The involvement of stakeholders and the public in societal decision processes has lately received increased attention. We suggest that appropriate and tailored techniques should be selected and integrated to provide the prerequisites for inclusive involvement depending on the issue, type, goals and phase of the decision process in question, i.e. an analytic, systematic and dynamic approach to collaboration. In a transdisciplinary case study design we integrate diverse analytical methods whereby a process of mutual learning between science and people from outside academia is strived for. Our framework for collaboration is illustrated by a case study on sustainable landscape development in the Swiss prealpine region of Appenzell Ausserrhoden.Keywords Societal decision process Á Involvement of stakeholders and the public Á Collaboration Á Transdisciplinary case study design Á Sustainable development

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Interdisciplinary scientific knowledge is necessary but not sufficient when it comes to addressing sustainable transformations, as science increasingly has to deal with normative and value-related issues. A systems perspective on coupled human-environmental systems (HES) helps to address the inherent complexities. Additionally, a thorough interaction between science and society (i.e., transdisciplinarity = TD) is necessary, as sustainable transitions are sometimes contested and can cause conflicts. In order to navigate complexities regarding the delicate interaction of scientific research with societal decisions these processes must proceed in a structured and functional way. We thus propose HES-based TD processes to provide a basis for reorganizing science in coming decades.

Today, there is an increasing need for researchers to demonstrate the practical value their research can generate for society. Over the past decade, experts in transdisciplinary research have developed numerous principles, methods, and tools for making research more societally relevant. If researchers are unfamiliar with transdisciplinary research, they may miss opportunities to adapt these principles and tools to their research projects. We are developing a 10-step approach for joint use by transdisciplinarity experts and researchers about how to best align their research projects with the requirements of transdisciplinarity. We have successfully applied this approach in numerous workshops, summer schools, and seminars at ETH Zurich and beyond.Ten questions guide discussions between transdisciplinarity experts and researchers around research issues, identify and review the societal problems addressed, identify relevant actors and disciplines, and clarify the purpose and form of the interaction with them. The feedback we have obtained clearly indicates that the 10-step approach is a very useful tool: It provides a systematic procedure for thinking through ways to better link research to societal problem solving.

BackgroundSocieties are facing medical resource scarcities, inter alia due to increased life expectancy and limited health budgets and also due to temporal or continuous physical shortages of resources like donor organs. This makes it challenging to meet the medical needs of all. Ethicists provide normative guidance for how to fairly allocate scarce medical resources, but legitimate decisions require additionally information regarding what the general public considers to be fair. The purpose of this study was to explore how lay people, general practitioners, medical students and other health professionals evaluate the fairness of ten allocation principles for scarce medical resources: ‘sickest first’, ‘waiting list’, ‘prognosis’, ‘behaviour’ (i.e., those who engage in risky behaviour should not be prioritized), ‘instrumental value’ (e.g., health care workers should be favoured during epidemics), ‘combination of criteria’ (i.e., a sequence of the ‘youngest first’, ‘prognosis’, and ‘lottery’ principles), ‘reciprocity’ (i.e., those who provided services to the society in the past should be rewarded), ‘youngest first’, ‘lottery’, and ‘monetary contribution’.Methods1,267 respondents to an online questionnaire were confronted with hypothetical situations of scarcity regarding (i) donor organs, (ii) hospital beds during an epidemic, and (iii) joint replacements. Nine allocation principles were evaluated in terms of fairness for each type of scarcity along 7-point Likert scales. The relationship between demographic factors (gender, age, religiosity, political orientation, and health status) and fairness evaluations was modelled with logistic regression.ResultsMedical background was a major predictor of fairness evaluations. While general practitioners showed different response patterns for all three allocation situations, the responses by lay people were very similar. Lay people rated ‘sickest first’ and ‘waiting list’ on top of all allocation principles—e.g., for donor organs 83.8% (95% CI: [81.2%–86.2%]) rated ‘sickest first’ as fair (‘fair’ is represented by scale points 5–7), and 69.5% [66.2%–72.4%] rated ‘waiting list’ as fair. The corresponding results for general practitioners: ‘prognosis’ 79.7% [74.2%–84.9%], ‘combination of criteria’ 72.6% [66.4%–78.5%], and ‘sickest first’ 74.5% [68.6%–80.1%); these were the highest-rated allocation principles for donor organs allocation. Interestingly, only 44.3% [37.7%–50.9%] of the general practitioners rated ‘instrumental value’ as fair for the allocation of hospital beds during a flu epidemic. The fairness evaluations by general practitioners obtained for joint replacements: ‘sickest first’ 84.0% [78.8%–88.6%], ‘combination of criteria’ 65.6% [59.2%–71.8%], and ‘prognosis’ 63.7% [57.1%–70.0%]. ‘Lottery’, ‘reciprocity’, ‘instrumental value’, and ‘monetary contribution’ were considered very unfair allocation principles by both groups. Medical students’ ratings were similar to those of general practitioners, and the ratings by other health professionals resembled those of lay...