Since my last post on the impact of social media on the jury system, I have been thinking about the concept of juries. Clearly from the examples given, there are some not-very-bright people being chosen for this very important task. These people, who hold the fate of another in their decision-making process, didn’t have enough common sense to not comment on cases on social media, not contact defendants and other participants in the trial via social media, or in one instance, to not brag about escaping jury duty on social media. And the woman who used a Facebook Poll to help her decide about a defendant’s guilt – words escape me. Quite frankly if I had been involved in any of these trials I would probably have been glad to see the back of these people.
So does the jury system stack up? Twelve people randomly selected from the eligible adult population, panelled to hear evidence which may be of a highly technical nature, in an adversary system. Shouldn’t there be an IQ test? Perhaps expert jurors who know and understand the law might be a better option? And why twelve? Presumably it is a small enough number that a decision might actually be reached, yet still large enough to allow for the….hmmm, shall we say “outliers”? A large enough number for any extremist views and crackpots to be ameliorated by the others. And then of course they do try to screen out the true crackpots and those with vested interests and strong prejudices.
Now I am not a lawyer, nor do I work in the legal system, but I have come across the concept of citizen juries in the health system. And this might restore all of our faith in the system.
Citizen Juries in health decision-making are provided with a variety of unbiased information such as costs of alternate treatments, population numbers and demographics, health statistics, epidemiology (how many people are affected by a particular illness or disease). This information should be unbiased and factual in nature, not opinion-based. In this way it does differ from the adversarial legal system where the two sides of the case are presented by the legal teams who are paid to present a particular point of view. Citizen juries are randomly selected, and are often paid a small stipend for their time.
WA Health Economist Professor Gavin Mooney has trialled the use of Citizen Juries as a way of increasing public participation in the health care system, and more importantly, in the prioritising of health care expenditure. With Australia’s ageing population increasingly calling on the health system for lifestyle and age-related diseases, increased expectations of the population in general that medical care can and will do everything to resolve their illnesses, and the technological and pharmaceutical boom which is creating more and more high-end expensive treatments and diagnostics, our health budget is unable to keep pace. Many years ago I saw a statistic that showed if the South Australian health budget continued to grow at its (then) current rate, it would absorb the entire state budget by 2032. Clearly that is not viable.
So somehow as a society we need to make decisions about what health services we do and do not want to provide on the public purse. So for instance, we make decisions between relatively cheap treatments that might improve the health of millions of people versus an extremely expensive treatment for a disease or condition that occurs for one in 20 million people. And between prevention strategies and emergency care (keeping in mind that the stats for health run at ~$1 prevention saves ~$9 cure later on). And between groups in the community already at considerable health disadvantage – for instance Aboriginal and Torres Strait Islander people – and other groups that already have a longer health expectancy and have access to resources to assist themselves in remaining healthy. And between those groups that we have compassion and sympathy for – for instance premature babies – and those that we feel less compassionate about – for instance those we consider to have caused their own illnesses.
Now of course, when you yourself are unwell, you want everything possible done, so these decisions need to be made in advance and in a theoretical framework. Prof. Mooney has facilitated seven such exercises in Australia: “two at a state-wide level in WA (one on health care in general and the other specifically on equity); one in an area health service; three in general practice and primary health care; and one in an Aboriginal health service”, and has published a free handbook on Citizen Juries, which is available here. In the handbook Prof Mooney is careful to point out that the juries are developing broad principles and priorities to inform the decision-making rather than specific decisions and allocations of dollars.
So do they work? From what I have read, and in my opinion yes, but it has to be noted that this is at least because (disclaimer here) the decisions the juries came to concur with my own opinions. The following excerpts are from the handbook:
in each of the citizens’ juries I have facilitated, greater equity has been identified as a priority. The citizens consistently want a better deal for the disadvantaged, especially Aboriginal people. They also have some concerns for other disadvantaged groups and want a shift to more prevention and away from cure.
and the handbook gives a specific example of a 2005 jury identifying as priorities:
the principles of greater transparency in decision-making, greater equity, more prevention and increased resources for mental health. To achieve this, they were willing to give up some small inefficient hospitals and Emergency Departments.
(And just to be clear, decision-making in health doesn’t mean cutting out all emergency services and redirecting all funding to prevention – it is a balance of the priorities across numerous very valid and deserving services.)
These are not the priorities you would come to if you based your judgement on the television news or the front page of the newspaper, but (IMHO) they are the priorities you would choose if you saw the statistics on effectiveness and took a long-term view of population health.
Want more information? Prof Mooney’s website has links and his contact details.