The deliberative citizen process
| If decisions should take account of public opinions, as we suggest in our second commitment, a mechanism must be used to find out what these are. One approach is to ask members of the public directly. This can involve explicit polling questions, such as a recent YouGov poll that revealed that the public would give priority access to ventilators to doctors and nurses, parents, and the armed forces above supermarket workers, members of parliament or the Royal Family.10 More complex and subtle questions can also be asked, such as the MIT moral machine experiments, which asked people to consider and vote on which of two groups of people should be killed by an autonomous car if it crashed.11 This revealed that there are significantly different opinions around the world, and some opinions that may be seen to be ethically surprising: for example it found that people are more willing to kill a criminal than a dog. Polling relies on the public having appropriate information to make useful judgements, and does not provide space for discussion and reflection. For that reason, many groups have used more expansive deliberative processes.12 These bring a number of people together to discuss issues, with information given from both neutral and partisan sources. They vary in scale from the large-scale Deliberative Opinion Poll, pioneered by Jim Fishkin,13 which brings together 500 or so people for a few days, to Citizen's Juries, which assemble 1,224 people, often for half a day. The bigger the group, the more representative, but the greater the cost. Ireland has used Citizen's Assemblies to drive major changes, including constitutional reforms and the repeal on the ban on abortions. The breath of engagement and discussion were very effective at changing broader public and political opinion. Manchester has run smaller Citizen's Juries to consider questions such as ‘To what extent should patients control access to patient records?’ and the use of artificial intelligence in healthcare, especially the trade-off between explainability and accuracy.Decisions about what medical services to provide have often been driven by expert clinician preferences, which may not accord with the public and patient experience. More recently, there has been more engagement with patient representatives, which has advantages in understanding lived experience, but does not necessarily reflect the wider views. When difficult decisions have to be made about which services to provide or not to provide, deliberative citizen engagement is a powerful and underused tool to help make choices. |