Citizen engagement on ethical, legal, and societal issues (ELSI) of health technologies is a relatively recent but growing field with a wide variety of methods and no shared standards. Citizens are engaged for different purposes (e.g. education, sensitization, feedback on research projects, co-creation in governance) through various tools (e.g. surveys, qualitative interviews, deliberative forums) on varying scales (local, national, international) and in diverse contexts (e.g. policy-making, research, or field-based issues). Given the increased calls for citizen engagement, it becomes urgent to reflect on its practices holistically and critically and share challenges, lessons learned, and suggestions for best practices from that perspective. Based on our cumulative experience with regional, national, and international citizen engagement on the ELSI of health technologies, we take that step back to ask ourselves two critical questions: 1. What is the essence of citizen engagement, regardless of the methods used? In other words, what should all citizen engagement initiatives have in common to be considered meaningful? 2. What are common challenges and best practices to ensure meaningful citizen engagement? In the past, citizens were usually approached strategically using one-way communication from the experts to the “ignorant” people to enhance their literacy and trust in science and promote its benefits to gain support. If this ‘deficit model’ is now criticized and old fashioned, it sometimes persists in the mind-set of policymakers, scholars and practitioners, who thereby perpetuate power imbalances from society into the engagement process, between those who engage and those who are engaged. Hence, the engagement practice is shaped by the expectations and needs of powerful actors. In response to this, we argue that the more citizens are put at the centre of the process, the more the engagement practice becomes meaningful, regardless of the methods used. We define the citizen-centred approach as the empowerment of citizens by focusing on their perspectives (e.g. values, concerns, needs, and experience) and considering them as equal partners, as far as is feasible, in the engagement process. This way, citizens are enabled to add their unique contributions as lay stakeholders and have a say on issues impacting them. With that essence of citizen engagement in mind, we developed a set of suggestions for best practices to conduct citizen-centred engagement based on our lessons learned and the challenges we encountered. These are: 1. Be as transparent and honest as possible towards citizens regarding the process and use of the outcomes; 2. Minimize hierarchy to create a ‘safe island of democracy’; 3. Trust the process and what citizens can add; 4. Interpret, present, and disseminate the outcomes as objectively as possible; 5. Make engagement a continuous process, not a single event. Through this reflection, we invite any stakeholders who can positively (empower) or negatively (disempower) impact the role of citizens in the engagement process to think ethically about their power and, consequently, their responsibilities towards citizens.
