The five contributions in this issue build on the analysis of normative practices that was developed more than twenty years ago in the Netherlands by Henk Jochemsen, Jan Hoogland, and myself for the practice of health care (Hoogland et al. 1995; Jochemsen and Glas 1997; see also Hoogland and Jochemsen 2000; Jochemsen 2006). This analysis was based on Dooyeweerd’s systematic philosophy, especially his views on the nature of individuality structures (or entities), as well as on Alasdair MacIntyre’s notions of practices, virtues, and the goods that “are internal to practices” (MacIntyre 1984). It was also—loosely—based on Immanuel Kant’s distinction between constitutive concepts and regulative ideas. This analysis resulted in a model that became known as the normative practice model (npm). Since its inception, the model has been embraced not only by Christian thinkers but also by others; and not only in health care but also in the fields of education, agriculture, communication studies, and journalism.
The npm distinguishes between types of practices, each practice having its own internal structure which consists of a constellation of norms with various roles; to wit, qualifying norms, conditioning (or: enabling) norms, and foundational norms. The practice itself is guided by the ethos of its participants—i.e., a set of overarching values and fundamental motivations which give direction and purpose to the practice. The distinction between normative structure and guiding ethos mimics the Dooyeweerdian distinction between the internal structural principles of an individuality structure and the religious dynamic that sustains and guides the development of this structure. Following in the footsteps of Mouw and Griffioen (1993), most of the contributions in this issue add another dimension to the model, namely, contexts. The initial formulations of the npm focused primarily on the individual professional–patient relationship. The context of this relationship was more or less presupposed (but considered to be important, of course). Developments within the practice of health care as well as in the other fields mentioned above necessitate a broader focus which takes meso- and macrolevel aspects of the practice into account.
Jansen, Van der Stoep, and Jochemsen start with an analysis of the normative structure of public communication by governments. They argue that this communication is shifting from a centralist, top-down, one-way approach toward an approach that is participatory, two-way, and guided by the idea of co-construction. As a result, ideas about what it is to communicate as a representative of the government have changed: from allocution to consultation, and from legitimizing to explaining what governments do. The authors see government communication as qualified by the linguistic aspect. They believe the core (or, meaning kernel) of this aspect to be expressing meaning (rather than aiming for clarity)—i.e., clarifying a given governmental policy by indicating what its meaning is. Communication officers, therefore, are not so much representatives defending governmental policies as monitors and managers of relationships in which the government and governmental agencies are involved.
Glas continues by putting the normative practice model to the test in broader contexts than just the individual professional–patient relationship. He emphasizes that it is not the aim of the npm to offer a blueprint, but that it serves as a heuristic device that helps professionals and administrators to orient themselves both conceptually and normatively. Differences between contexts lead to different constellations of normative principles and to different descriptions of core responsibilities of stakeholders. Activities at the institutional and societal level can still be understood from the perspective of the npm, taken in its broadest sense. However, these activities themselves are determined by non-moral types of norms—i.e., norms that are related to efficiency, sound policy making, and fair distribution of means. At the mesolevel of analysis, the emphasis is on dealing adequately with the need for health care services. At the macrolevel, the focus is on fair distribution of means and on protection of the general population—from natural disaster, epidemics, and general health risks. Another, relatively new (though not unexpected) dimension of the npm is its facilitating role in connection the different normative dimensions to core responsibilities of employees and stakeholders in their various relevant contexts.
Verkerk, Holtkamp, Wouters, and Van Hoof emphasize the complexity of current health care. In an interesting case study on how patients use and experience orthopaedic devices (they focus on the foot orthosis, a device that supports the ankle), they first point to the tunnel vision of many professionals. As a result of this tunnel vision, professionals are primarily focused on their own contribution, are not adequately focused on the needs of patients, and do not manage the care cycle as a whole. The authors then turn to the Triple i approach to normative practices. This approach has been developed as an organizational variant of the normative practice approach and has been applied in sustainability studies and evidence-based design processes. The i refers to the identity of the organization, interests of stakeholders, and ideals and basic beliefs of the organization as working community. These three aspects are more or less similar to structure, context, and direction, respectively. They co-shape guidelines, habits, and attitudes of employees, and managerial relationships. Next, user practices and the chain of care are discussed. In the case of the orthopaedic devices, at least four practices are involved, to wit, the health care practice (general practitioner, medical specialist), the engineering practice (designing the device), the manufacturing practice, and the user practice. Each of these practices—except the user practice, I am inclined to say—is embedded in an organization.
Another, beautiful case example is worked out in the article by Boshuijzen-van Burken and Haftor about the Uber app. They attempt to distinguish ride-sharing applications such as Uber from ordinary taxi enterprises from a normative practice perspective. The authors first conduct a structural analysis of Uber as a practice by making distinctions at the level of (1) aspects; (2) radical types, genotypes, and phenotypes; and (3) part-whole relationships, enkaptic relationships, and interlinkages. They conclude that the genotype of such taxi matchmaking enterprises as Uber represents a novel normativity that could positively serve society and also produce normative challenges, depending on its governance. The authors suggest that regulators should not dismiss the entire genotype of taxi matchmaking enterprises, but should address the phenotypes that are illegal or that cannot thrive without the illegal behaviors of its users. They base this conclusion on a variant of the normative practice model.
Rademaker, Glas, and Jochemsen, finally, investigate how the concept of sustainability is to be understood in livestock farming. They argue for the economic sphere as qualifying sphere and for the formative aspect as founding (or, foundational) aspect. Competent farming also requires that justice is done to the conditioning norms. Failing to obey these and other norms will not present an immediate threat to the livestock farming practice, but it will affect its stability and integrity in the long run. The authors also argue that the subject of their investigation cannot be considered apart from its context: sustainability and the livestock farming practice depend on the broader system of food production and distribution.
The articles in this special issue were first presented as papers at the international conference “Christianity and the Future of our Societies,” organized by the Association for Reformational Philosophy and the Evangelische Theologische Faculteit in Leuven, Belgium, from 15 to 19 August 2016. They echo the open-mindedness, broadness, and welcoming and hopeful spirit of the conference.
Hoogland J. , and Jochemsen H. (2000). Professional Autonomy and the Normative Structure of Medical Practice. Theoretical Medicine and Bioethics 21 (5), pp. 457–475.
Hoogland J. , Jochemsen H. , Polder J.J. , and Strijbos S. (1995). Professioneel beheerst—Professionele autonomie van de arts in relatie tot instrumenten voor beheersing van kosten en kwaliteit van de gezondheidszorg. Rapport van het Prof. dr. G.A. Lindeboom Instituut (no. 12). Ede: Lindeboom Instituut.
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( Hoogland J. Jochemsen H. Polder J.J. Strijbos S. 1995). Professioneel beheerst—Professionele autonomie van de arts in relatie tot instrumenten voor beheersing van kosten en kwaliteit van de gezondheidszorg. Rapport van het Prof. dr. G.A. Lindeboom Instituut (no. 12). Ede: Lindeboom Instituut.
Jochemsen H. (2006). Normative practices as an intermediate between theoretical ethics and morality. Philosophia Reformata 71 (1), pp. 96–112.
Jochemsen H. , and Glas G. (1997). Verantwoord medisch handelen. Proeve van een christelijke medische ethiek. Amsterdam: Buijten & Schipperheijn.
Mouw R.J. , and Griffioen S. (1993). Pluralisms and Horizons: An Essay in Christian Public Philosophy. Grand Rapids: W.B. Eerdmans Publishing Company.