ABSTRACT
This chapter describes an argument in favour of a deliberative process that incorporates views of the public – a key stakeholder in all National Health Service decisions. This argument provides a theoretical answer to the question about the added value of the Citizens Council. The chapter provides few conditions that a process should meet in order to hold decision makers accountable for the 'reasonableness' of their decisions. The Citizens Council is a method for improving deliberation in that process and to bring a typical citizen's reflections to bear on the ethical controversies that underlie specific limit-setting decisions. Stakeholder participation can increase the legitimacy of limit-setting decisions in both private and public organisations by increasing accountability for reasonableness. The key idea behind accountability for reasonableness is that fair-minded people will agree that the reasons underlying a decision are relevant and driven by an aim to meet healthcare needs fairly under reasonable resource constraints.
