Medicine and Politics

The failures and successes of democracy is a topic that goes back at least 2000 years. I haven't seen this direct comparison before though. Medicine and politics are similar in that the people make decisions. Differences:
Medicine Politics
Expert body: medical profession civil service
Subject who chooses: patient citizen
Quantifiable outcome by which choices are to be selected: Health / longevity Wealth / quality of living
Scope of choice: affects subject only affects subject / family / society
Basis of optimal choice: statistical evidence + either generally accepted medical common sense, or bayesian reasoning complex reasoning, combining multiple factors from extensive knowledge + educated guesswork
Conflicts of interest: minimal unless patient's goal isn't health or longevity significant particularly if governing body form a class separate from the governed.
Subject bias: patient beliefs and preconceptions only - as doctor is able to give statistics of outcomes of choices Cultural, media-derived notions of causal relations between policy and outcome – may be misguided; not clarified by exposition; essentially impossible to predict
Source of information to subject: doctor who is also expert politician who is essentially elected and wants to be chosen - not the civil servants who are experts
Need for subject intelligence in deciding which choice is best to attain the given goal: virtually none if good doctor extremely high despite being highly informed – required intelligence rises exponentially with amount of information taken in
At the root of this metaphor is the assumption that political decisions are basically a kind of expert decision.
Note that in medicine, the there are only 2 ways in which subjects truly have 'choice' — i.e. where their opinion of how to act is different from that of the expert. This is when the subject has strongly different beliefs about what constitutes a good outcome (for example specific religious beliefs), or when the subject has different moral values, than the expert. This is why doctors often use phrases such as "Would you say you’re the sort of person who would rather...", when checking for strong beliefs and moral values. In the cases of patients who have such strong beliefs and values, it is the quantitative balance of these beliefs and values that influence decisions.

If the comparison is to be taken further, therefore, the crucial points upon which a political decision should hinge are the people’s beliefs and moral values. Given this data, the government job is to make its decisions on how best to act in order to suit the net beliefs and values of the people.

Democracy, without allowing subjects to make decisions?

With this premise, a subject's input to a government's decision is limited to the specific details of his beliefs and values. The vote, then, is an instrument to convey this input, and should address these issues. Beliefs and values depend on the time; they are ephemeral, and socially determined. Therefore the question arises, what information should a 'vote' extract from the subject?

One must decide which subjective beliefs and values are relevant for making political decisions. This is a function of time and social context, and it will determine the form of the vote. The vote must be cast in terms that subjects are familiar with, and must specifically address the beliefs and values pertinent to decisions. Additionally, it may be possible to assume certain values as default, and design votes to maximise gained information.

Votes would therefore resemble questionnaires. Examples of questions relevant to political decisions would include
  • "Are you the sort of person who would rather..." –
    • take a 15% risk of the world being uninhabitable in 100 years, or
    • rather reduce quality of life 15%,
    • etc.
The questions would need to be posed in a simplified scenario, so as to be understandable by as many people as possible. Questionnaire design is a formidable task, almost as hard as deciding on action based on the results. The gist of the questions is to establish empirical facts about human nature, as independently as possible of culture.

Questions that could never aid a government in making the correct decision would include
  • "would you like to tax rich people more and poor people less” ,
  • “should the working day be longer".
Deciding how to act based on subjects' views on this kind of action is unjustifiable: the effects of these decisions have complex and difficult to predict effects of society in the longer term. The actions and outcomes are not directly related, and it is the outcome that is important, not the action. It is the outcome that subjects should choose, and not the means. Clearly any voting system that confounds these difficult questions would result in circular definitions of morality, as well as decisions in different domains which lead to unforeseen combined effects.

Intermediate questions exist, where the outcome effects for each option are complex, but moral values appear to be involved: e.g. Capital punishment, . There is an argument subjects in general are not qualified to make such decisions, as they may not have the same emotional experience as other people, e.g. consider someone who's child has been murdered: you might say their opinion on homicide law is determined by their experience/circumstance. But this circumstantial opinion is valid precisely because we class it as a moral value – either as something that is 'understandable' (other subjects can imagine themselves in that situation) or as something people are entitled to believe (it's historically acceptable).


A common argument against this view runs in parallel with trends in medicine: empowerment of the patient. The patient should be given as much information as he can retain & understand about the decision, and then allowed to choose for himself. Firstly is untenable in medicine itself; the doctors guiding hand inevitably colours any information that is given, and a patient straying from the advised path has to carefully reason his choice, and he must convince the doctor it is 'best for him specifically'. Likewise votes will need to be individually advised and 'seen through' to ensure the correct level of information and comprehension for the individual. Secondly, if individuals' empowerment to decide is generalised, we are performing an additional operation upon the decisions made: they are being averaged and binarised. Both of these operations are problematic, as outcomes of actions are hugely sensitive, and intermediate actions do not lead to intermediate outcomes. Averaging an ethical opinion, on the other hand, does not appear to pose such problems.

What if a government fail to fulfil their responsibilities in catering for the people's net beliefs and values? If we have appointed the best trained specialists in making a decision, the only standard that can be applied is whether each individual has acted in the way that could be expected of an 'equally trained and equally informed' specialist. There can be no higher standard of appeal, when asking whether the responsibility of a government has been fulfilled.

Why most people shouldn't vote

  • Nobody can fully understand the complex cause and effect from policy to change in life (including peoples’ children's lives). A select few people do understand the best models that we have today of policy-to-effect. But many other people think they do, following erroneous logic. They 'don't know what’s good for them'.
  • Many people are selfish: an improvement to their own life is a reason for choosing. There is no theoretical obstacle to determining which people are less selfish than others.
  • Choice is very often upbringing, habitual, or at best emotion-driven. Though emotion is clearly essential for determining the kind of outcome that is desired, it's pretty useless at determining the appropriate action to be taken to achieve that outcome. The best action may be counterintuitive.
  • Reasoned voting (on the other hand) is determined strongly by the media, which though regulated, may expound party policies in various levels of detail, with varying emphasis. Which paper one reads is in turn determined by upbringing.