Should We Use Citizens' Assemblies to Make Health Policy?

Abstract

This article assesses the normative case for using citizens' assemblies—small deliberative forums of randomly selected citizens—in health policymaking. Although they are increasingly popular, their normative justification remains underexplored. We reconstruct three possible rationales: Norman Daniels's ‘Accountability for Reasonableness’ (A4R) framework; an epistemic argument emphasising the value of outsider perspectives for making more just decisions; and a deliberative democratic argument focused on promoting legitimacy in the bureaucracy. We argue that A4R offers only weak and contingent support for citizens' assemblies. The epistemic argument highlights the value of lay perspectives in identifying epistemic blind spots but lacks clarity on when it outperforms expert knowledge. The deliberative democratic rationale is more compelling in potentially generating some kinds of legitimacy but applies only in a limited range of scenarios. We therefore conclude that the normative case for using citizens' assemblies is not as strong as their popularity in policymaking would lead us to believe.