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“Alberta ‘Citizens Jury’ Offers Public A Say”

by February 18th, 2010

By Keith Gerein

Should the government cover new cardiovascular drugs for seniors, or should the money be used to recruit specialists in child illnesses?

Is it better to fund surgical procedures that provide relief for cancer patients, or buy new technology to protect nurses from infectious diseases?

Health policy leaders are often confronted with these kinds of heartbreaking scenarios, yet their decisions sometimes fail to include a sufficient level of public input, says a University of Alberta scientist.

That’s why Dev Menon is attempting to address this deficiency with his latest research project, an unusual experiment that calls for the creation of a “citizens jury” of 16 Albertans, randomly chosen, to consider questions of funding, care and priorities.

As the Stelmach government pushes for more public consultation in its health system, Menon believes the method can serve as a superior example of ensuring societal values and informed opinions are passed on to the decision-makers.

“I’m a cynic, so take this for what it’s worth, but it’s easy to send out surveys to get the answers you want,” said Menon, a scientist in the U of A’s school of public health.

“Poorly conducted public engagement is sometimes worse than no public engagement … so let’s do it in a scientifically robust way that captures people’s true beliefs and values. People have to be informed and have to deliberate before they make choices on difficult things.”

Menon’s jury will be constructed in a similar way to those in the criminal court system. They’ll gather for three days, initially listening to “witnesses” including patients, government health leaders, doctors, pharmacists and executives from medical technology companies.

Then come the deliberations, as participants must rule on some difficult scenarios of health funding. The scenarios are designed to pit different groups against each other — children versus seniors, people with chronic diseases versus terminally ill patients, caregivers versus people from marginalized communities.

“We’ll pick two health technologies that will help populations with different mixes of some of these value attributes — age, current health status, how long they have been ill, if there are no alternative treatments and so on,” Menon said. “And the jury will have to choose one of the technologies.

“Sometimes the public doesn’t understand that all of these decisions are trade-off decisions. When you say you’re going to fund something, you’re implicitly saying you can’t fund something else.”

Menon has tried a citizen jury project once before, and they have been used in the United Kingdom and Germany, often ending with interesting results.

For example, if a decision comes down to helping babies or seniors, people typically choose babies, he said. But the issue gets more difficult when caregivers are included, because it’s believed such people should be protected. There is also sympathy for patients who have no other treatment options available.

“What we want to do is get an idea of what values the public considers important and should be considered when making decisions on resource allocation,” Menon said. “It can’t be just technicians or commissions or bureaucrats who set the standards for what should be funded, because values need to come into play.”