evaluation Report Neo Socratic Dialogue: Spain — 63
The NSD: 1= I
agre
eve
ry 2 3 4
5 =
Ido
n’t
Mea
n
Std
.D
evia
tion
18. Gave a clear answer, how to dealwith the problem XTP
30/3
32/1
84/4
52/3
2,79(3,00/2,64)
1,03(0,76/1,21)
19. Contributed to a clarification of myown standpoint
31/2
52/3
74/3
41/3
2,63(2,63/2,64)
1,01(0,92/1,21)
20. Provided new information aboutXTP
42/2
63/3
21/1
72/5
2,63(2,38/2,82)
1,01(1,19/1,25)
21. Created consensus about XTP2
0/2
105/5
42/2
31/2
2,42(2,50/2,36)
0,90(0,76/1,03)
22. Brought about a change in myposition towards the ethics of XTP
20/2
31/2
63/3
84/4
3,05(3,38/2,82)
1,03(0,74/1,17)
(Source: CSIC-Survey 2003)
According to Table 14, the most valued outcome from the two dialogues was the option
“Conveyed the instrument of NSD”, followed by “Allowed a dialogue equal to all participants”
and “Contributed to learning, to know other people and their standpoint”. The less valued
outcomes were: “Brought about a change in my position towards the ethics of XTP”,
“Allowed me to convince others with my point of view” and “Gave a clear answer, how to deal
with the problem XTP”.
But once more, there exist significant differences between both dialogues when looked
separately. The second group assessed more positively the “Provided an open atmosphere”
outcome. Same situation is observed with respect to the following options: “Allowed a high
level conversation”, “Provided a clearly structured discussion”, “Brought an exciting
discussion with regards to the content” and “Brought about a change in my position towards
the ethics of XTP”. The second dialogue group gave higher values to these categories that
the former NSD group with significant differences between the two. On the other hand, there
were no significant differences in rating in the remaining categories.
In summary, it can be concluded from Table 14 data that the participants in the second NSD
were more satisfied with the outcomes.
Some quotations from the telephone interviews serve to illustrate that several participants
did not attend the dialogue with previous expectations as they had very poor knowledge on
the type of exercise they were going to be involved:
• NSD1, participant 1, xtp researcher: “Bueno, sinceramente no me había hecho ninguna expectativa, pero
como no había participado nunca en lo que era una cosa de este tipo, a los que venimos un poco del
campo de la ciencia o de las cosas mucho más concretas es un tipo de forma de trabajar seguramente
distinta, y bueno la verdad es que no iba con ningún tipo de expectativa, ni con ningún... no le pedí, no
64 — National Evaluation Report Neo Socratic Dialogue: Spain
sé, no esperaba nada en concreto, iba casi más con la idea de aprender y de ver, que no con una idea de
decir... pensaba concurrir o no pensaba hacerlo”
Summary: “I was presuposing a different type of work to the classical research activity. But I did
not have a preconceived position: to learn and see”.
• NSD1, participant 5, interested in biotechnology: “No, no tenía ninguna hecha sobre el diálogo realmente,
porque tampoco tenía ninguna idea preconcebida. No, realmente no fue con ninguna idea... no esperaba
sacar nada... no es como si vas a curso, o vas... sino que iba con la idea de... bueno, voy a participar, si
puedo aportar algo bien, si no pues nada, ¿sabes?, pero no iba con la idea de yo percibir nada a cambio”
Summary: “I did not attend with a previous conception. I was not expecting any thing special
but… to participate without lookinf forward to any particular benefit”.
• NSD2, participant 3, interested in ethical issues of biotechnology: “Yo no iba con ninguna idea
preconcebida y la verdad es que iba expectante, ante lo que realmente lo que podía ser el diálogo, y
eso... discursivo y como método para hallar, me pareció... para plantear soluciones a problemas, no sé si
es eso lo que busca, o para simplemente debatir sobre ello, me pareció interesante”
Summary: “I was not holding any particular expectations but I was eager to follow and intervene
into a method based on dialogue and aiming to find something…”.
• NSD2, participant 5, doctor and interested in developments of biotechnology: “No, me parece que cubrió
bastantes expectativas. Me pareció que era un método para mí en cierto modo nuevo de abordar un
problema, creo que el moderador lo condujo con bastante rigor, que en general el nivel de los
participantes, aunque era un poco heterogéneo, se adaptaba bastante a la temática propuesta, y me
pareció que aportaba una nueva forma de discutir o de repensar los problemas”
Summary: “I found NSD as a new method to approach conflicting issues with a rigourous driving
of the debate and an active and well adapted participation”.
Table 15 gives an overview of the relationships between expectations and experiences.
National Evaluation Report Neo Socratic Dialogue: Spain — 65
Table 15: Comparison of expectations about and experiences with the NSD
Mean of ExpectationsTotal
(NSD1/NSD 2)
Mean of ExperiencesTotal
(NSD1/NSD 2)
Interest in the topic from other participants1,84
(2,00/1,73)1,63
(1,63/1,64)
An exciting discussion with regards tocontent
1,42(1,50/1,36)
1,89(2,38/1,55)
To get to know a different form of discussion1,26
(1,13/1,36)1,21
(1,38/1,09)
To learn to know other people and theirstandpoint
1,53(1,50/1,55)
1,16(1,13/1,18)
A dialogue equal to all participants1,47
(1,75/1,27)1,11
(1,13/1,09)
An open atmosphere1,53
(1,75/1,36)1,37
(1,75/1,09)
To learn to know the NSD1,47
(1,63/1,36)1,05
(1,13/1,00)
New insights into the ethics of XTP1,58
(1,63/1,55)2,32
(2,50/2,18)
A clearly structured discussion2,05
(2,25/1,91)1,84
(2,38/1,55)
To have a high level conversation2,11
(2,25/2,00)1,84
(2,13/1,64)
To better understand other participants’position
1,42(1,71/1,27)
1,68(1,75/1,64)
Time to think about an ethical problem2,74
(2,63/2,82)1,68
(1,50/1,82)
To develop my communicative skills2,47
(2,38/2,55)1,84
(1,88/1,82)
New information about XTP2,58
(2,13/2,91)2,63
(2,38/2,82)
Tolerance to my opinion2,16
(2,25/2,09)1,58
(1,50/1,64)
That other participants refer to myarguments
3,63(3,75/3,55)
2,23(2,25/2,18)
To clarify my own standpoint2,37
(2,50/2,27)2,63
(2,63/2,64)
That other participants listen to me and try tounderstand
2,89(2,75/3,00)
1,74(1,75/1,73)
To reach at a consensus concerning XTP2,58
(2,63/2,55)2,42
(2,50/2,36)
To change my position towards XTP3,05
(3,00/3,09)3,05
(3,38/2,82)
A clear answer, how to deal with the problemXTP
2,37(2,38/2,36)
2,79(3,00/2,64)
To convince others with my point of view3,58
(3,50/3,64)3,00
(2,89/3,09)
(Source CSIC-survey 2003)
66 — National Evaluation Report Neo Socratic Dialogue: Spain
Table 16 shows a cross between expectations as collected in Table 7 and the experiences
obtained as gathered in Table 14. Expectations have been considered as high when the
mean was between 1 and 2, 5. Experiences have been considered as high when the mean
value was between 1 and 2.
Table 16: Relation between expectations about and experiences with NSD
HIGH VALUED EXPERIENCES LOW VALUED EXPERIENCES
HIG
H E
XP
EC
TAT
ION
S
Interest in the topic from otherparticipants
An exciting discussion with regards tocontent
To get to know a different form ofdiscussion
To learn to know other people and theirstandpoint
A dialogue equal to all participants
An open atmosphere
To learn to know the NSD
A clearly structured discussion
To have a high level conversation
To better understand other participants’position
To develop my communicative skills
Tolerance to my opinion
New insights into the ethics of XTP
To clarify my own standpoint
A clear answer, how to deal with the problemof XTP
LO
WE
XP
EC
TAT
ION
S
Time to think about an ethical problem
That other participants listen to me andtry to understand
New information about XTP
That other participants refer to my arguments
To reach at a consensus concerning XTP
To change my position towards XTP
To convince others with my point of view
It can be stated that the optimal situation corresponds to those experiences placed in the
crosses “High expectations”-“High valued experiences” and “Low expectations”-“High valued
experiences”. From the 22 expectations and experiences assessed, 12 and two appeared
respectively in the first and second quartile (left side), with only eight registered in the right
side (three in the third quartile, five in the forth one). These eight reflect the less satisfactory
situations, as they were not assessed positively in the evaluation of experiences.
National Evaluation Report Neo Socratic Dialogue: Spain — 67
Table 17: Relation between expectations about and experiences with NSD1
HIGH VALUED EXPERIENCES LOW VALUED EXPERIENCES
HIG
H E
XP
EC
TAT
ION
S
Interest in the topic from otherparticipants
To get to know a different form ofdiscussion
To learn to know other people and theirstandpoint
A dialogue equal to all participants
An open atmosphere
To learn to know the NSD
To better understand other participants’position
To develop my communicative skills
Tolerance to my opinion
New insights into the ethics of XTP
A clear answer, how to deal with the problemof XTP
An exciting discussion with regards to content
A clearly structured discussion
To have a high level conversation
New information about XTP
LO
WE
XP
EC
T AT
ION
S
Time to think about an ethical problem
That other participants listen to me andtry to understand
That other participants refer to my arguments
To reach at a consensus concerning XTP
To change my position towards XTP
To convince others with my point of view
To clarify my own standpoint
When the two dialogues are taken separately, some differences can be observed. As could
be foreseen from all previous analysis, the first NSD reveals a less satisfactory pattern. Only
11 experiences emerge as high valued ones (14 in the total of both dialogues), supporting
the situation observed for this dialogue as deduced from the ex-post questionnaire.
68 — National Evaluation Report Neo Socratic Dialogue: Spain
Table 18: Relation between expectations about and experiences with NSD2
HIGH VALUED EXPERIENCES LOW VALUED EXPERIENCES
HIG
H E
XP
EC
TAT
ION
S
Interest in the topic from otherparticipants
An exciting discussion with regards tocontent
To get to know a different form ofdiscussion
To learn to know other people and theirstandpoint
A dialogue equal to all participants
An open atmosphere
To learn to know the NSD
A clearly structured discussion
To have a high level conversation
To better understand other participants’position
Tolerance to my opinion
New insights into the ethics of XTP
To clarify my own standpoint
A clear answer, how to deal with the problemof XTP
LO
WE
XP
EC
TAT
ION
S
Time to think about an ethical problem
That other participants listen to me andtry to understand
To develop my communicative skills
New information about XTP
That other participants refer to my arguments
To reach at a consensus concerning XTP
To change my position towards XTP
To convince others with my point of view
As may be expected, the results for the NSD2 (see Table 18) do not show marked
differences with the total of the two NSD. Experiences included in the quartiles 1 and 2
amount to 14, identical value to the gathering of both dialogues results.
5.6.2. Participants´ overall assessment
In order to obtain an overall of the participants on the exercise, they were asked to identify it
with any of the different levels: Excellent, Fair, Satisfactory, Sufficient and Unsatisfactory.
Results are shown in Table 19.
The mean for the two NSD amounts to 1,89, a value near to the “Fair” level. A high majority
of the participants (89%) qualified the experience as “Excellent” or “Fair”, a very positive
result.
National Evaluation Report Neo Socratic Dialogue: Spain — 69
As in many other assessments, the trend for a more positive appraisal for the second
dialogue group is maintained in the overall assessment. The mean for the first NSD was 2,25
and for the second NSD was 1,64. The first value matches with an option between “Fair” and
“Satisfactory”, while the second one places between “Excellent” and “Fair”.
Table 19: Assessment by school gradesE
xcel
lent
Fai
r
Sat
isfa
ctor
y
Suf
ficie
nt
Uns
atis
fact
ory
Mea
n
Std
. Dev
iatio
n
Altogether I assignto the event thefollowing schoolgrade
4(0/4)
13(6/7)
2(2/0)
0(0/0)
0(0/0)
1,89(2,25/1,64)
0,57(0,46/0,50)
(Source: CSIC-Survey 2003)
The participants were also asked if they would recommend the participation in such type of
exercise to their colleagues, and the response is a high “Yes” (see Table 20).
In broad terms, all the participants in the NSD would recommend the dialogue to their
colleagues. The mean value was 1,21, a store very closet o the most positive option “Very
much recommend”.
In spite of this overall positive result, the trend of the second NSD being more positive is
kept. Its mean amounts to 1,09, almost exactly matching with the highest appraisal, while in
the first the mean was 1,38. In any case, this clear positive results constitutes one of the
mean assets of the Neo Socratic Dialogue experience in Spain.
Table 20: Willingness to recommend the NSD to colleagues
Ver
y m
uch
reco
mm
end
Rat
her
reco
mm
end
Rat
her
not
reco
mm
end
Not
reco
mm
end
Mea
n
Std
. Dev
i atio
n
Would you recommend suchan event to an interestedcolleague?
15(5/10)
4(3/1)
0(0/0)
0(0/0)
1,21(1,38/1,09)
0,42(0,52/0,30)
(Source: CSIC-Survey 2003)
70 — National Evaluation Report Neo Socratic Dialogue: Spain
5.7. Was it possible to disseminate the results of the Neo SocraticDialogue into a wider discussion?
This document will be mailed to all participants, with the recommendation of disseminating
and discussing it with their colleges. We suppose that the participants have commented on
the event in their professional environment.
On the other hand, up to now we do not see more discussion about xenotransplants from the
Neo Socratic dialogue, especially since its reach is limited to the individuals which
participated in the two dialogues.
5.8. In which way were the results of the Neo Socratic Dialogue broughtin the xenotransplantation debate?
Up to now, we do not believe that the Neo Socratic dialogue has led to more debate about
xenotransplantation in Spain, given the difficulties of dissemination of the event.
The answer of this question remains for the further dissemination phase.
National Evaluation Report Neo Socratic Dialogue: Spain — 71
6. Impact
6.1. Which consequences do participants think that the Neo SocraticDialogue will have for their professional and private everyday life?
The participants were asked about the potential usefulness of the NSD for their personal or
professional life. The results are recorded in Table 21.
Taking together both dialogues, 95% of the participants considered the method as “Very
useful” or “Rather useful”, while only 5% rated it as “Rather not useful”. With respect to this
point, the differences between the two dialogues are noteworthy, with a more positive
evaluation resulting from the second NSD. The mean in this case was 1,82, a value situated
in the interval between “Very useful” and “Rather useful”. In the first dialogue, the mean was
2,13, corresponding to an interval between “Rather useful” and “Rather not useful”. The
overall assessment regarding the issue of “usefulness” is very positive.
Table 21: Assessment of the usefulness of the NSD for the own work
Ver
y us
eful
Rat
her
usef
ul
Rat
her
not
usef
ul
Not
use
ful
Mis
sing
dat
a
Mea
n
Std
. Dev
iatio
n
If you think about the instrument of the NSD -To what extent do you think is this process tothink about ethical problems useful for yourprofessional or voluntary work?
2(0/2)
16(7/9)
1(1/0)
0(0/0)
1,95(2,13/1,82)
0,40(0,35/0,40)
(Source CSIC-Survey 2003)
6.2. Did the dialogue change their awareness of ethical problems ofxenotransplantation?
Only one participant from the first dialogue said, in the ex-post questionnaire, that the Neo
Socratic dialogue had changed his point of view about xenotransplantation.
This participant expressed, in the questionnaire, that the Neo Socratic dialogue had helped
him to discover other opinions and different points of view about the issue of
xenotransplantation. Listening to the judgements and thoughts of others allowed him to be
more tolerant.
• NSD1, expost questionnaire: “Contemplar diferentes puntos de vista y aspectos que hasta ahora no
conocía me han hecho modificar un poco mi actitud, haciéndola más positiva”
Summary: “By looking to other points of view uncovered to me up to now, I have slightly changed
my attitude towards being more positive”.
72 — National Evaluation Report Neo Socratic Dialogue: Spain
In the second dialogue, 45% of the participants declared that their knowledge and points of
view about xenotransplantation had changed due to the Neo Socratic dialogue, according to
the ex-post questionnaire.
Those persons who admitted that the dialogue had changed their opinions, expressed two
main ideas: the dialogue have increased their knowledge about transplantation in general
and they modified some opinions after listening to the judgements and opinions of the other
participants.
• NSD2, expost questionnaire: “No es que modificara mi actitud y juicio frente a los xenotrasplantes, pero sí
ha influido en la forma de plantearme el tema y establecer un juicio hacia él”,
Summary: “NSD has helped to look to xenotransplantation , to make a judgement”.
• NSD2, expost questionnaire: “Ha ampliado mis conocimientos porque mi base era escasa, por lo que
asistí sobre todo a escuchar y a aplicarlo sobre mis propias valores creencias”
Summary: “NSD has enlarged my knowledge base and to look to it in relation to my own beliefs”.
• NSD2, expost questionaire: “Me ha proporcionado más información y una forma más rica y de ver el
tema, considerando más elementos y más puntos de vista”
Summary: “I have got more and richer information with more faces and pints of view”.
• NSD2, expost questionnaire: “Veo que los técnicos puede que no sean los que en última instancia
asuman los riesgos”
Summary: “I realized that the technical experts could be not the ones taking risky decisions”.
• NSD2, expost questionnaire: “Empiezo a considerar los xenotrasplantes como un problema global, de
implicaciones comunitarias y no sólo individuales”
Summary: “I am starting to look at xenotransplants as a global problem”.
The participants of the second dialogue thus emerged as more receptive to the ideas of the
others than the participants of the first dialogue.
6.3. Did the dialogue change their communicative patterns andcapabilities in related ethical questions?
On the whole, the participants of both dialogues expressed, in the ex-post questionnaires, a
positive point of view about the Neo Socratic dialogue. This kind of dialogue has some
advantages which are not evident in other types of debates or discussions.
The dialogue allows participants to express different ideas, opinions or thoughts, without the
common tendency of exchanging fixed positions among the audience. Even if discussion
takes place, the moderator tries to integrate all the different opinions in a final judgement or
statement.
National Evaluation Report Neo Socratic Dialogue: Spain — 73
There is no intention of integrating all the opinions or points of view in other classical types of
debate or discussion. All the participants express their thoughts but nobody takes care of
finding a common point or a final general judgement. An example of this type can be found in
the political debates on television.
The strict order in which people speak facilitates the participation of the whole audience.
Each person can express his or her opinion clearly, without interruptions from the rest of the
speakers. In the conventional debates, sometimes it is impossible to hear the opinions of all
participants, because there are persons who try to force their voices to be heard or to
convince the audience.
The telephone interviews allowed to collect deeper reactions than the written questionnaires.
The question about “Whether the NSD has influenced participants’ attitudes in relation to
controversial situations that have been faced along the professional or personal lfe, gave rise
to the following responses:
• NSD1, participant 1: “Yo creo que la conclusión que aprendes es que dialogando pues todo el mundo
puede entenderse, y (ININTELIGIBLE) y que exista una actitud abierta en todo el mundo, pues de
intentar buscar siempre un consenso en ese sentido y seguramente luego conseguidos estos consensos,
siempre acaban siendo consensos de mínimos, pero también es muy difícil... yo creo que cuando no
tienes evidencias claras y concretas de lo que estás haciendo es difícil llegar a mucho más”
Summary: “I believe the possibility remains in reaching minimum consensus… which is not bad
when there are not clear evidences”.
• NSD1, participant 6: “Yo creo que sí. Porque lo que aprendes es a escuchar otros puntos de vista, otras
formas de ver las cosas diferentes a las que tú tienes, y que muchas veces surgen puntos de vista que a
ti ni se te habían imaginado, entonces yo creo que en ese aspecto sí que me ha servicio de utilidad, que
es muy importante escuchar a otras personas la opinión que tienen para... porque tú igual tienes una
visión sesgada de la realidad, la tienes de hecho, y entonces al escuchar a otras personas se te abren
nuevos horizontes”,
Summary: “I have found it useful for opening new visions”.
• NSD2, participant 3: “No me lo he planteado, yo creo que a nivel de resolución, o para plantear formas de
resolución de cuestiones nuevas, por ejemplo, en el área de las tecnologías, etc., pues parece que puede
ser un método interesante, un método de abordaje interesante. Claro, como no va directamente a
analizar el problema, sino que se busca a través de... por llamarlo así, de un planteamiento de una
cuestión paralela o problemas que se hayan podido plantear en la vida que esté relacionados, que me
parece que es interesante. Yo creo que sí”
Summary: “I found interesting the NSD as an interesting approach”.
• NSD2, participant 5: “No, no lo diría, pero no porque en sí mismo no me pareciera atractiva la fórmula,
sino porque de alguna manera primero la experiencia fue limitada, y en segundo lugar, es difícil plantear
esto en un ámbito cotidiano salvo que estés en... cómo te diría yo, en el contexto adecuado y con la
gente preparada, y con una cierta información sobre el tema o sobre la forma de discutir, sí puedo decirte
74 — National Evaluation Report Neo Socratic Dialogue: Spain
que evidentemente a la hora de manejar una determinada discusión pues sí hay algunos elementos que
se pueden introducir... que pude tomar del modelo neosocrático, pero no todo el modelo”
Summary: “I do not think it is so easy. The model is attractive but…”.
• NSD2, participant 7: “No, vamos a ver, fue una toma de contacto con una forma nueva de buscar
soluciones a problemas, a conflictos, pero tampoco luego... yo es que estoy en un Comité asistencial de
ética de un hospital, entonces también utilizamos los métodos de resolución de conflictos que supongo
que conocerás, entonces lo que sí me pareció fue una expectativa muy buena de conocer un nuevo
método, que no lo había practicado y que no lo había puesto en práctica nunca, pero, vamos, ¿si me
varió la forma de resolver conflictos?, bueno, dependiendo del conflicto vas utilizando un método u otro
¿no? de toma de soluciones”,
Summary: “For me that I am used as member of a Committee on Ethics, the NSD was a way to
know a new method. Different conflicts may require different methods”.
• NSD2, participant 8: “No, ya te digo, que es que no se ha presentado ninguna situación así conflictiva,
generalmente reacciono, y hasta el momento no se me ha presentado ninguna situación. En el momento
que se me presente y tenga que reflexionar sobre algo, ya que sí probablemente razone más, en eso sí
que me ha valido, pero vamos, hasta el momento no lo he utilizado”
Summary: “Up to now I have not been confronted to a situation of this type. I think the NSD Hill
serve me in the future as my professional career evolves”.
As can be seen from these comments, which follow the general pattern of the participants,
the NSD has not arrived to change in substantive manner how to confront labour or personal
conflicts. The main influence seems to lie in having evolved more open attitudes towards
others’ opinions and by being more prone to dialogue. This is, poor as it may appear, a very
important outcome for the Spanish ways of approaching.
In any case, the participants declared that they have not had the opportunity to apply the
method since the dialogue took place, as many of them state that its applications into normal
life situations does not seem easy.
National Evaluation Report Neo Socratic Dialogue: Spain — 75
7. Resonance
7.1. Did the Neo Socratic Dialogue have a resonance in the policymaking process, scientific community, media, public debate orindustry?
So far, we have no news about the resonance of the Neo Socratic dialogue in any of these
spheres.
Only two pieces of news have been published in relation with xenotransplantation since
finishing the baseline evaluation.
It can be said that the debate on xenotransplantation is not actively engaged in Spain, like it
seems to be in the sphere of European Union.
76 — National Evaluation Report Neo Socratic Dialogue: Spain
8. Summary and conclusion
This part of the document addresses the evaluation of the NSD that took place in Spain
within the frame of the XENO project. It intends to know the level of fulfilment of the
objectives, six in total, as agreed in the course of the project (Karlsruhe meeting, 2003). The
questionnaires ex-ante and ex-post, the tape record transcriptions of the NSD and the
telephone interviews has served as support for its elaboration.
8.1. Goal 1: To raise awareness of relevant actors and the public forethical questions of XTP
8.1.1. Raise awareness of relevant actors and the public for ethical questions of XTP
Some specific details and indications about this objective are given in the section 3.1 and 5
of the present document.
As it has been repeatedly indicated since the Baseline Evaluation of the project, there are no
many prominent actors on the issue of xenotransplantation in Spain. There are few
researchers, although one of them performs his work at a very advanced level in the
transplant of pigs to baboons. Two of them have been attending the NSD1. Also present
were bioethicists, journalists, doctors, representatives of patients and patients, together with
some more lay people in relation to the issue at stake, though all of them holding a university
degree. We would not count on political representatives, except for the sporadic presence of
one of them, neither on the defenders of the rights of animals. These last have been invited
but we did not have a positive answer from them.
Almost half of the participants stated their strong or medium relation to the topic of
xenotransplantation. Similar percentage was obtained from the participants when they were
asked on their level of information on the topic –slightly more than half of the participants
identified themselves with the option “Fully informed” or “Fairly informed”.
With respect to the characteristics of the group (see Table 12), the appraisal was highly
positive, with the exception of the variable “Well composed”.
8.1.2. General assessment of the NSD
On the global assessment of the event, the participants stated a mean of 1,89, very close to
the option “Fair”, though important differences among the two NSD were observed, as the
mean value for the first NSD was 2,25 and 1,64 for the second one. It seems therefore that
the participants in the second NSD have expressed a more favourable opinion that those
from NSD1 with respect to the issue of inviting their colleagues to participate in future Neo
National Evaluation Report Neo Socratic Dialogue: Spain — 77
Socratic Daialogues, an indication of the higher level of satisfaction reached by the second
group.
The majority of the participants showed positive positions about the potential development of
this medical technology. A low percentage, less than 25%, manifested some reservations on
the convenience of that technology. In any case, it can be clearly stated that the NSD did not
contribute to change the initial position with respect to xenotransplantation. At its maximum,
the dialogue has contributed to gather new information on technical questions up to now
unknown by some participants.
With reference to the eventual usefulness of the conclusions on xenotransplantation for the
professional having some links to this biomedical technology, the majority of them stated in
the telephone interviews that they believe the NSD outcomes may influence their work. The
outcomes have brought to them new view points arising from a heterogenous gathering of
individuals, what represents an important gain to the traditional point from which the experts
perform their research activity. Further information about this issue can be found in the
section related to changes in the awareness of ethical problems of xenotransplantation.
8.1.3. Specific outcome from the NSD
Items like “Gave me new insights into the ethics of XTP”, “Gave a clear answer, how to deal
with the problem of XTP”, “Clarification of my own standpoint”, “Provided new information
about XTP”, “Created consensus about XTP” and “A change in my position towards the
ethics of XTP” have received scores which place them as “Low Valued Experiences” (Table
16).
Specific responses found in the ex-post questionnaires such as “NSD has helped to look to
xenotransplantation, to make a judgement”, “NSD has enlarged my knowledge base and to
look to it in relation to my own beliefs”, “I have got more and richer information with more
faces and points of view”, “I realized that the technical experts could be not the ones taking
risky decisions”, “I am starting to look at xenotransplants as a global problem” serve as
examples on how they have reacted to the translation of the dialogue experience to the
specific topic. According to these statements made by the participants, the Neosocratic
dialogue has helped to enlarge their vision of xenotransplantation but not to substantially
modify the previuos opinions on it.
78 — National Evaluation Report Neo Socratic Dialogue: Spain
8.2. Goal 2: Discuss ethical problems of XTP
8.2.1. Transfer of NSD results to the ethics of XTP
According to the proposed methodology in the NSD, the last phase would permit a transfer
of the dialogue outcomes to the ethical aspects on xenotransplantation. In the Spanish case,
this phase proceeded with difficulties, particularly in the case of the first dialogue.
As stated along this document, the participants in the first dialogue did not reach adequate
fluency in their interventions. The facilitator had to encourage them to express their views at
several steps during the event. The final phase aiming to transfer the outcomes to the issue
of xenotransplantation was not an exception. Besides this lack of fluent dialogue, too much
time was devoted to the selection of the example and its explanation. By this reason, barely
one hour could be allocated to the transfer phase. It was possible to express judgements on
the way how it can be possible to face broad risks in relation to biotechnology for there were
no possibilities to reach any specific agreement on the xenotransplantation field, took the
initiative to minimize the risks issue in relation to the promotion of research in this topic.
The second NSD was somewhat more positive at this respect. Dialogue was more easy,
participants were keen to talk and express their views without the need for the facilitator to
encourage them. All this favoured and alternative exchange of views without appearing too
many uncomfortable silences. The phase of transfer had some more time for its
development what led to a greater exchange of ideas. The participants expressed their
opinions about the optimal conditions for beginning xenotransplantation trials and their
subsequent medical practice and on who should participate in the committees that would be
acting in agreement with those conditions. Many participants express their wishes that the
experts committees should be composed by individuals both with relationship with research
and with no links to that activity in order to gain independence for the normative process.
Further details and information on the results of the process of transfer can be found under
item called “Transfer from the dialogue to the XTP issue”.
8.2.2. Which problems did arise in the NSD?
1. There are no many actors involved in the xenotransplantation issue in Spain.
Moreover, this topic has not raised a great debate and interest among our citizenship
as it has been already stated in the Baseline Evaluation phase. It has not been easy
to attract the well trained and knowledgeable people on xenotransplantation for
several reasons. One of the main problems was the disponibility of time, as many
invited persons had to cancel their participation in the last minutes by agenda
problems. On the other hand, the active participants expressed views that more time
National Evaluation Report Neo Socratic Dialogue: Spain — 79
would have been necessary for extending the dialogue in order to reach more fruitful
results. There is a paradoxical situation with respect to time availability criteria.
2. Spain and the Spanish society are not used to the dialogue as socio-political
instrument. There is no a deep-rooted experience of participation in dialogue and
consensus instruments. One of the reasons stems in the Spanish educational
system that does not favour, at least in earlier periods, the active attitude to express
opinions in the normal life process of schools, colleges and universities. This
prevents the people that have been educated according to other schemes to get
acquainted with socio-political methodologies base on participation. For this reason,
the evolution of both NSD has suffered from lack of fluency in the participants
behaviour, though the facilitator made strong efforts to “get out” their personal
opinions.
3. Each NSD was allocated six hours time for development, though only the last one
was devoted to the transfer phase. According to the opinions collected from the ex-
post questionnaires and the telephone interviews, the participants requested more
time for this last phase in order to enable the drawing of conclusions related to the
specific case of xenotransplantation. Many have also suggested the organizer to
propose the examples in order to short time in the initial phase. This argument
probably runs against the same nature of the NSD. Those raising this argument
thought that it should favour the election of an adequate example in order to make
easy the correct development of the NSD.
4. About half of the participants in the Spanish NSD did not have a professional or
personal direct link with the issue of xenotransplantation. Nevertheless, all the
participants hold a high cultural and educational level, as all of them possess a
university degree. One can think about the convenience of the intervention in all
these participative methods of individuals with distinct educational and socio-
economic levels. This appears it be the only way to guarantee an adequate sample
of our societies. But this argument, that has been present since the onset of this
project (first meeting in Vienna), immediately raises the question about the feasibility
to carry out a NSD with such a blend of participants. Further information and details
are expounded in the section of actors enrolled in the NSD.
5. As it can occur with other methods based on the discourse and participation, the
legitimation of such type of exercise and the relation to the political process of taking
decisions is, at least, unclear and there no seems to follow directly. In our specific
project context, the dissemination and diffusion of results was left to the participants
themselves. It is tempting to think that in the future, would be interesting to settle,
even prior to the same NSD, instruments of diffusion involving relevant actors and
even institutions.
80 — National Evaluation Report Neo Socratic Dialogue: Spain
8.2.3. Specific assessment of outcomes
We have attempted to correlate expectations with experiences. Expectations on the NSD
have been classified in Table 6 according to four different categories: “Topic of XTP”,
“Method of the NSD”, “Qualities of the dialogue” and “Personal rewards from the dialogue”.
The experiences as an indication of the evaluation of the outcomes do match with the
foreseen expectations and can be classified according to those typologies.
As it is shown in Table 14, the higher valued experiences with scores lower to 1,50 were:
“Conveyed the instrument NSD”, “Allowed a dialogue equal to all participants”, “Contributed
to learning to know other people and their standpoint”, “Allowed me to get to know a different
form of discussion” and “Provided an open atmosphere”. Four of these five experiences
belong to the categories “Method of the NSD” and “Qualities of the dialogue”. It seems clear
that the participants from both groups, taken together, valued more positively the approach
and experience of the new method as well as its advantages as a way of dialogue than the
other aspects of the debate: i. e. the relationship to the issue of xenotransplantation or the
self-rewarding result of the dialogue.
More information on the assessment of the experiences is forwarded in the section “How do
participants explain their assessment?”
8.2.4. General assessment of the NSD
All of the participants in the dialogue assure that it fulfilled most or all of their expectations,
according to the respective question from the questionnaire ex-post.
The results on the question about the general expectations of the NSD are collected in Table
13. From the total, more than 63% of participants selected the options “Surpassed” or “Met”
to give an average of 2,16. It should be underlined that none of the participants opted for
“Rather did not” or “Did not met”, a strong indication that none of the participants of the two
NSD felt disappointed by the outcomes of the experiment.
As stated, the members of the second group gave a more positive assessment to the
exercise with a value of 1,82 mean, as compared to a mean of 2,63 for the first dialogue.
The first average (second dialogue) reaches a value close to the option “Met” while the
second approaches the option “Rather met”.
The telephone interviews concerning the participants in the first NSD also provide a positive
general assessment with regard to the possible expectations. A significant majority declared
that the experience satisfied the expectations or, at least, part of them. Only two interviewees
expressed different opinions: one of them considers the experience as unfavourable; the
National Evaluation Report Neo Socratic Dialogue: Spain — 81
other states that he/she did not have expectations on “a priori basis” as considered the NSD
as an “experiment”.
All of the interviewees without any exception have praised the dialogue by its novelty and by
its marked difference with the usual way to carry out debates.
The attitudes towards the NSD were experimental what implies statements about lack of
techniques and patterns of behaviour to be followed in the new mode of debate. This
statement is supported by the fact that half of the respondents expressed uncertainty about
their participating roles due to the lack of knowledge on this social technique.
In the case of the NSD2, the assessment is highly positive because a great majority of the
interviewees declared their expectations to have been surpassed or covered. The remaining
expressed less positive assessment indicating that some or all their expectations have not
been attained. This extreme position has to be shaded by the fact that they dif not have a
preconceived opinion or expectations, but in any case all three considered the exercise as
fruitful in broad terms.
8.3. Goal 3: Clarify the responsabilities of various actors for ethicalquestions of XTP
The first step to move the actors involved in the development of xenotransplantation to
express and clarify opinion about some ethical aspects implies their willingness to participate
in the NSD. As it has been stated in previous sections of this report, there are no many
actors in Spain. Participants in the Spanish NSD were scientific and social researchers,
medical transplantation practioners, representatives of patients associations, one journalist,
bioethicists. This sample in considered by the authors of this report as quite satisfactory in
view of the limited social impact of the xenotransplantation issue in Spain.
During the course of the two dialogues, those participants holding a tighter professional or
personal link to xenotransplants were the most positive and active. They intervened
frequently and fluently in the dialogue. The great majority of them have expressed, both in
the questionnaires and in the interviews, very strong argument on the outcomes of the NSD
to know foreign opinions on the topic and to become aware of ethical and social aspects
unknown to them before the exercise.
The ex-post questionnaire asked the participants about the opinion on a possible usefulness
of the NSD for the future work. The results are commented in length in section 5.1 The mean
of both surveys matches close to the option “Rather useful”, with, as usual, a more positive
evaluation by the participants in the second NSD, mean 1,82, as compared to that of the first
82 — National Evaluation Report Neo Socratic Dialogue: Spain
NSD, mean 2,13. These differences, as has been stated repeatedly, are almost surely due to
the composition of both groups.
The telephone interviews did not differ in the appraisal. It can be considered as a shaded
positive. The participants in the first NSD were quite supportive of this methodology in
relation to its possible use or application to the professional activities of the participants.
However some nuances were indicated to improve the efficacy:
• To increase the dynamics and promote the active participation of the attendants.
• To select a good moderator-facilitator of the dialogue.
• To give more structure and order to the discourse and to limit its boundaries.
• To better define the framework of the discussion in order to achieve concrete and
practical conclusion.
The assessment from the second NSD is also very positive in relation to the utility of the
experience in the work projection.
The main critical comments refer again to the lack of familiarity on the mechanism of this
type of debate as well as to some more practical questions: need for a better formation of the
participants, a simpler structure, shorter, more concise and with the selection of more precise
examples previously selected.
An indicator to value this goal refers to the question about the possibility to reach a
consensus on the issue of xenotransplantation. This experience has been collected in the
Table 14 of item 5.6.1. The mean is 2,42, one of the lowest appraisals. In Table 16, this
experience has been placed within the group “Low expectations”-“Low valued experiences”.
8.4. Goal 4: To provide information to decision makers about the ethicalbasis and consequences of XTP
In general the accomplishment of this goal will be part of the dissemination strategy. The
NSD had some decision makers in the group. Their participation was a contribution to this
goal, they will be kept informed about the further progress of the project.
8.4.1. Dissemination strategy
The members of the Spanish team have been worked in some activities which contribute to
the dissemination of the results of the XENO project. These activities are essentially
addressed to a knowledgeable public as scientists, clinicians, bioethicists, social scientists,
scholars on biotechnology courses, etc.
National Evaluation Report Neo Socratic Dialogue: Spain — 83
8.4.1.1. Conferences or seminars
• David Santos, “Xenotransplantation: analysis of press contents”, Seminar: “Los desafíos
de la biotecnología en el mundo actual”, Cátedra Miguel Sánchez Mazas, 12 de
diciembre de 2002, Universidad del País Vasco, Vitoria-Gasteiz.
• David Santos and Marta Plaza, “Biotecnología, sociedad y opinión pública”, Máster en
Ciencia, Tecnología y Sociedad, 16 de septiembre de 2003, Universidad de Salamanca,
Salamanca.
• David Santos and Marta Plaza, “Percepción social de la transgénesis, xenotrasplante y
clonación animal”, Seminar: “Transgénesis, clonación animal y xenotrasplante: aspectos
científicos, éticos y jurídicos”, Cátedra Interuniversitaria Fundación BBVA - Diputación
Foral de Bizkaia de Derecho y Genoma Humano Universidad de Deusto, 24 y 25 de
noviembre de 2003, Universidad del País Vasco/EHU, Bilbao.
8.4.1.2. Papers Published
• “Xenotrasplante y debate ético: un proyecto europeo”, David Santos y Emilio Muñoz,
Alcer, número 122, julio, agosto, septiembre, 2002, Madrid.
• “Xenotransplantation, ethical issues of a challenging biomedical development”, Emilio
Muñoz y David Santos, Business Briefing Global Healthcare 2003, mayo 2003, Londres.
• “Opinión pública y debate ético-social sobre un reto de la biotecnología: los
xenotrasplantes”. David Santos y Paolo Dordoni, Sistema: Opinión pública y
biotecnología, Editorial Sistema (forthcoming).
8.5. Consensual policy options for ethical problems of XTP
As has been discussed in the section 8.2, it has been rather difficult to draw conclusions or
patterns for action in relation to the specific issue of xenotransplantation. In both NSD, the
transfer phase was too short and it was only possible to reach consensus on principles to be
applied to risk situations, but without allowing to make them concrete and applicable to the
case of transplantation of animal organs.
The criteria adopted by the participants are specified in section 5 of this report. In that
section, there is a detailed exposition of those judgements that raised great interest and had
been supported by a great majority of the participants. It has become evident from all
analysis that in order to enable evident the proposal of policy options in relation to
84 — National Evaluation Report Neo Socratic Dialogue: Spain
xenotransplantation, it would have been necessary to allocate more time to the last phase of
the NSD. This argument has been clearly stressed all along the telephone interviews.
8.6. To improve the communicative patterns and capabilities of actorsin the field to cope with ethical questions arising from modern scienceand technology
We have estimated as adequate indicators to value this goal those related to expectations
and experiences which had been gathered under the categories “Qualities of the dialogue”
and “Personal rewards from the dialogue”, as shown in Table 16. On the other hand, Table
16 shows the assessments of the participants on each one of those experiences.
“A dialogue equal to all participants”, “An open atmosphere” and “To learn to know other
people and their standpoint” were the best valued experiences, reaching scores close to 1
which is the maximum one. The less valued experiences were “To convince others with my
point of view”, “To clarify my own standpoint” and “That other participants refer to my
arguments”.
In the telephone interviews, the participants were asked about the possibility that the NSD
method enabled the participants to modify their attitudes when facing conflicts in their
professional and personal life as well as the way to solve them.
The great majority of the responses to this issue from the NSD first group do not recognize
that the Neo Socratic method has contributed to any essential modification in the way they
are facing the normal life problem. Seven persons answered in this direction. Only one
person stated clearly that this form of debate participation helped him/her to understand
other points of view and to open more ways to dialogue.
It should be noted however that five out of the seven participants not recognizing a positive
impact on the way of acting, considered the experience a positive one and very interesting
as well as a new path to reach consensus among confronted positions.
The responses from five members of the second NSD were largely more positive at this
respect while recognizing that the method has driven them to change attitudes and ways of
doing in relation to personal conflicts, while the remaining six did not find the NSD useful for
solving personal conflicts, though they admitted the experience as attractive and new.
Authors: David Santos, Emilio Muñoz, Gloria Ponce and Paolo Dordoni
Title: National Evaluation Report Neo Socratic Dialogue: Spain
Projektbericht/Research Report
© 2004 CSIC
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