Reflective equilibrium and equipoise

I can't believe, or don't want to, that it's nearly 15 years since I posted - 

h2cm and clinical equipoise in 2010. 

The post didn't try to be 'technical', but perhaps demonstrates the journey here.

In a post to follow, in London 4-7th July I came across a book by Edouard Machery and upon return up north, found a paper which refers to reflective equilibrium. This, one again technical or not, is a purpose of Hodges' model.

Machery, Edouard, Philosophy Within Its Proper Bounds (Oxford, 2017; online edn, Oxford Academic, 24 Aug. 2017), https://doi.org/10.1093/oso/9780198807520.001.0001, accessed 24 June 2025.

Reflective equilibrium has an entry in the The Stanford Encyclopedia of Philosophy:

'If you believe that conduct in some case is right or wrong, you have a moral judgment or intuition. Perhaps you have many such judgments about different cases. You might, nevertheless, consider that judgments alone do not justify the moral views they express. You and your moral interlocutors might be concerned that “what we actually accept is fraught with idiosyncrasy and vulnerable to vagaries of history and personality” (Elgin 1996: 108) or displays “irregularities and distortions” (Rawls 1971: 48).

John Rawls proposed to address these concerns through the method of reflective equilibrium.We first ensure that our judgments are considered, being made in circumstances appropriate for moral deliberation. We are then to consider general principles that might accommodate our set of considered judgments—and more than that, explain and extend them. On the standard wide reflective equilibrium, we are to consider

all possible descriptions to which one might plausibly conform one’s judgments together with all relevant philosophical arguments for them. (Rawls 1971: 49)

This requires that we reflect on a wide range of principles, arguments, and theories. Equilibrium is reached where principles and judgments have been revised such that they agree with each other. In short, the method of reflective equilibrium is the mutual adjustment of principles and judgments in the light of relevant argument and theory.'

The encyclopaedia entry is informative for studies here. I will revisit clinical equipoise in the near future; and bring in the idea of 'holistic bandwidth'.

Knight, Carl, "Reflective Equilibrium", The Stanford Encyclopedia of Philosophy (Spring 2025 Edition), Edward N. Zalta & Uri Nodelman (eds.), URL = <https://plato.stanford.edu/archives/spr2025/entries/reflective-equilibrium/>.

Rawls, John, 1971, A Theory of Justice, Cambridge, MA: Belknap Press of Harvard University Press.

Health & Social Care - Shoeing the Horse*

Anvil

*humanistically ...

Anvil image:
http://en.wikipedia.org/wiki/File:Blacksmith_anvil_ganson.svg

Original horseshoe image:
http://www.ranchomilagrokansas.com

h2cm and clinical equipoise

The past few weeks reading the Journal of Evaluation in Clinical Practice - I've encountered the concept of equipoise: specifically the clinical form.

The Health Career - Care Domains - Model is all about 'poise'.

The model's care domains provides the perfect workout.

Medicine, health and social care constantly exercises us. We are, whether or not we recognize it, on a balance board. In fact if you consider that image and then factor in the complexity of health care today you realise just how much stuff (technology), how many people (subjects, agents) need to be on that same board. Who does the board belong to though? Well of course it's -

Jo Public's (... and often off-balance, strengths depleted, sick (and tired), relapse prone...)

The April 2010 issue of the above journal is a fascinating read. I noticed today that some of our placement students were not aware of the recent and current position regarding health policy: that is the 'long view' of decades such as: Health of the Nation, the National Service Frameworks, Darzi ... They need to address that and I'm sure they will.

This journal issue prompts me to consider evidence based medicine anew, especially:

• Its history spanning 20 years.
• Its occupying the SCIENCES domain, with its weight threatening to overbalance all (you could say it's a significant singularity).
• The realization that the Emperor is short on clothes.
• Given the above it can mature. Bogdan-Lovis and Holmes-Rovner (2010)

Back to that board: and stepping onto the health care domains - all four of them so spread your feet - you can see instantly (feel that feedback) how EBM, shared decision making and (person) patient-centered care are all related. As Bogdan-Lovis and Holmes-Rovner (2010) highlight:

Equipoise is the heart of the shared decision making movement, and it embodies the problems for which patient decision aids are most often developed to explain the risks and benefits of competing alternatives. p.377.

h2cm is well suited to this task on so many levels.

The past week or two I've also noticed several mentions of the need to nudge people - here and there - both in the media and in Bogdan-Lovis and Holmes-Rovner's paper and references.

More to follow - and as you step-off take care ....

Wilson, K. (2010) Evidence-based medicine. The good the bad and the ugly. A clinician's perspective. Journal of Evaluation in Clinical Practice, 16, 398-400.

Bogdan-Lovis, E., Holmes-Rovner, M. (2010) Prudent evidence-fettered shared decision making. Journal of Evaluation in Clinical Practice, 16, 376-381.

And for the week ahead:

One mind, many minds - ONE PLANET. One need, many needs - ONE PLANET: what price stability?

http://hodges-model.blogspot.com/2009/02/one-mind-many-minds-one-planet-one-need.html