Force of the Better Argument

The second measure to discuss is force of the better argument which is at the core of deliberative democracy because it is concerned with decision making being based on the better or rational argument. This does not mean that deliberation will always lead to consensus but rational arguments should enable participants to consider and perhaps accept the positions of others even if those arguments are not in line with their own. Dryzek (1990) argues that authority should not be based on anything other than good arguments so the force of the better argument also encourages equality in participation as it is the argument that is important; not who the participant is. This is particularly important in epistemic

communities where experts are dominant and have a privileged place (Moore, 2010).

This measure can also tell us about preference change and when a better or rational argument has influenced committee members to change their preference i.e. the transformation of preference.

Coding was applied to speech acts when; a) there was a change in position and if reasons for this change were provided; b) when there was a change but no reference made to the

arguments heard during deliberation; c) when there was no change in position but there was an acknowledgement that other positions have their value; and d) when there was no change in position and no acknowledgment of the value of other arguments heard.

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Table 5.2 displays the frequency of position change in the vitamin D and NSP sample and this is presented with the citizen data in the Belgium study to shed light on how the NICE PHAC meetings compare with other deliberative environments in relation to preference change.

Table 5.2: NICE and Citizen data - Force of the better argument (percentage and number)

NICE (Vitamin D) NICE (NSP) Citizens (Belgium)

(a) Changed position gives reason 6.0% (10) 0.0% (0) 0.7% (12) (b) Changed position does not refer to

arguments heard

1.2% (2) 0.0% (0) 0.6% (10) (c) No change – acknowledges the value of

other positions heard

82.1% (138) 87.2% (41) 41.5% (691) (d) No change – no value acknowledged 4.8% (8) 0.0% (0) 57.2% (951)

(e) First time spoken 6.0% (10) 12.8% (6) 0.0% (0)

In table 5.2, the first two codes (a) and (b) refer to position change occurring. There was no position change in the NSP sample suggesting that committee members in this process were less likely to change their position when compared with the vitamin D process. This is because there was a slightly higher frequency of position change in the vitamin D sample.

Codes (c) and (d) in table 5.2 refer to no position change. In both processes, there was a high frequency of no position change but an acknowledgment of the value of other positions heard during PHAC meetings (c). There was a slightly higher frequency of this in the NSP sample (87.2%) when compared with the vitamin D sample (82.1%). Overall, this suggests that NICE committee members such as clinicians, doctors and professors are not likely to change their position but perhaps to remain respectful of and value the position of others.

When measured with the citizens in the Belgium study, the data in table 5.2 suggest that in different deliberative environments and with different groups of deliberators (citizens versus

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committee members) position change rarely occurs as the frequency of no position change was higher than position change across all samples.

However, the data presented in table 5.2 shows that position change occurred more often in the NICE PHAC meetings when compared with the Belgium case. This is surprising as experts might be expected to have firmer views on issues than lay citizens as they possess higher levels of information, have probably given the issue more consideration and might be assumed to be less inclined to change position.

Overall, the data supports that there is very little position change occurring. The key difference is whether the value of other positions are acknowledged and this is higher amongst committee members (82.1% in vitamin D and 87.2% in NSP) when compared to other deliberators such as citizens in the Belgium study (41.5%).

Due to this, committee members may be described as being more respectful deliberators because they acknowledge the value of what others are saying and appreciate the value of their argument when compared with citizens. Citizens appear less likely to acknowledge the value of other positions heard. The frequency of no change and no value acknowledged in the Belgium study was 57.2% which was considerably higher when compared with the NICE data. There was no explanation for this provided by Caluwaerts et al (2013). However, this may have been the case because there was a deep societal divide and citizens did not

appreciate the value the arguments of others.

The NICE data suggests that very few of the speech acts correspond to the habermasian ideal where a speaker acknowledges that the better argument changed his or her opinion. There was a very low frequency of this occurring in the NICE PHAC meetings. However, when

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compared with other cases, NICE do have a higher frequency of this occurring across the two samples. There are very few empirical studies about the force of the better argument and it is difficult to establish whether positions are changed due to the better argument or for strategic reasons (Steiner, 2012) or even due to the topic under deliberation. Together the cases show that at both expert and citizen level it rarely happens that deliberators “explicitly acknowledge that they have learned from each other and correspondingly change their position” (Steiner, 2012, 150).

The data corresponds well to what committee members discussed during the interviews. Members stated that they had learned from others and were exposed to other perspectives but that this did not necessarily influence them to change their own preference or position. Only a few stated that this had actually occurred.

Despite the low frequency of position change, committee members in the interviews spoke about the importance of deliberation allowing them to hear different position, information and evidence. Even if position change does not occur there is still value in deliberating and encouraging this between different individuals even if only between different committee members.

“...the actual process of being involved was learning itself, you know, not just about the process but about the research you heard etc and the different perspectives. So it did allow for that opportunity”(Topic Expert, NSP)

"There' so much more about NICE that I never really understood until I worked with them and my position on NICE has changed...I tend to form my own very strong views and will listen to both sides and then from that form my own view. So I wouldn’t say I've particularly swayed but I think from the whole point of NICE, my whole way of looking at things has been very different" (Community member, NSP and VD)

It is also clear that different people play a role in influencing position change. The comments below from interviews highlight that certain members can provide information or knowledge

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that challenges original positions encouraging individuals to reconsider. Topic experts were named as being particularly influential in the deliberative process. This may be because they have specialist knowledge in the area.

Interestingly, one topic expert in the NSP process said that a community member who was a service user representative provided a very different insight to what other members provided and because of this were highly influential.

"I'm thinking of a user representative (community member)...she sort of made me see things, she was probably the most influential person in that respect, that she gave a very different insight" (Topic Expert, NSP)

This particular type of committee member brought a service user perspective to the

deliberation and given the notable gap in representation from those who access services, this was an important role to highlight as they may have presented a very different type of evidence / experience. There is a need to include service users in deliberation as they can provide a very different account from other members such as topic experts and can enrich the deliberation by bringing their experience and knowledge to the table. Service users may also play an important role in changing the positions of those committee members who are removed from the reality of living with certain conditions and the real impact decisions have on their day to day lives. This notable gap of service user involvement needs to be brought to the attention of NICE.

The NICE data has highlighted that some participants may never agree with the other, but may recognise that the other side also has a valid point (Steiner, 2012, 151). This recognition might simply be enough where the topic under deliberation is highly complex involving an epistemic community. This is because the process of deliberative transformation takes times (Curato et al, 2017). When a variety of individuals are involved in deliberation, the argument

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pool may be larger and individuals require time to be able to consider and change their preferences. The NICE data suggests that while committee members are not particularly influenced by others to change their position, they do respect and value the position of others and that some types of individuals may influence position change more than others.