Covid Treatment Lottery

“For patients with similar prognosis, who cannot be separated in other ways, a random allocation, such as a lottery, may be used”, says the protocol.

So says a Report in the Daily Telegraph (UK) of 5th January by Paul Nuki titled “Covid ‘lottery’: Doctors draw up triage protocol in the event treatment has to be rationed” (Telegraph usually paywalled, but this seems open-access)

It refers to a paper in J Medical Ethics “Development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity: a discussion paper” also accessible f.o.c.

This is circulating in NHS hospitals as a proposed protocol.

The protocol – drafted by medical, legal and palliative care specialists at the Royal United Hospital Bath NHS Trust – is the most sophisticated attempt yet to devise an ethical system for rationing care in the event that there are insufficient resources to treat everyone.

Now this is exciting! But it is not new. Right from the start of organ transplantation (1960s) such moralistic contentions were weighed up.

In Seattle the so-called ‘God committee’ was set up to make these difficult choices (reported in Calabresi & Bobbit (1978) Tragic Choices). The committee eventually found that it was too agonising to make these choices, and passed the task back to the medical practitioners. In the end it was felt that only medical  factors should be taken into account. Even if no overt rules on social merit were in place, we should not be surprised if the doctor, genuinely uncertain on medical grounds,  was to pick the ‘nicer’ of the two patients.

A secret lottery?

Elster (1989) in his masterly ‘Solomonic Choices’ gives the example of child custody cases, where the judge is frequently unable (in his own mind) to give a clear-cut decision. Yet decide he must, so he goes ahead, dressing up the verdict with trappings of rationality.

This, claims Elster, satisfies both parties, the winner praising the wisdom of the judge, the loser cursing his bias. No doubt a similar process might go on when a medical doctor decides, even if partly randomly and in secret, between her two patients: So long as both patients believe that their case is decided clinically by an expert, then both winner and loser may find it acceptable.

The doctor herself may even be a bit cognitively dissonant—convincing herself that she is doing the right thing for the right reason, exercising judgement based on intuition  rather than validated knowledge. This form of fudging may be acceptable all round, but it is fraught with dangers.

If fakery is suspected, patients rapidly lose their trust in their professionals. Unwitting discrimination seems inevitable. True expertise will fail to develop unless its limits are acknowledged.

Against a lottery is Greely (1977) who suggests that if recipients can argue about any allocation, they feel more satisfied. Anand was also interested in what is called ‘voice’—that one of the reasons a coin-toss was thought to be unfair is that it deprived customers of a say in the decision.

In favour of a visible act of coin-tossing Calabresi & Bobbit explain that it draws attention to the fact that resources are limited. Edgeworth (1888) suggested another benefit would be that the public, seeing a random drawing take place, would be alerted to the ‘aleatory nature’ of the decision. Bureaucrats might not like having such attention focussed on this shortage of resources and their uncertain knowledge.

[This was part of my 2006 thesis Who Gets The Prize. It can be viewed in full on my website www.conallboyle.com]

Wang Shaoguang and Yves Sintomer on sortition

A 2019 hour-long discussion on sortition at Shandong University with Wang Shaoguang and Yves Sintomer was recently published by its moderator, Daniel A. Bell.

This is a rather wide ranging discussion, and its lack of focus is somewhat of a flaw, in my opinion. Ideas on various matters are expressed. Many of those are well-hashed ideas, and the discussants are content to simply repeat them rather than examine them critically.

One idea that I think is relatively novel is briefly offered by Sintomer toward the end when Bell asks for proposals for applying sortition:

I would give the power to citizen juries randomly selected to judge politicians, when they are accused of misbehavior. Because I don’t trust other politicians to do this, as in Brazil or in the USA, where the impeachment is voted by the Congress. I think it’s a bad setting. And I don’t trust judges for judging politicians. Because judges are a very specific, professional body, and very often, a highly conservative body. I trust more randomly selected citizens to judge politicians when they are accused of misbehavior.

Galland and Schnapper: Citizen conventions and representative democracy, Part 2/2

The second part of an article in Telos by Olivier Galland, sociologist at the CNRS, and Dominique Schnapper, researcher at the EHESS and an honorary member of the Constitutional Council. The first part is here.

2. The choice of those of those responsible for the organization of the discussions, for informing the people convened by selecting the “experts”, for helping them to form an opinion, for writing and disseminating the conclusions must meet specific conditions as well. Who will select the people in those roles and what will be their legitimacy for making choices which may guide the conclusions of the deliberations? On this issue, it is important to distinguish clearly, when organizing the deliberations, between testimonies of scientific experts and those of other actors – activists, representatives of the state, trade unionists and business people. A distinction must be made consistently and meticulously between objective data – even if it is controversial – and opinions or beliefs which are a matter of ideological or political convictions or personal or group interests. Such a distinction is necessary so that the members of the conventions would be able to form judgement which is as informed as possible, especially in an era where mistrust of science has increased dangerously.

The members of this type of conventions can make political choices, but when they do so, they must be fully aware of the reasons for their choices and of their full implications. It is also necessary to shield them from pressure and influence that they may be subject to by activists and lobbies outside the convention. The experience of the CCC seems to show that risk is very real. A trial jury must be protected from outside influences in order to make its judgement impartial, but how can “a citizen convention” be protected against pressures originating from activists and interest groups?

3. However, the most decisive is the definition of these “conventions”, which are unmentioned by the constitutional texts and the democratic tradition: except for their makeup and their function, what is their purview, what is their legitimacy?
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Sortition in 2020

Continuing the series of yearly reviews appearing on this blog every December since 2010, in this post I review the 2020 sortition-related events that appear to me most significant or interesting. I invite readers to add their own reviews in posts or comments.

The most prominent sortition-related development of 2020 was without a doubt the work of the French Citizen Climate Convention. This body of 150 allotted citizens started its work in back in 2019 and has published its report in June. It received significant media attention in France even before it published its report, but public attention has intensified over the last 6 months. In fact one commentator was alarmed that discussion of sortition in France has reached pandemic proportions.

In the face of the expected pushback from elite groups, the French public has shown significant support for the CCC itself and for its recommendations. Toward the end of the year warnings have been raised about what appears to be the government’s attempts to abandon or water-down the implementation of the Convention’s proposals. In late breaking news, Macron has indicated that he is aiming to put constitutional changes aligned with the Convention’s proposals up for a referendum.

The work of the CCC and the aftermath of its report received scant coverage in the English-speaking media (with the sole exception of Equality-by-Lot).

At the same time, sortition made more modest progress in other countries as well. It was implemented or discussed in multiple contexts in Germany: 1, 2, 3, 4. Sortition was also implemented or proposed in Switzerland, Belgium, Greece, the United States, and Scotland.

In the United States, sortition got some fairly high profile exposure by Malcolm Gladwell (1, 2). On three different occasions sortition was proposed by undergraduate students as a replacement for the electoral system. It was also proposed as a way to achieve citizen oversight over the police.

Finally, two sortition-related books of interest were published this year. One is a hefty report published by the OECD on “Innovative Citizen Participation”. The report makes a historical summary of hundreds of cases of citizen participation in government, draws its conclusions and makes recommendations. The second book is by notorious sortition activist Paul Rosenfeld. In stark contrast to the OECD publication, Rosenfeld’s book, a combination of an autobiography and a sortition manifesto, makes for an easy and entertaining afternoon read.

The New Flemish Alliance does not want to see democracy turning into a “lottocracy”

A translation of an article from the Belgian La Libre.

Government reform: The New Flemish Alliance does not want to see democracy turning into a “lottocracy”
November 25, 2020

The government reform undertaken by the De Croo government cannot be a pretext for turning parliamentary democracy into a sortition-based system, warned on Wednesday the head of the N-VA (The New Flemish Alliance) in the Chamber of Representatives, Peter De Roover, during a discussion in the Constitution Committee on the presentation regarding political directions by the ministers for institutional reforms.

The new government drew up for the upcoming year a “platform of dialog” regarding the future of the Belgian federalism along the lines of that which is planned regarding the future of Europe. A “large scale consultation involving citizens, in particular young citizens, as well as civil society, universities, experts, and local authorities” will be undertaken, indicated the document by ministers David Clarinval and Annelies Verlinden.

The way in which citizens would be involved in the process raised questions among the nationalist opposition which asked whether the Vivaldi Coalition is going to resort to sortition, a method which was promoted over the last few years by some intellectuals. “I have more confidence in a body that was elected by the citizens than in a panel of allotted citizens”, emphasized De Roover who would not like to see democracy replaced by a “lottocracy”.
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A practical and transparent method to sort

In this short post, I introduce a method that might interest readers from this blog. I present a practical method that randomly pick people without the need for a trustworthy third party. Before describing it in more details, I want to insist on its two main features.

The method is practical because it only requires a basic computer (a smartphone largely suffices). Computers cannot generate random numbers because they are deterministic, however they can produce long sequences of numbers that do not repeat themselves for a long time. If you don’t know how the computer generated sequence work it is difficult to predict the next outcome. The numbers in this sequence will constitute our set of random numbers.

How could we generate the set without a trustworthy party? A malevolent individual can let the computer run until they obtain the desired results. If you know the initial number of the sequence and how the sequence works the result becomes entirely deterministic. We call this number the seed and this number will entirely determine our set of random numbers. We use this property to generate an impossible to forge sorted list of members. But how do we pick this seed?

Our method uses a stock market index. This has two interesting properties, firstly it is impossible to predict (otherwise tell me so we can become rich fast :) and every market agrees on it. This guarantees true randomness. Secondly, everybody will be able to reproduce our sortition if they have the seed value, the member’s list and the script we used. This guarantees transparency and accessibility.

We will employ this method in our association (l’Association Française pour la Sortition) to constantly renew our board. I already wrote the code using the CAC40 index to perform this task, it is free, open-source and you can access it you can follow this link: https://framagit.org/PersonnePirate/sort.

Random Selection for the Supreme Court

In an opinion piece in The New York Times, Yale law student Melody Wang lays out an extremely cogent argument for random selection in choosing cases. She emphasizes the power of random selection to prevent corrupt practices, and to focus advocates on directing their arguments to the general good, rather than to specific decision makers.

Yamaguchi: Lottocracy: Considerations on Representative Democracy by Lot

Akito Yamaguchi is a second-year doctoral student at the University of Tokyo, Japan, specializing in political philosophy, especially lottocracy. This is the author’s summary of a paper by Yamaguchi published in the Japanese Journal of Political Thought (May 2020).

Lottocracy: Considerations on Representative Democracy by Lot

This paper aims to examine the relevance of “lottocracy” as a lawmaking system. Lottocracy is the idea of a representative system in which representatives in the legislature are appointed by lottery rather than by election. This paper compares lottocracy and electoral democracy in terms of instrumental value, i.e., the value of the outcomes of these procedures. It assesses the value of both systems in terms of the interests of the people: how well do the systems promote the interests of the people?

To assess the instrumental value of the electoral and lottocratic systems, I use two methods. First, I use two criteria to assess the interests of the people: the criterion of equal reflection and the criterion of competence. The criterion of equal reflection is a criterion for assessing the extent to which the system equally reflects the will of the people. The criterion of competence is a criterion to assess for assessing how competent a legislator is in terms of lawmaking.

Second, I assess the electoral and lottocratic systems in both an ideal condition and a non-ideal condition. In the ideal condition, I assess each system in the condition in which it functions best. In the non-ideal condition, I assess each system in the real world in which we live.

Section 1 assesses both systems in the ideal condition. In the ideal condition, the electoral system is superior to the lottocratic system. This is because representatives who are superior to others are elected in the electoral system and so the electoral system is higher in terms of the criterion of competence. Continue reading

New edition of Down with Elections!

The latest edition of “Down with Elections! a plan for Democracy without Elections” is now available. The paperback is at https://www.amazon.com/DOWN-ELECTIONS-plan-DEMOCRACY-WITHOUT/dp/B0851M9H3F.

Users of this forum can obtain a free digital version (epub, mobi or PDF) directly from me (email to cwallace@free.fr).

Changes from the last published version (V3) are mainly explanatory, there are no major changes to the model of government proposed. (Changes from earlier versions are too numerous to list here.) Nothing I have seen or read recently has persuaded me that the overall design of the system proposed in the book needs changing, and events of the last few years – indeed of the last two hundred years – have only reinforced my opinion that we cannot have true democracy until we replace elected parliaments by ones chosen by lot.

Une version française est maintenant disponible (en broché) :
https://www.amazon.fr/démocratie-sans-élections-Campbell-Wallace/dp/B085R72PK5 (5,38 € + livraison)
ou
https://www.thebookedition.com/fr/democratie-sans-elections-p-372653.html (7,23€ + livraison)

On peut avoir la version digitale gratuitement en envoyant un mail à cwallace@free.fr.

Deliberative assemblies are finding their feet – but also facing political barriers

On Friday the 16th of October, the Hannah Arendt Center at Bard College hosted a webinar entitled ‘Revitalizing Democracy: Sortition, Citizen Power, and Spaces of Freedom’, which you can watch here. The workshop heavily featured people putting sortition into practice right now, and so the overall focus was very much on deliberative assemblies in advisory roles, rather than non-deliberative juries or lawmaking roles. If you’d rather not spend the whole day watching a videoconference, here’s the CliffsNotes:

David Van Reybrouck, who gave one of the keynotes, helped design the new citizens’ council and assembly system in the parliament of the German-speaking region of Belgium – an area with only 76 000 citizens, but devolved powers similar to Scotland’s. The system involves a permanent citizens’ council and temporary citizens’ assemblies, both selected by sortition, as well as a permanent secretary who acts as a sort of ombudsman for the system. The council sets the agenda for the assemblies, and chases up their conclusions in the regional parliament – essentially acting as an official lobby group for the assemblies’ recommendations. Politicians have to report back to the council a year after each assembly, setting out how they’ve acted on their recommendations and, if they’ve deviated from them, why. In this respect it is a major step forward in the institutionalisation of sortition. Under the Belgian constitution, however, sortitional bodies cannot be given legislative power, so the assemblies are restricted to an advisory role until and unless momentum can be built for a constitutional amendment.

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