Living and dying with covid: Resolving the hard questions of living with covid-19 – the need for public deliberation

Jamie Webb, University of Edinburgh

Hugh Whittall, Nuffield Council on Bioethics


  • UK public engagement during the pandemic so far has focused on measurement: of the public’s beliefs, intentions and opinions.
  • Navigating our covid future will require making difficult, value-laden policy choices that affect us all. The public should be involved in these decisions.
  • Future UK public engagement needs to place deliberative democracy – engaging ordinary citizens in making policy recommendations – at the heart of the Covid recovery.

When policy makers have engaged the public during the covid-19 pandemic so far, it has largely been through opinion polls and surveys conducted to measure the public’s beliefs about covid, their compliance with social distancing requirements, their intentions about receiving vaccination etc. The flow of authority has been one way. From the government – supported by scientific advisors – who decides, to the public who receives instruction. On this approach, the goal of engagement is gauging public understanding of these decisions and identifying attitudes towards them.

Focusing on these forms of engagement is most justifiable when the path ahead is clear. The need to prevent a clearly unacceptable number of deaths demanded lockdown measures – measures that received a high degree of public support. But with the success of the UK’s vaccination program and the gradual reopening of society, there are now difficult decisions to be made about how we live with covid.

For example, in a recent piece, Ethics Accelerator researchers Jonathan Pugh, Dominic Wilkinson, and Julian Savulescu identified challenges for the long-term management of covid-19. Restrictions that are limiting the spread of the virus, but also harshly restricting civil liberties, can be lifted. But that release can only happen if we either target mitigation measures towards certain groups – such as the unvaccinated or the particularly clinically vulnerable – or accept an increased level of mortality and harm from the virus. In this covid trilemma where liberty, equality, and mortality must be weighed against each other, we may not be able to prioritise all three.

Our covid future will be filled with such tensions. For example, as the immediate crisis recedes, questions of intergenerational justice will come to the fore. Young people have made great sacrifices in terms of freedom, income, and employment, often with the explicit goal of protecting older generations. They now face a post pandemic economy where already entrenched inequities have been exacerbated by the virus.

More radical public engagement needed

More radical forms of public engagement are now essential if we are to resolve these value-laden questions. Fortunately, the covid pandemic arrived during what the OEDC has labelled “the deliberative wave”, a huge growth over the last several decades in processes where citizens are brought together to contribute to the development of policy solutions. Model deliberative processes include Citizens Juries, where small groups of citizens gather to learn, hear expert testimony, discuss, deliberate, and make recommendations on complex problems. Citizens Assemblies take place on a larger scale, where groups demographically representative of the broader population are constructed with decision-making authority.

Deliberative methods have been used in other countries during the pandemic to engage the public on contentious questions like whether age should be considered in covid triage for critical and hospital care. They have also been used by local regions in England, including Bristol and the West Midlands, and by the Scottish Parliament, to engage the public in deliberations about the covid recovery. It is now time deliberative democracy to become an institutionally ingrained dimension of the UK government’s response to covid.

Such engagement serves several purposes. It enables us to discover the values that are important to people and how they weigh them; it improves policy-making by ensuring it is responsive to the informed interests of the public; it helps in policy implementation by demonstrating transparency and engendering trust; and it enhances democratic accountability.

Doing deliberative democracy during a pandemic is not without challenges. Adapting to online video conferencing has been a particular challenge to an approach that emphasizes human connection. Citizen Juries and Assemblies usually take place over several weeks, or even months, with final recommendations being arrived at following a substantial period of discussion, although some policy decisions during a health crisis do require more rapid deliberative approaches. And good public deliberation requires meaningful expert testimony to inform the content of discussion: but in a pandemic where information and understanding is changing so rapidly, and who is considered a bearer of knowledge is constantly under scrutiny, it will be a challenge to provide expertise that deliberators can rely on. But this does not mean we shouldn’t try: in an area where conditions may change and preparedness is essential, such engagement needs to be extensive and continuous.

Politicians may be reluctant to cede even a degree of their power to members of the public. But engaging ordinary citizens in the difficult value tradeoffs, and integrating their recommendations into government decision making, will give much needed democratic legitimacy to the difficult policy choices to come.

This work is part of the Public values, transparency and governance workstream of the UK Pandemic Ethics Accelerator.

Contact details

Jamie Webb, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG.

Hugh Whittall, Nuffield Council on Bioethics, 100 St John St, London EC1M 4EH.

About The Accelerator

The UK Pandemic Ethics Accelerator is a new initiative that brings UK ethics research expertise to bear on the multiple, ongoing ethical challenges arising during pandemics. We provide rapid evidence, guidance and critical analysis to decision-makers across science, medicine, government and public health. We also support public debate on key ethical challenges.


The UK Pandemic Ethics Accelerator receives core funding from the Arts and Humanities Research Council as part of UKRI’s covid-19 funding. Grant number AH/V013947/1.