Choices without reasons: citizens' juries and policy evaluation

Area of Science:

• Health Services Research
• Public Policy
• Bioethics

Background:

• Citizens' juries are proposed as a democratic method for health service reviews.
• Their effectiveness is attributed to rational deliberation over consumer preferences.

Purpose of the Study:

• To critically evaluate the assertion of critical detachment in citizens' juries.
• To determine if juries employ reason to resolve fundamental disagreements in health service provision.

Main Methods:

• Analysis of the theoretical underpinnings of citizens' juries.
• Examination of reported jury practices and their evaluative frameworks.

Main Results:

• Citizens' juries may promote a bureaucratic framework (social welfare maximization) rather than critical detachment.
• Jury practices can involve suppressing everyday moral language in healthcare evaluation.
• This suppression can lead to a system where denying treatment to sick individuals is deemed permissible.

Conclusions:

• Citizens' juries are primarily concerned with non-rational persuasion, not rational deliberation.
• They are morally and democratically irrelevant as a substitute for voting.
• Juries do not adequately protect the public from zealous minorities.