Decision Focused Public Engagement model
The Decision Focused Public Engagement model was developed by Roger Bernier, a U.S. Department of Health official, who sought a way to engage the public and involve 'ordinary citizens' in formulating health policy regarding ethical issues. The model stands out with its focus on only 'non-expert' participants, making a clear a separation between scientific (or medical) facts and ethical values.
Contents
Background
When trying to formulate government policy on infant vaccination, Roger Bernier was shocked to see how anti-vaccination activists were quick to dismiss concrete scientific evidence showing no connection between vaccines and the development of autism in infants. He realized that ‘hard’, empirical evidence was not enough to convince a public already entrenched in their views. There was a basic trust issue with many citizens simply not willing to listen to the scientific and medical experts.
Bernier decided that increased public engagement was needed to bridge this gap of mistrust. Instead of trying to engage the public in the debate around vaccinations and autism, he decided to try his experiment on the issue of pandemic influenza. He believed that while the public already had entrenched opinions that would be hard to change about the autism claims, the issue of pandemic influenza was relatively unknown and the participants could therefore begin the experiment with a ‘clean slate’.
He decided to use the problem of pandemic influenza vaccination prioritization to try a new public engagement model.
Purpose
The purpose of the engagement would be to formulate a clear policy regarding the use of the vaccine for pandemic influenza. The U.S. holds only a limited stock of the vaccine, so a decision had to be made regarding who to give the vaccine to in the event of a breakout. Bernier and the Health officials realized that this issue was not purely a professional, medical issue, but that there were ethical considerations that needed to be taken as well. Citizens are the “repository of our core public values” and therefore are the best to decide on ethical and normative issues (Bernier & Wills-Toker, 2014). Therefore, the officials decided that (legitimate) ethical decisions must be made by the public.
They developed a process based on three premises: First, the formulation of the vaccination policy required the policy-makers to understand the society’s values regarding the issues. Second, the values would be best expressed through a public engagement process. Finally, there would need to be an inclusive model that would best reflect the common values.
Recruitment
With the above goal in mind, the organizers carefully selected the participants using both “inclusion” and “exclusion”. They selected participants that would reflect and represent the spectrum of the citizenry, while purposefully choosing participants without a medical or professionally-related background to focus solely on society’s values as opposed to the empirical findings. In this way, the organizers attempted to engineer their participating public to express norms that reflected the kind of public the organizers wished to reach. (In addition, the organizers created a separate "National Stakeholder Group" of professionals and experts who would function as an advisory council to consider the citizen recommendations before implementation.)
The participants were all self-selected (volunteers) who applied to participate in the engagement. The organizers then sifted through the lists of volunteers and designated the ‘stakeholder’ (those with vested interests) and ‘non-stakeholder’ groups for the ethics-focused stage allowing only the non-expert, non-stakeholder group to participate.
Thus, the mini public designed for the deliberation ended up being 250 volunteers who had been deemed as non-stakeholders, with no previous professional medical or scientific knowledge or experience related to the issue.
Deliberative Process
The organizers defined 5 stages of the project:
Phase I
First meeting of the stakeholder group (approximately 50 people) to plan the project and define the issues. The group sat through a number of presentations and lectures to ensure that all the stakeholders were 'on the same page' and had a strong general understanding of the issues.
Phase II
One day, open deliberation for the citizens (non-stakeholders) to select the goals for the vaccination program. 101 citizens (volunteers) gathered and presented with a list of potential goals for a national pandemic influenza vaccination program. The choices/goals were:
- Save those most at risk
- Put children and young people first
- Limit the larger effects on society
- Use a lottery system
- Use the principle of "first come, first served"
Before deciding on the goals, the participants were given presentations on the subject as well as undertook ethics dilemma exercises to prepare them for the deliberation on the issues. The participants were then separated into 14 smaller groups where they discussed the issues, and then voted to rank the priorities.
Phase III
Second meeting of the stakeholder group to consider the citizen priorities and decide what are the highest priority goals.
Phase IV
Feedback session with the citizen group to obtain reactions to the priority list and suggestions for changes.
Phase V
Compiling of final report by the Stakeholder Group on the public’s perspective on the highest priority goals for a national pandemic influenza vaccination program.