A joint initiative of the Centre for Biomedical Ethics (CBmE), NUS Medicine and the Patient Advocacy and Support Office (PASO), NUHS

Method

Collective Reflective Equilibrium in Practice

Pioneered at the Centre for Biomedical Ethics, CREP is one of the methods the PACT Lab employs. It addresses a particular problem: what to do with public input once it has been gathered, and how to move from what people think to what can be justified.

The problem it addresses

Public input does not settle policy questions on its own. A majority view may rest on a mistaken premise, may conflict with a commitment the same respondents hold, or may not survive the respondents' own reflection. Nor can normative argument proceed as though public views were irrelevant, since the people affected are owed reasons they can accept.

CREP is a staged process for integrating the two: it treats considered public judgements as evidence to be weighed against theoretical commitments, and revises both until they cohere. The aim is neither to read policy off opinion nor to settle moral truth, but to reach recommendations that are transparent, reproducible, and publicly justifiable.

The stages

Is public inputwarranted? Whose viewsare relevant? What to ask,and how Integrate withnormative frameworks Justify therecommendation Not every question callsfor public input Which public, andon what basis Instruments anddeliberative formats Weigh considered viewsagainst commitments In terms the affectedpublic can accept

One method among several

CREP was developed at CBmE and is one of the methods the PACT Lab applies when a project needs to move from public input to a defensible recommendation. It is not the only method the Lab uses, and much PPIE work does not call for it: for example, reviewing participant materials, co-designing a study with the people it will recruit, or convening a condition-specific consultation each require different methods, drawn from the wider literature on patient and public involvement.

Related

Public panel

The Health Opinion Panel Singapore

The standing public panel the PACT Lab draws on for gathering input at scale, and how access to it works.

Publications

Methods

The CREP reference paper and related methodological work.

References

  1. Savulescu, J., Gyngell, C., & Kahane, G. (2021). Collective reflective equilibrium in practice (CREP) and controversial novel technologies. Bioethics, 35(7), 652–663. Open access
    https://doi.org/10.1111/bioe.12869
  2. Savulescu, J. (2025). Collective reflective equilibrium, algorithmic bioethics and complex ethics. Cambridge Quarterly of Healthcare Ethics, 34(2), 204–219.
    https://doi.org/10.1017/S0963180124000719

Further methodological work is listed under Methods on the publications page.

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