As debates relating to allocation of limited life-saving resources, mandatory vaccination and challenge trials illustrated, disagreement may paralyse ethical policy formation in public emergencies and controversial medical practices. This programme will further develop and refine a novel methodology for addressing the ethical issues and deriving and applying wide public values to policy making in such situations.
The ethical procedure for forming policy: Collective Reflective Equilibrium (CRE), brings theoretical considerations (ethical principles, theories, concepts, professional guidelines, policies) into coherent equilibrium with public values (screened for prejudice, inconsistency and alignment with fundamental theories, principles and concepts). It builds on John Rawls’ political philosophy, [3]. this procedure is applied in the COVID-19 pandemic.

The aim is to develop this instrument for forming value-based policy in the face of disagreement. This instrument is also used to create ethical algorithms for decision making in medicine: Algorithmic Bioethics. Algorithmic Bioethics aims to make explicit the values involved in arriving at policy and the placed in a structured and ordered way. There can be obligatory and optional steps in the procedures. This is applied to the allocation of ventilators in the pandemic (BJA) and
mandatory vaccination (Nat HUM behave and JME). The advantage of such an approach is that it makes clear the values, their priority and order, and the role of scientific evidence in a way that enables dialogue and evolution of the decision-making process in a publicly accountable and defensible way.