The Jersey Assisted Dying Citizen’s Jury was commissioned by the Minister for Health and Social Services in response to a petition signed by 1,861 people. The jury considered whether assisted dying should be legalised and the circumstances under which it should be permitted.
This case study has been completed by Jessica Chitty as the final assignment in the module "Collective intelligence" at the University of Southampton 2022.
Problems and Purpose
The Jersey Assisted Dying Citizens' Jury was established to address the problem of legalising assisted dying. Their key purpose was to deliberate and then vote on the question: "should assisted dying be permitted in Jersey, and if so, under what circumstances?" (Involve,2021). A Citizens' Jury is a type of deliberative mini-public, which purpose is to discuss complex and often ethically troubling issues (Smith and Wales, 2002). This participatory innovation produces recommendations which inform the wider debate and updates elected officials on the community's view of an issue (Involve, 2021).
Background History and Context
Assisted dying is when a person with a terminal illness or condition which limits their quality of life is helped to die (Lewis, 2007). The term assisted dying is used to describe two methods of ending a life: assisted suicide and voluntary euthanasia. In the United Kingdom assisted dying is illegal, but in Jersey, there is no law prohibiting the ending of your own life or aiding someone else (States Greffe,2021). However, there is legislation which rules that attempted murder, aiding and counselling murder are offences and thus someone assisting a death could be charged (States Greffe,2021). Therefore, there is some uncertainty around the legality of assisted dying. Furthermore, in Jersey, a resident is allowed to travel to a country which offers legal assisted dying, such as Switzerland but there are significant costs associated with this (up to £25,000). As a result, there are considerable inequalities in access to lawful assisted dying (States Greffe,2021).
Therefore in 2018, an online petition was established urging for the States Assembly to change Jersey law and legalise assisted dying (Involve,2021). The petition argues that in other countries there have been moves to decriminalise assisted dying, they use the example of Guernsey in which there was a failed attempt at legalising assisted dying. This urged the petitioner to argue that 'the time has come for it to be debated in Jersey with all options considered' (States of Jersey, 2018). The petition was signed by 1,861 people, meeting the 1000 signatures needed for a response from the Health Minister (States of jersey, 2018). The views expressed through this petition were also reinforced by online opinion surveys. A survey of 1,420 citizens found that 86.5% of respondents thought assisted dying was acceptable to some extent and over 50% of the 71 Jersey doctors surveyed supported assisted dying (4insight, 2019a; 4insight, 2019b). In February 2020, in response to growing public support for assisted dying within Jersey, the Minister for Health and Social Services, Richard Renouf, promised to commission a citizens' jury (Involve,2021). The Citizens' Jury aimed to make sure the States Assembly would have a developed understanding of the citizens' views on the ethical, medical and legal issues of assisted dying before a formal State debate was conducted (Involve,2021)
The Assisted Dying Citizens' Jury is the fourth deliberative body established by the government of Jersey (PAC, 2022). But this is the first time this democratic initiative had been used in such an ethically complex policy area. Other initiatives concerned policy areas of mental health and children living in care (PAC,2022). A report by the Public Accounts Committee, which scrutinises the expenditure of government projects, identified that the use of Citizen Juries, Assemblies and Panels have 'been a valuable process in assisting Government decisions' (PAC, 2022).
Organizing, Supporting, and Funding Entities
This innovation was funded by the government of Jersey which commissioned a participation charity, Involve, to organise the process of the Citizens Jury. Their main role was to support the set-up of the Jury process, facilitate the sessions and communicate with participants (Involve,2021). Involve hired the facilitators who ran group discussions. Importantly, all facilitators had training in deliberative participation and ensured proper discussions took place but also guaranteed all Jurors had a chance to share their views (Involve, 2021). Involve also wrote and published the final report of the Citizens' Jury.
The Jersey government worked collaboratively with Involve to oversee the practical arrangements of the Jury. Officers from the government provided logistical help with the planning and delivery of the sessions.
The Jury was also supported by an independent advisory panel, content oversight consultants, expert advisors and the Sortition Foundation (Involve, 2021)
- The independent advisory panel was tasked with overseeing the Jury process to ensure its integrity through scrutiny. The panel was made up of 4 members and was chosen by the Health and Social Minister. The members were chosen based on their ability to be impartial and provide an objective voice but also to challenge the Jury process. 1 to 2 members from the panel observed each jury session and the whole panel met 5 times.
- The content oversight team was made up of three experts on assisted dying, but all had a range of positions on the issue. Their job was to ensure the Jury sessions were informative and balanced.
- A further two expert advisors attended all sessions of the Jury to answer questions from Jurors.
- The Sortition Foundation was in charge of participant recruitment for the Jury. They advocate for the use of random selection in democratic processes and aimed to ensure the participants were representative of the population of Jersey.
Finally, due to the sensitive nature of assisted dying, well-being support was offered to Jurors by the charity Mind Jersey (Involve,2021).
Participant Recruitment and Selection
In January 2021, 4,600 invitations were sent to a random sample of addresses in Jersey (Involve, 2021). The invitations allowed anyone over 16 to register their interest to participate in the Jury. A total of 477 citizens registered their interest (Involve, 2021). An external organisation, Sortition Foundation, conducted the recruitment of the participants through a civic lottery. A process called sortition was used to randomly select a small sample of participants, 23 people were selected. They ensured that the participants broadly represented the demographics of Jersey over key criteria: age, gender, location, socio-economic status, place of birth and their attitude towards assisted dying (Involve,2021).
In terms of why people chose to participate, the only material incentive that participants received for taking part was a payment of £300 (Involve,2021). However, it is not clear if this was advertised at the initial invitation to register interest or after.
Methods and Tools Used
This case is an example of a Citizens Jury, a type of deliberative mini-public where a 'jury' meet and are informed in detail on a particular issue (Smith and Wales, 2002). This jury is intended to be a sample representative of the population. The uniqueness of citizens juries as a participatory process lies in involving citizens to improve their knowledge of a policy area, ask questions, engage in group discussion and deliberating to reach a final decision and/or set of recommendations (Smith and Wales, 2002). The reasoning behind this choice of method was demonstrated by the Minister for Health and Social Services, who commissioned the jury. He stated that a citizen's jury needs to be used in this case as 'rehearsing the debates of our neighbours is not satisfactory' and that they 'need to ensure that our Assembly… have an in-depth understanding of our community's response to the medical ethical, legal and regulatory issues associated with assisted dying before we launch into debate' (Renouf, 2020).
In addition to the method of the participatory process, tools and techniques are also used to support the process. In this case, small group deliberation was a key technique used to facilitate deliberation and participation. As well as working as a collective jury, jury members worked in small groups (the size of which hasn't been reported) with a group facilitator. This is aimed at creating a more inviting environment to encourage all jurors to communicate their views (Involve, 2021). In addition, the Jury took part in three votes, one of which used a preferential system of voting. This voting technique was used to identify the jury's preference for the circumstances when assisted dying should be permitted. The final report states that the choice to use this system of voting was based on examples of previous citizens' juries and assembly processes (Involve, 2021)
What Went On: Process, Interaction, and Participation
The Assisted Dying Citizen's Jury ran from 18th March to 15th May, the Jury met online for 10 sessions, each lasting between 2-2.5 hours (Involve,2021).
The voting process
The main purpose of the jury was to deliberate and vote on the questions: "Should assisted dying be permitted in Jersey? And, if so, under what circumstances?". There were three stages to the voting process, the first vote was held after session 8, the second after session 10 and the final a week after the second vote.
The first vote was on the question: In principle, do you agree or disagree that assisted dying should be permitted in Jersey? The result of the initial vote shaped the future discussion and the content of the second and final vote. The results were: 48% of Jurors 'strongly agree', 26% 'tend to agree', 9% tend to disagree and 17% strongly disagree (Involve,2021). Because the majority of Jurors voted in favour of assisted dying, the following sessions discussed the circumstances when assisted dying should be allowed.
The second vote concerned the second part of the question, under what circumstances assisted dying should be allowed. This vote used a preferential voting system to indicate clear preferences, Jurors were asked to vote on eight questions. However, this voting technique did not serve its intended purpose in all examples. Notably, when asked 'who should be eligible of assisted dying related to age criteria?', no preference achieved an overall majority. If the juror's first preferences were taken into account 'over 18s only' no majority would be achieved. But, if the second preferences were also considered it resulted in a tie between 'over 18s only' and 'anybody of any age'. This is problematic as it means that the Jury's recommendations for age eligibility were not definitive.
The final vote asked jurors to vote again for or against allowing assisted dying, accounting for the circumstances identified through the second vote.
A clear majority, 78% of Jurors, voted that assisted dying should be allowed in Jersey under the following circumstances:
• Jersey resident
• age 18 or over
• terminal illness or unbearable suffering
• stringent safeguards are in place (e.g. pre-approval process).
Influence, Outcomes, and Effects
The recommendations of the Jury were presented to the State Assembly, Jersey's parliament, and in response, an in-principle debate was held. In November 2021, Jersey became the first British government to approve the principle of assisted dying, voting 36 to 10 to support the proposition (Parsley, 2021) The decision of the State Assembly followed the exact recommendations of the Jury who asked the State Assembly to agree in principle that assisted dying is authorised under certain circumstances. Following this decision, the State Assembly must now consider more detailed proposals for legislation on assisted dying, this debate is scheduled for November 2022 and a change to legislation is expected to occur by 2024 (gov,je, 2022). Importantly, as a British Crown Dependency, Jersey is authorised to legislate independently from the UK government, therefore it is very likely this legislation is passed (gov,je, 2022). Ultimately, this case achieved its intended result and successfully informed the State Assembly of the public's view of assisted dying.
In addition to achieving the intended aim of the Jury, the case has been recognised as a successful democratic innovation. The Public Accounts Committee of Jersey reviewed recent democratic innovations and concluded that the Assisted Dying Citizens' Jury was the most successful example of a deliberative process in Jersey (PAC, 2022). This was 'due to its transparency, facilitation, availability of presentations and evidence provided to the Citizens' Jury, minimisation of overspend, and the clear and structured feedback provided by its members' (PAC, 2022). The PAC then recommends that this case be used as a model for future deliberative innovations.
Analysis and Lessons Learned
The analytical framework of democratic goods as developed by Smith will be applied to this case (2009). The framework enables an analysis of democratic innovations based on the extent to which they have goods/qualities considered desirable of democratic innovations. This framework includes four 'democratic goods'; inclusiveness, popular control, considered judgement and transparency (Smith, 2009). There are also a further two institutional goods; efficiency and transferability, which are important in the practicality and institutionalisation of the democratic innovation (Smith, 2009).
A key strength of this case is that feedback was collected from the jury at the end of the process, evidence from these results will be quoted throughout this analysis. The Jury were asked to rank their agreement to a series of statements, 1 being the lowest level of agreement and 5 the highest.
This first democratic good concerns the extent of demographic and effective inclusion in the participatory process (Smith, 2009). When assessing the level of inclusion focus must be given to both the way participants are selected and the extent to which a participant has a voice within participation (Smith, 2009). A key issue of mini-publics, such as citizens' juries, is that no matter the size, participation is restricted (Smith, 2009). Inclusion is best achieved through an institution open to participation from everyone, but evidence suggests that when citizens are given an equal chance to participate, the level of participation differs across social groups (Smith, 2009). In this case, citizens were asked to reply to an invitation and register their interest in participating, this self-selection may replicate existing inequalities in political participation, such as the more wealthy and educated being most involved in politics (Fishkin and Farrar 2005). As a result, the selection mechanism used in this case purposely accounted for this issue and aimed to increase the inclusivity of participation. The sampling method of sortition ensured that the demographic make-up of Jury members represented Jersey's population across key demographics. For example, the stratification criteria sex was almost identical to the population of Jersey (49.6 % male population, 47.8% jury members male).
Secondly, inclusion can be measured through effective inclusion, the extent to which participants have equal opportunities to express their opinions and influence the output of the institution. The strength of using mini-publics is that they are structured to enable voice and communication between participants, this is true in this case as the design of the sessions allowed jurors to work in small groups with a facilitator. Jurors were asked to give an evaluation of their involvement in the jury, the feedback indicates that inclusion rates within the jury were high (Involve, 2019). For example, the average score in response to the statement 'the small group facilitator helped to make sure everyone could contribute' was 4.68 and 4.69 to the statement ' I had ample opportunities in the small group discussions to express my views' (Involve, 2021).
Popular control concerns the extent to which participants have control over the decision-making process (Smith, 2009). The Policy Stages Framework will now be used to assess where control was given to participants, this analysis will use the first two stages to demonstrate the level of popular control exercised in this case (Hoefer, 2021). The first stage is policy agenda setting, in this case, the participants did not play a direct role in this as the jury was established to deal with a predetermined policy issue. However, there was significant popular control realised by citizens of Jersey who used a petition to successfully pressure their politicians to act on the issue. Further, democratic participation is often limited to 'safe' issues in order to avoid conflict, but assisted dying is a very ethically and morally complex issue which crosses both religious and scientific borders (Smith, 2009). This suggests that popular control was realised in the agenda-setting stage on a significant policy issue. The next stage is policy formulation, this is when policy solutions to the issue are developed (Hoefer, 2021). When popular control is realised on significant issues a common criticism is that participation has little effect on decision-making (Smith, 2009). However, this case again seems to be an exception, the recommendations of the jury were presented to the States Assembly, and this was used to inform their debate. Ultimately Jersey became the first parliament in the British Isles to vote that assisted dying should be allowed in principle. Finally, when answering the question 'I feel my participation in this citizens' jury will have an impact' the average score was 4. This supports that the jurors believe they had a high level of popular control.
Considered judgement concerns the capacity of citizens to make thoughtful and reflective decisions (Smith, 2009). Considered judgment requires that citizens both develop their understanding but also appreciate the views of opposing perspectives (Smith, 2009). There are two elements of this case that facilitated considered judgement within participants. The first being the provision of sufficient information to properly learn about the topic. This was ensured by having the participants listen to a range of speakers. The content oversight team was in charge of selecting speakers and the evidence which would be shared with the Jury. When asked to judge the statement 'I have learned a lot during the citizens' jury on assisted dying' the average score from participants was 5 (very strong agreement).
The second element was the presence of mechanisms which ensured participants listened to and respected one another even if they have opposing views. At the start of the Jury, participants agreed on how the Jury would operate together and drew up an agreement (Involve, 2021). Key principles of this include 'be gentle with one another' and 'don't be judgemental about people's views and hear their opinions' (Involve,2021). Again, the feedback from participants demonstrates that this mechanism was successful in helping realise considered judgement, they gave an average score of 4.63 (strong agreement) to the statement 'my fellow participants respected what I had to say, even when they didn't agree with me' (involve,2021).
The Transparency of a democratic innovation can be divided into two forms: internal and external (Reig et al, 2021) Internal transparency refers to the amount of information the participants know about the process (Reig et al, 2021). External transparency relates to the visibility of the case to the public (Reig et al, 2021). In this case, participants had high internal transparency, and the jury had a clearly defined and understandable task, answering set questions. This is shown through the response to the statement 'I know how the decisions and recommendations jury members have made are going to be taken forward by the States' Assembly' which had an average score of 4.74 (Involve, 2021). To increase transparency, it is also important that participants can scrutinise the proceedings (Reig et al, 2021). In this case, participants were offered a chance to give feedback after each block of jury sessions, which allowed for 'real time' changes to be made. This helps participants build trust in the system they are operating under.
Due to the nature of the issue being personal and sensitive, external transparency of the content of the Jurys deliberations is low and the minutes of such sessions have not been published (Involve, 2021). Instead, the minutes of the meetings of the independent advisory panel and the content of the evidence speeches were published (Involve, 2021). In addition, external transparency can also be referred to as publicity. Because of the saliency of the issue, this case received huge media attention both locally and nationally across major UK media outlets, such as BBC and ITV news and therefore achieved external transparency through publicity (Lacobucci,2021). As Smith argues, this level of external transparency is also a significant inducement for the participants to act in a more societal-focused way and not in a self-serving manner (2009). This in turn may influence participants to realise the democratic good of considered judgement (Smith, 2009).
The Efficiency of a democratic innovation regards the trade-off between outcomes and costs of the process for both officials and citizens (Smith, 2009). Since an independent body (Involve) was commissioned to run the jury, there was little administrative or bureaucratic reorganisation needed, resulting in minimal costs. However, there was a large financial cost, totalling £65,952, with each participant being paid £300 for their commitment (Involve, 2021). The main burdens of participation on citizens are time and energy, however, this is often outweighed by the perceived rewards (Smith, 2009). Participants committed a lot of time to this case, they took part in 10 sessions which lasted an average of 2-2.5 hours each (Involve, 2021). Despite this, participants viewed the experience positively and 80% of participants strongly agreed that citizens' juries should be used more often to inform governments on policy-making (Involve, 2021).
Transferability relates to the ability of a democratic innovation to be applied under different circumstances, for example, transferred across cultures, topics and levels of governance (Smith, 2009). Mini publics and more specifically citizens juries have a history of successfully being transferred, even across levels of governance and policy issues. Key evidence of the transferability of this case is that an almost identical case was successfully held in New Zealand in 2018, this case had very similar results as a majority of jurors voted in support of legalising euthanasia (Balance, 2018).
The design of mini-publics, such as this Citizens Jury, influences the probability of achieving the six democratic goods defined by Smith (2009). The recruitment of participants and interaction between participants facilitated the achievement of inclusion and considered judgement. What is striking about this case is that where mini-publics are often weakest, realising popular control and transparency, the Jersey Assisted Dying Citizens' Jury was successful.
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