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number of A to C exam marks at GCSE (regardless of subject mix).19
19
Reliance on over-simple performance indicators, and over-complex regimes of
accountability that use them, is widely criticised, even by those who enforce them,
who now commonly pay lip-service to lighter touch regulation . The criticisms are
well articulated in the work of the Better Regulation Commission, formerly the Better
Regulation Task Force, which advises the UK government on action intended to
Trust, accountability and transparency 175
Reliance on simplified performance indicators supposedly has a
number of merits: it is said to be cheap and objective; it is said to
provide a clear ranking of the performance of different individuals
and institutions. Supposedly it can be complemented by require-
ments for transparency (to which we turn below), and so offers the
inexpert both affected individuals and the public at large a means
to judge performance. However, these supposed merits will be
illusory unless performance indicators actually provide reliable
measures of quality of performance. Unfortunately this is often in
doubt, for two basic reasons. First, there are sometimes no reliable
and simple indicators of quality of performance for complex tasks.
Good performance of complex primary obligations may not be
readily measurable by simple indicators. Second, even when a
performance indicator offers a reasonably useful measure of some
aspect of performance, its use may create perverse incentives to
concentrate on that aspect of performance at the expense of others,
and to pursue high scores on the salient indicators (the so-called
key performance indicators ) rather than good performance. The
costs of marginalising informed judgement can be high.
But can judgement be both informed and independent? If we insist
on extreme conceptions of these two requirements, they will be
incompatible. For example, if we deem anybody who has trained
as a pathologist, a psychiatrist or a pharmacist as ipso facto incapable
of independent judgement of performance in these fields, we will
have boxed ourselves into a position in which we see insider judge-
ment as the price of informed judgement. Equally, if we deem
all outsiders as ipso facto incompetent to make an informed judge-
ment of performance, we box ourselves into a position in which we
have to accept ignorant judgement as the price of independent
judgement.
But generally we are not so stupid. It is typically not impossible to
find outsiders with the necessary competence or expertise, and to
make regulation and its enforcement accord with the five Principles of Good
Regulation , which it identifies as Proportionality, Accountability, Consistency,
Transparency and Targeting. See http://www.brc.gov.uk/. Unfortunately, lively
debate is not the same thing as lively progress towards better regulation.
176 Rethinking Informed Consent in Bioethics
provide institutional support for their independence. A considerable
degree of independence is achieved by school examiners who do not
teach the pupils they examine; by university examiners who work for
other universities; by health and safety inspectors who are not
employed by the companies they inspect; by auditors who are barred
from selling further services to those whom they audit. Medical and
scientific practice can achieve similar, or better, standards. Methods
for securing the independence of those who hold to account in some
areas of professional life may need improving: but improvement is
neither impossible nor obscure. A large range of measures, including
those set out in successive reports of the Committee on Conduct in
Public Life (originally the Nolan Committee), are relevant.20
If we drop the artificial pretence that expertise and independence
are intrinsically incompatible, we can aim for forms of accountability
that combine informed and independent judgement. Professional
cosiness, laxness and impropriety can be limited by robust institu-
tional measures to secure independence.21 Such measures may
include rigorous certification of competence to practice, proper
appointment processes and measures to bear down on lax profes-
sional practice or casual approaches to failure. In each activity,
accountability for good practice can combine informed with inde-
pendent judgement.
So if we want serious and intelligent accountability we can neither
turn our backs on professionalism and expertise nor rely on cosy,
unmonitored professionalism, in which conflicts of interest persist
unchallenged and professional solidarities swamp the needs of those
whom professionals are meant to serve. But there is no forced choice.
It is possible to support and maintain robust and expert ways of
monitoring standards, investigating failure, disciplining the slipshod
20
See http://www.public-standards.gov.uk/.
21
The 2002 Enron scandal illustrates the dangers of ignoring these standards.
Although not all issues have been resolved in the courts, it appears in 2005 that
Arthur Andersen, Enron s auditors, may not have been adequately independent of
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