Does deliberation reduce the gap between citizens' and legislator's ethical preferences? First...

IntroWhat’s the matter with German MPs & PGD?

What’s the matter with German voters & PGD?Summary/Conclusion

Does deliberation reduce the gap between citizens’and legislator’s ethical preferences? First results

from a large-scale survey experiment

Kai Arzheimer

Kai Arzheimer Bioethical Preferences (1/32)



What is this all about?

I Germany has recently moved from a complete ban onPreimplantation Genetic Diagnosis (PGD) to a slightly moreliberal regime

I But even this modest liberalisation was unexpectedI (Slightly dated) circumstantial evidence suggests that the

general public holds more liberal attitudes on this issue thanMPs




What is this all about?

This study tests . . .I Whether there is indeed a sizeable gap between MPs’ and

citizens’ preferences re PGDI Whether this can be narrowed by making citizens reflect on

arguments from a parliamentary debate




What is PGD?

I A procedure used in the context of In Vitro (extracorporeal)Fertilisation (IVF)

I IVF usually results in several fertilised egg cells (blastocysts),which are cultivated for five to six days outside the body

I Blastocysts are visually assessed for viability before 2-3transferred to uterus

I PGD = Additionally testing blastocysts for severe geneticdisorders before implantation

I Widely available in Belgium, Netherlands, UK; complete ban inAustria, Ireland, Italy




Why should this matter?

I Currently more than 50,000 women undergoing the procedureeach year, resulting in at least 170,000 testable blastocysts(possibly many more)

I Numbers likely to rise further (demographics and fertility)

I PGDI Can increase the generally low success rate of IVFI Can massively reduce the risk of miscarriageI Can thereby reduce costs & reduce the burden on women’s

healthI But is deemed ethically controversial

I Huge commercial interestI A a good proxy for other bioethical issues, whose salience will

increaseI An example for programmatic overlap of New Left/Centre Right

positions on the liberal/authoritarian dimension






I Numbers likely to rise further (demographics and fertility)I PGD

I Can increase the generally low success rate of IVFI Can massively reduce the risk of miscarriageI Can thereby reduce costs & reduce the burden on women’s




positions on the liberal/authoritarian dimension










increase

I An example for programmatic overlap of New Left/Centre Rightpositions on the liberal/authoritarian dimension











positions on the liberal/authoritarian dimensionKai Arzheimer Bioethical Preferences (4/32)



Germany’s bioethics legislation – “an extreme outlier”The 2011 vote on PGD

Capitalism & Catholics

I Germany should be at forefront of Assisted ReproductiveTechnology (ART)

I Flourishing pharmaceutical industryI One of the most generous/expensive health care systems of the

world & dominant role of private providersI Trend towards late parenthood

I Post-unification, less than 1/3 (nominal) CatholicsI Strong Christian Democratic parties should politicise moral

issues, resulting in liberal rules (Engeli et al. 2013)





Liberal rules & contradictions

I Early, liberal legislation in moral policy domains (e.g. 1975abortion law)

I Full range of prenatal testing available, 1995 amendment defacto legalises (late) abortions of babies with (minor) defects

I But 1990 Embryo Protection Act (EPA) gives absoluteprotection to fertilised egg cells before implantation

I Left parties voted against EPA in 1990 b/c they demanded evenstricter rules

I “Normal” conflict over gay rights, abortion,I But genetics, embryology, stem cells: depoliticised & almost

completely banned





The past as a possible explanation

I Nazis committed genocide on the basis of (alleged) genetictraits

I Also killed at least 70,000 “Aryans” with (assumed) geneticdisorders and other disabilities

I Generally promoted eugenicsI Even launched a program (“Lebensborn”) for abducting,

adopting, and breeding “Aryan” offspring for the SS in Germanyand occupied countries

I New Left began mobilising against ART b/c of alleged similaritywith National Socialism as early as 1985

I Emergence of “blue/green” Christian/Catholic/Conservative &Feminist/Environmentalist/Disabilities issue coalition againstART and biotechnology





Why a vote?

I MPs assumed that EPA implied total ban on PGD; re-affirmedthis view in 2002

I But in 2010, owner of a fertility clinic forced court ruling thatdeclared PGD legal unless explicitly banned

I Bundestag held free vote in 2011I No whippingI No advice/recommendations by party leaderships, instead three

nominally cross-partisan groups; three draft bills

I (Took years to implement b/c of translation into administrativelaw & creation of sub-national structures)





What was at stake?

Draft Bills1. Complete ban (38%)2. PGD permissible if history/high risk of stillbirth, miscarriage,

death of child within first year of birth (10%)3. As 2., plus severe genetic diseases (51%)

I Either way, PGD still illegal, but no punishment for women,doctors if procedures are followed:

I Women have to appeal to regional ethic boards for permissionto have testing performed

I Health providers will carry the costs if permission grantedI Third bill was passed by a majority 55% in second vote





What was at stake?





I Health providers will carry the costs if permission granted

I Third bill was passed by a majority 55% in second vote





What was at stake?





I Health providers will carry the costs if permission grantedI Third bill was passed by a majority 55% in second vote





How cross-partisan were the groups?

1. Headed by (Kauder) leader of Christian Democrats inBundestag & Göring-Eckardt (Green frontrunner and leader ofcaucus in 2013), both vocal Christians

2. Headed by Hinz (Greens) and Röspel (SPD), both known forrestrictive views on stem cell research

3. Headed by Hintze (CDU) and Flach (FDP), both known forhaving liberal views on stem cell research





What other factors could have played a role?

I GenderI Affiliations with churches & other religious organisationsI Affiliations with medical professions & disability groups

I The public?I Relatively little media coverageI Small number of surveys shows low levels of information . . .I . . . but remarkably liberal preferences





What other factors could have played a role?

I GenderI Affiliations with churches & other religious organisationsI Affiliations with medical professions & disability groupsI The public?

I Relatively little media coverageI Small number of surveys shows low levels of information . . .I . . . but remarkably liberal preferences





A model for the legislative vote on PGD (second round)

I Gender: (male)I Party affiliation: (CDU), SPD, CSU, FDP, Greens, LeftI Denomination: (not stated), Catholic, Protestant, none/otherI √ number of affiliations with Christian groupsI √ number of affiliations with disability groupsI Connection to medical sector: (no)





Some descriptives

I Female: 32%I Denomination: 42% no statement, 27% Catholics (population:

29%), 27% Protestants (population: 27%), 4% non-believers orother religions

I Christian charities and other groups: 22% have at least oneaffiliation (population: less than 10% say religion is “veryimportant part” of their lives)

I Disability groups: 7% have at least one affiliationI Medical sector: few doctors, but about 6% have some

connection





Findings I

I Being female & affiliations with disability groups have nostatistically significant effects

I In line with framing/positions in parliamentary debateI Having some connection to medical sector has borderline

significant positive effectI In line with über-cautious position of GMC andI More vocal support from specialist associations

I But denomination & religiosity make a big differenceI So does party affiliation (even after controlling for religion)





Findings II: Religion

.2

.3

.4

.5

.6

.7

Pre

dic

ted

Pro

ba

bili

ty

0 1 2 3# Christian affiliations

Catholic Protestant Not stated

Denomination:





Findings III: Party affiliation

I Mainstream Christian Democrats: 40% support, but BavarianChristian Democrats (CSU) only 17% support for liberalisation

I SPD: mostly in favour, and FDP (almost) unanimously in favourI Greens and Left (!) do not differ significantly from CDU MPs




A large-scale survey experimentFindings

Why bother?

I PGD not a very salient, but potentially very relevant (see above)I Surveys commissioned by media around the 2011 vote

suggested support of up 80 per cent for liberalisation . . .I . . . that was passed with a relatively small majorityI To overcome impasse, Bundestag needed external trigger & free

voteI Christian Democratic/Green coalitions now more common at

state level, perhaps even an option for 2017I How would citizens chose?





How would citizens chose . . .

I . . . if properly sampled?I . . . if given an extended set of choices?I . . . if confronted with arguments from parliamentary debate?





Data collection

I Funding by German Research Foundation (DFG)I Ca. 2,000 face-to-face interviews (CAPI) conducted by Infratest

over a five-week period in summer 2016I Moderate oversampling of East Germans

I Short, neutral primers on IVF/PGDI 2 × 2 design

I Let respondents chose between 3 options / 5 optionsI Before / after asking them 16 arguments from the plenary

debateI Additional options:

I allow PGD for any (potential) carriers of genetic disorders (UK)I allow PGD for everyone (Belgium)

I Other batteries





Data collection

I Funding by German Research Foundation (DFG)I Ca. 2,000 face-to-face interviews (CAPI) conducted by Infratest

over a five-week period in summer 2016I Moderate oversampling of East GermansI Short, neutral primers on IVF/PGDI 2 × 2 design

I Let respondents chose between 3 options / 5 optionsI Before / after asking them 16 arguments from the plenary

debateI Additional options:

I allow PGD for any (potential) carriers of genetic disorders (UK)I allow PGD for everyone (Belgium)

I Other batteries





Background information on IVF/PGD

317100245

WAS IST KÜNSTLICHE BEFRUCHTUNG UND PRÄIMPLANTATIONSDIAGNOSTIK?

Die künstliche Befruchtung kann Paaren

helfen, Kinder zu bekommen.

Dabei werden Eizellen im Reagenzglas mit Samenzellen zusammengebracht. Wenn die

Befruchtung gelingt, werden die befruchteten Eizellen nach einigen Tagen in die Gebär-

mutter der Frau eingepflanzt.

Eltern, die an einer Erbkrankheit leiden oder die Veranlagung dafür tragen, geben diese mit

einer gewissen Wahrscheinlichkeit an ihre

Nachkommen weiter. Manche Kinder sind gesund, manche sind nur Überträger der

Anlagen, wieder andere erkranken selbst. In einigen Fällen sind diese Erkrankungen so

schwer, dass die Kinder noch im Mutterleib oder kurz nach der Geburt sterben.

Seit einigen Jahren gibt es die Möglichkeit, die künstlich befruchteten Eizellen vor der Einpflanzung in den Mutterleib auf Defekte am Erbgut zu untersuchen.

Dies bezeichnet man als Präimplantationsdiagnostik (PID).

Hierfür wird dem Embryo ca. 3 Tage

nach der künstlichen Befruchtung eine

Zelle entnommen und auf genetische Defekte untersucht.

Anschließend werden der Frau nur

gesunde Embryonen eingepflanzt.

Embryonen, deren Erbgut erkennbar geschädigt ist, werden weggeworfen.

Liste 1

SamenspendeEizellspende

Befruchtung im

Reagenzglas

PID ist die Suche nach

Gendefekten bzw. Erbkrankheiten …

… bei Embryos, die

durch künstliche Befruchtung

entstanden sind und

sich im Achtzell-Stadium befinden

(ca. am 3. Tag).





The experimental component

Group I1st measurement

3 options

Confrontationwith arguments

Group I2nd measurement

3 options

Group II1st measurement

5 options

Confrontationwith arguments

Group II2nd Measurement

5 options

Rando

misation





Did they have any previous knowledge?

IVF

%never heard about it 6.2heard a little 41.2heard a lot but gave little thought 43.2gave a lot of thought 9.4

PGD

%never heard about it 29.8heard a little 36.7heard a lot but gave little thought 26.7gave a lot of thought 6.8





What were the arguments, and where did they come from?

I Lengthy plenary debate before final voteI 16 arguments in favour/against liberalisation, boiled down to a

single statementI Respondents asked to think about each statement, then

measure agreement

I ExamplesI “Legalising PGD will lead to discrimination against handicapped

people”I “PGD is a lifeline for couples in a very difficult situation”I “It’s a slippery slope: Any liberalisation will eventually to more

and more testing”I “PGD can prevent unnecessary suffering”





What were the arguments, and where did they come from?

I Lengthy plenary debate before final voteI 16 arguments in favour/against liberalisation, boiled down to a

single statementI Respondents asked to think about each statement, then

measure agreementI Examples

I “Legalising PGD will lead to discrimination against handicappedpeople”

I “PGD is a lifeline for couples in a very difficult situation”I “It’s a slippery slope: Any liberalisation will eventually to more

and more testing”I “PGD can prevent unnecessary suffering”





How long did respondents take to evaluate the arguments?

0

.05

.1

.15

.2

De

nsity

0 10 20 30 40Time to evaluate arguments (minutes)

Median: 4:30 min ; Mean: 5:10 min





Did they find it difficult to make up their mind?

0

.1

.2

.3

Fra

ctio

n

very easy very difficultEasy/Difficult to decide?





What do citizens want?

%complete ban 13.6stillbirth/death 26.3severe genetic diseases 60.1

I Party ID, education, age group, denomination, (gender): no(significant) differences

I But strong effect of self-stated religiosity





Religiosity and citizens’ preferences

0

.2

.4

.6

.8

Pro

ba

bili

ty

not at all veryreligiosity

Predictive Margins with 95% CIs





Does deliberation make a difference?



I Citizens still more liberal than lawmakers, religiosity still mattersI 9.8% become more conservative, 8.7% become more liberalI Think: “more liberal” respondents +29 seconds, “more

conservative” +69 secondsI “Severe genetic diseases” is most stable choice (91.7%),

“stillbirth” least stable (78.5%)I “stillbirth” → “severe genetic diseases” is biggest change

(18.6%)








I Citizens still more liberal than lawmakers, religiosity still matters

I 9.8% become more conservative, 8.7% become more liberalI Think: “more liberal” respondents +29 seconds, “more



(18.6%)








I Citizens still more liberal than lawmakers, religiosity still mattersI 9.8% become more conservative, 8.7% become more liberal

I Think: “more liberal” respondents +29 seconds, “moreconservative” +69 seconds

I “Severe genetic diseases” is most stable choice (91.7%),“stillbirth” least stable (78.5%)

I “stillbirth” → “severe genetic diseases” is biggest change(18.6%)









conservative” +69 seconds

I “Severe genetic diseases” is most stable choice (91.7%),“stillbirth” least stable (78.5%)











“stillbirth” least stable (78.5%)












(18.6%)





What if we give them more choices?control experiment

% %complete ban 13.6 9.1stillbirth/death 26.3 11.6severe genetic diseases 60.1 24.2all genetic diseases 0.0 18.6everyone 0.0 36.5

I γ = 0.63 (p<0.00)I Majority (54%) for liberalisation beyond current status quoI But support for “stillbirth” also halved - anchoring?I Preferences just as stableI No relationship between time of deliberation ↔ more

liberal/restrictiveI “Everyone” most stable (93%), followed by “ban” (83%), others

74-80%







I γ = 0.63 (p<0.00)I Majority (54%) for liberalisation beyond current status quo

I But support for “stillbirth” also halved - anchoring?I Preferences just as stableI No relationship between time of deliberation ↔ more


74-80%







I γ = 0.63 (p<0.00)I Majority (54%) for liberalisation beyond current status quoI But support for “stillbirth” also halved - anchoring?

I Preferences just as stableI No relationship between time of deliberation ↔ more


74-80%







I γ = 0.63 (p<0.00)I Majority (54%) for liberalisation beyond current status quoI But support for “stillbirth” also halved - anchoring?I Preferences just as stableI No relationship between time of deliberation ↔ more


74-80%Kai Arzheimer Bioethical Preferences (29/32)



Summary

I Citizens more liberal than lawmakersI Religiosity the only relevant factor (so far)I Willing to engage with arguments, but little changeI Experimental variation of policy options suggests further

willingness to liberalise




So . . .

1. Is there indeed a sizeable gap between MPs’ and citizens’preferences on PGD?

yes2. Would citizens support a further liberalisation of the PGD

regime? yes3. Are citizens’ preferences shaped by the same determinants as

those of their MPs? yes/no4. Can the gap between citizens and MPs be narrowed by making

citizens reflect on arguments from a parliamentary debate? no




So . . .

1. Is there indeed a sizeable gap between MPs’ and citizens’preferences on PGD? yes

2. Would citizens support a further liberalisation of the PGDregime? yes

3. Are citizens’ preferences shaped by the same determinants asthose of their MPs? yes/no

4. Can the gap between citizens and MPs be narrowed by makingcitizens reflect on arguments from a parliamentary debate? no




So . . .


2. Would citizens support a further liberalisation of the PGDregime?

yes3. Are citizens’ preferences shaped by the same determinants as

those of their MPs? yes/no4. Can the gap between citizens and MPs be narrowed by making





So . . .








So . . .



3. Are citizens’ preferences shaped by the same determinants asthose of their MPs?

yes/no4. Can the gap between citizens and MPs be narrowed by making





So . . .








So . . .




4. Can the gap between citizens and MPs be narrowed by makingcitizens reflect on arguments from a parliamentary debate?

no




So . . .








Outlook

I Other factors?I Related policies/valuesI Personal experienceI ?

I What next? Turn this project into proper manuscripts(hopefully soon)


Does deliberation reduce the gap between citizens' and legislator's ethical preferences? First...

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