Intended for healthcare professionals

Editor's Choice

Are we at risk of being at risk?

BMJ 2010; 341 doi: (Published 02 September 2010) Cite this as: BMJ 2010;341:c4766

Citizens' juries in healthcare

Dear Editor,

Moyhinian raises a crucial question: how to constitute more
independent and broadly representative panels that can deliberate - for
example, about what defines a disease and what value of a biological
characteristic can be defined "normal" - outside the long shadows of the
drug industry?[1]
After several years of experience in promoting citizens' and patients'
involvement in healthcare decision making,[2] our proposal is to include
citizens in decision making processes about healthcare issues of public
interest. We heartily agree with the call for a broader and stronger role
of society in public health decisions, particularly when at issue is
labelling some people "sick", reported by Moyhinian and underlined by the
editor of BMJ.[3] This is in fact very consistent with an Italian project
of deliberative democracy called "Giurie dei cittadini", planned within
the PartecipaSalute project.[2]

In its first phase the "Giurie dei cittadini" project will set out to
organize citizens juries to deliberate on whether it is worth offering
prostate cancer screening to all men aged 50 and older. The citizens
involved will be trained giving them complete, plain and evidence based
information and providing them with critical appraisal instruments. They
will be offered consultations with various experts, presenting different
points of view. All those involved (citizens, clinicians, researchers)
will be required a declaration of conflicts of interest.

The aim of this pilot phase is to define a reproducible method
applicable in public healthcare decisions, addressing some critical
issues such as citizens inclusion criteria, how to involve them, the
representativeness of juries, criteria for selecting the information and
the experts, and the outcome of the deliberation. The project has been
conceived and developed in collaboration with a healthcare public agency,
local public health offices, a no-profit foundation and a private
foundation, a medical society, and it is currently under funding review.

We believe it is time to involve lay people in public healthcare
decisions, especially when the uncertainty about benefits and risks is
very high and different values and preferences need to be elicited in a
democratic fashion.


1. Moynihan R. Who benefits from treating prehypertension? BMJ 2010;

2. Mosconi P, Colombo C, Satolli R, Liberati A. PartecipaSalute, an
Italian project to involve lay people, patients' associations and
scientific-medical representatives on the health debate. Health Expect
2007; 10:194-204.

3.Godlee F. Are we at risk of being at risk? BMJ 2010; 341:c4766.


Competing interests: No competing interests

08 September 2010
Cinzia Colombo
Roberto Satolli, Alessandro Liberati, and Paola Mosconi, on behalf of "Giurie dei cittadini" working group
PartecipaSalute, Mario Negri Institute, Milan