Author: Pravar Petkar, Head of Strengthening Democracy Desk
Have we found the solution to navigating assisted dying in England? The recent citizens’ jury on assisted dying, organised by the Nuffield Council on Bioethics, would appear to suggest so. Yet, research suggests that though a welcome innovation, the jury instead shows us how not to do deliberative democracy. This is down to the lack of a pathway to influence Government, the limited public awareness of the process and its small scale. This apparent failure should not put us off, but instead encourage further experiments on new ways to do democracy.
What are citizens’ juries?
A citizens’ jury is a three-stage process in which a randomly selected group of citizens comes together to learn about an issue, deliberate upon it and produce recommendations for policymakers. It is usually regarded as a smaller version of a citizens’ assembly, following the same process in a shorter time and with fewer participants. Citizens’ juries are examples of deliberative and participatory democracy: they rely on directly bringing citizens into the policy process to come to reasoned conclusions.
What did this citizens’ jury decide?
The jury members agreed that the law should change to permit assisted dying in England where adults with decision-making capacity are terminally ill. This could be either through physician-assisted suicide or voluntary euthanasia. This follows the introduction of a Private Members’ Bill on assisted dying into the House of Lords, and a similar Bill into the Scottish Parliament. The Lords’ Bill is expected to be withdrawn, as a Bill is to be introduced into the House of Commons on 16 October 2024.
Best practice: the Irish case
The best example of a deliberative exercise on a morally controversial issue is the Ireland Citizens’ Assembly on abortion, which took place between 2016 and 2018. 99 randomly selected citizens came together as an independent body established by the Irish Parliament for five structured weekends, at the end of which they produced a series of recommendations. Each weekend featured expert presentations and the consideration of submissions from members of the public, followed by structured roundtable discussions on specific issues. A committee of both chambers of the Irish Parliament considered the assembly’s recommendations to replace the constitutional ban on abortion with a provision allowing Parliament to legislate on the matter. The proposal was approved by Parliament, and then the people in a referendum on 25 May 2018. The evidence sessions were broadcast to the public, providing objective information for the referendum vote and creating wide awareness of the assembly process.
The Jersey case: success closer to home
Deliberative democracy has already been tried in the UK on the matter of assisted dying. In 2021, a citizen’s jury met in Jersey to provide its legislators with a detailed community response to the medical, ethical, legal and regulatory issues involved in permitting assisted dying. Following ten sessions of learning and deliberation, each lasting between 2 and 2.5 hours, the citizens’ jury recommended that assisted dying be permitted for Jersey residents aged 18 or over with a terminal illness or who were experiencing unbearable suffering. The citizens’ jury discussed a series of safeguards for the process, including a pre-approval process, the necessary involvement of medical professionals and the rights of those professionals to be conscientious objectors to the procedure. Two months’ later, Jersey’s legislature (the States Assembly) approved the availability of ‘assisted dying’ in principle. A Bill to allow assisted dying is now being drafted.
What went wrong in England?
Since both the Ireland citizens’ assembly and the citizens’ jury in Jersey were successful in both driving change and meaningfully engaging citizens, it seems logical to repeat the exercise in England, as the Nuffield Council on Bioethics did. Despite this, there are three design issues with the citizens’ jury that reduce its effectiveness and legitimacy:
- No clear pathway for the jury’s recommendations to influence Parliament.
Where citizens’ juries are set up by institutions external to the official decision-making process, there is no guarantee that decision-makers will consider the jury’s recommendations, still less that they will follow them. The most successful citizens’ juries in the UK have been initiated by local councils which have then directly implemented the recommendations.
- Limited public awareness of the process.
A crucial factor in both the Irish case and the citizens’ jury in Jersey was the public awareness around the process. This occurred through making the learning sessions of the deliberative process publicly available. In Jersey, moreover, the citizens’ jury followed an e-petition and an online public survey. Yet in England, only the results of the jury have been covered in the media, with seemingly little public information on the topics and experts who presented. It is difficult to view it as a genuinely ‘national’ conversation.
- The scale of the citizens’ jury was perhaps too small.
The citizens’ jury on assisted dying in England had 30 participants. This is slightly bigger than Jersey’s citizens’ jury, but a third of the size of Ireland’s citizens’ assembly. Even though the 30 participants were randomly selected by an objectively fair algorithm, many might doubt that there were enough participants to genuinely represent the views of over 55m people.
The need for further experiments
No process of experimentation or innovation has a 100% success rate; partial successes and errors are valuable in pointing in the right direction. The citizens’ jury on assisted dying in England plays a role like this, identifying some pitfalls to avoid as the country mulls over this complex issue. Yet there is enough evidence from elsewhere in the world to suggest we are barking up the right tree. Further deliberative exercises taking into account some of the issues raised here will benefit us, not only in resolving the issue of assisted dying but in crafting a more effective British democracy.
