Public participation is commonly advocated as part of the solution to the problem of democratic deficit in the development and implementation of policy. This article considers the democratic function of different arrangements for public participation, with reference to alternative rationales for democratic engagement in the health services context. We review the limitations of aggregative and representative notions, before exploring the senses in which a deliberative approach based on justification to the public can increase confidence in the democratic legitimacy of decisions. This theoretical understanding is used to evaluate the democratic potential of the legal framework for Patient and Public Involvement (PPI) in healthcare governance in England.
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