Good Government, Democracy and Referendums

 

Government is an ongoing process. Any single referendum aimed at making a binding decision on some issue is not an ongoing process. Any such referendum is of course a process, but it is a process designed to bring about closure if the possibility of a further referendum is excluded. In this posting I will argue that accepting the result of some types of referendums, such as the Brexit one, is damaging to good government and is fundamentally undemocratic.

Democracy might be defined as the belief in freedom and equality among people. Democratic government might be defined as “a system of government in which all the people of a country can vote to elect their representatives.” (1) The two definitions are connected because if people aren’t free they can’t govern themselves. What does it mean to govern oneself? The ability to govern oneself is the ability to make decisions without being deceived or coerced and to enact those decisions. The ability to govern a state is much the same. It is the ability to decide which policies a state wishes to pursue together with the capability to enact them. The ability to govern of course applies to both dictatorships and democratic states. Democratic government takes place by its citizens determining its policies either directly, through such means as referendums, or by electing representatives. Personal government must of necessity be an ongoing process. Let us assume someone governs herself and that she decides at time t1 doing x is best thing for her to do. Let us next assume at time t2 and in a roughly similar situation she finds that she is unable to do anything other than x. I would suggest that at time t2 she is unable to fully govern himself. To be able to fully govern herself at t2 she must have the ability to revisit her past decisions and if necessary revise or change them. Accepting the above of course does not mean she must change her decision or even consider changing it. Moreover, any inability at t2 doesn’t need to be connected to any lack of further reflection on her part, she may be perfectly satisfied with her previous decision and feel no need for further reflection. However, even if she simply accepts some decision her acceptance cannot be forced onto her and she must retain the ongoing ability to accept or reject this decision. The same is also true of states. Governing a state requires that the state retains the continuing ability revise and if necessary change its own policies. Governing a state must of necessity be an ongoing process. States that don’t do so become lifeless and fossilised.

I now want to argue that the use of some sorts of referendums damage this ongoing process. It might be objected that provided the electorate in some referendum is not deceived or coerced that the result of the referendum can contribute to good government. I accept my objector’s position holds in some circumstances referendums can contribute to good government. Nonetheless I would argue that my objectors position doesn’t always hold in all circumstances. I will argue that use of some sort of democratic referendums to determine policy can damage good governance. Of course a democratic referendum might help to determine a policy. However, a democratic government must retain he ability to revise and if necessary change its own policies. If a referendum determines some government policies for the foreseeable future, then that government loses part of its ability to make and change some of its own policies in the future. The above holds even if the referendum in question was conducted democratically. In what follows I will consider referendums which determine some government policies for the foreseeable future rather than binding ones. No binding referendum binds forever, binding referendums only determine some policy for the foreseeable future. Referendums can express the will of the people but this expression isn’t the everlasting will of the people as everlasting will just doesn’t exist, people can, do and should be able to change their minds. Accepting he above means accepting that the use of a democratic referendum by any government, when the result of the referendum determines a policy for the foreseeable future, damages good government because good government is an ongoing process.

I have argued that referendums which determine government policy for the foreseeable future damage good government. It might be objected that I’m misrepresenting the point of referendums. The point of referendums is to shift the focus from elected government to a more direct form of governance. I accept my objector’s point. I accept that referendums can shift the focus from elected government to a more direct form of government. However, I will now argue that any referendum which is designed to determine long term policy damages good governance. How can direct government by the use of referendums possibly damage good governance? I am not suggesting all such referendums damage good governance. I am only suggesting that those referendums which determine some policy for the foreseeable future damage the ability of the electorate to govern themselves directly. Let us imagine a state which is governed directly by its electorate by the use of referendums. Let us assume that one of these referendums determines one of this states policies for the foreseeable future. I will now repeat my central argument as to why such a referendum damages good governance. Let us accept that government must be an ongoing process. This referendum damages this ongoing process. I have argued that someone’s ability to govern himself means she must have the retain ability to change his decision and that the same is true of voters. If voters in some referendum determine some policy for the foreseeable future, then they deprive themselves of the ability to decide on some policy at some future date. Even if referendums, which are designed to govern directly, are conducted democratically they can still damage good government and if they deprive the electorate of the ability to make further decisions on some matter are undemocratic. Both good government requires retaining the ability to react to changes in circumstances, any referendum which determines government policy for the foreseeable future destroys this ability to react. I suggested above that such referendums in spite of appearances are fundamentally undemocratic. Clearly any democratically conducted referendum which aims to elect a leader for life destroys democracy. I now want to argue that any referendum which takes place in a democracy with the aim of determining some policy for the foreseeable future damages that democracy. In a democracy the electorate must retain the ability to shape government policy. It might be objected that if the electorate have democratically determined some policy in a referendum that nothing can be more democratic than that. I would suggest soundness of this objection depends on how long such a referendum is meant to determine a state’s policy. Let us assume that a referendum determines some state’s policies for the foreseeable future. Such a referendum is undemocratic. Over time he electorate changes. Some electors die whilst others become enfranchised. It follows that the result of the referendum over time might come not represent the will of the majority of the electorate. The will of the majority might be ignored.

Let me once again make my position clear I’m not saying all referendums damage good governance or are undemocratic. Referendums which are advisory or determine short or perhaps even medium term policy need not damage a government’s ability to govern nor are they fundementally undemocratic. I am saying all referendums which determine long term policy or policy for the foreseeable future damage good governance and are undemocratic. I believe the Brexit referendum to be such a referendum. What conclusions can be drawn from the above? Firstly, referendums should never be used to determine long term policy. Secondly if referendums must be used to determine policy in the medium term they should not be decided by a simple majority of actual voters. At the very least referendums to determine medium term policies should require a majority among all those eligible to vote in order to be valid. A larger majority should mean that the result of the referendum would remain the democratic will of the electorate for a longer period.

1. http://www.oxfordlearnersdictionaries.com/definition/english/democracy?q=democracy

Charlie Gard and Experimental Treatment for Children

Until recently I assumed without much reflection that it would be best if Charlie Gard was allowed to die peacefully. After some reflection I still believe this would be the most sensible option. However, after this reflection it seems to me that this case raises an important philosophical issue. What should form the basis of our decision making when deciding whether some experimental treatment might be appropriate for children. In this posting I will examine this issue. I have previously argued that autonomous adults with life threatening conditions have a right to try experimental treatments provided these treatments are privately financed, see wooler.scottus . I would argue that this right to try applies to all potential experimental treatments even when the chances of a cure are slim and possibilities of adverse side effects high. If the above is accepted, then it might appear to automatically follow that children’s parents have a right to try experimental treatment to combat their children’s life threatening conditions. I will argue this appearance is unsound and that the issues are more complicated when children are involved.

Let us accept a Millian account of autonomy is correct.  Let us accept that someone’s “own good, either physical or moral, is not a sufficient warrant” to preventing her from exercising her will provided this exercise does not harm to others. This acceptance implies that we must accept that autonomous adults have the right to try experimental treatments, subject to certain conditions, even when the results might be harmful. The same right does not extend to children. Parents must consider the physical, mental and moral good of their children. If parents fail to do so, then a court must decide what is in the child’s best interests. If we accept the above then it doesn’t mean children should never receive experimental treatment. However, it does mean the situation is more complicated than that in the case of adults.

It is generally accepted that parents should act in their children’s best interests and that if they fail the do a court has the right to intervene in order to protect these interests. Let us consider a case in which an experimental treatment becomes available to treat a gravely ill child. How should the child’s parents decide on whether she should undergo the treatment? Intuitively we might assume that they should decide whether the proposed treatment is in the child’s best interests. For any experimental treatment what is in the child’s best interests is a question of probability. Medical probabilities are complicated and parents and courts should usually take the advice of medical experts.

Does accepting the above mean parents should never accept any experimental treatment for a child who is gravely if this treatment is not recommended by the majority of medical experts and carries a low probability of success? Surely any treatment with a low probability of success cannot be in a child’s best interests. However, the above is not always true. In a few cases, experimental treatment might well be in a child’s best interests even if in the majority of cases it isn’t and in these cases might even be harmful. The philosophical issue I want to raise is on what basis should parents and courts use when deciding whether experimental treatment should be accepted. Most would suggest that the decision should be based on what is in the child’s best interests even if the probabilities attached to these interests are extremely hard to determine. I now want to argue such a suggestion is mistaken and that the decision should instead be based on the probability of whether any experimental treatment is likely to harm the child concerned.

Medical ethics is concerned with beneficence, non-maleficence and respect for patient autonomy. Usually parents or in some cases the courts decide whether experimental treatment is appropriate on the basis of what is in the child’s best interests. They apply the principle of beneficence. I appears that acting on the principle of beneficence excludes considerations of autonomy. I argued elsewhere that this assumption might not hold in the case of competent adults, see autonomy and beneficence . I have suggested above that in the case of a young child and experimental treatment that is sometimes impossible to ascertain what is in her best interests making it impossible to apply the principle of beneficence. Kant argued ought implies can. Let us accept Kant was right. It follows if we cannot ascertain what is in a child’s best interests that we ought not apply the principle of best interests. I would suggest that in this situation we should adopt the principle of non-maleficence. Adopting the principle of non-maleficence when considering the acceptability of using an experimental treatment for a child has two important consequences. First it means we need consider harm to the child. In the case of terminally ill children the harm of most concern must be the child’s suffering. Whether someone is suffering should be easier to determine than what is in her best interests. Secondly adopting the principle of non-maleficence brings respect for autonomy back into play. If the autonomous wishes of a sick child’s parents will not harm her then then these wishes matter.

What does accepting the above mean in practice? It might be objected that in practice it is just as difficult to act in a non-maleficent manner as it is to act beneficently. I would suggest such an objection carries little weight provided we ask and can answer three important questions concerning harm. First, we must ask whether the proposed treatment will cause any additional suffering to the child. Second, we must ask whether such treatment would extend the duration of her suffering. Thirdly, we must ask whether moving a child to receive such treatment will cause her further suffering. These questions remain difficult to answer. However, some further more practical questions might be asked to help us answer to answer the first three. I’m a philosopher and for this reason I will only tentatively outline some of these more practical questions. Is the child currently in pain? Will any experimental treatment lead to extra pain? Could any extra pain be controlled? Will the treatment cause nausea? These are clear cut questions and for this reason should be easier to answer than deciding if some treatment is in the child’s best interests. It follows that provided some experimental treatment will not cause a terminally ill child any further suffering, that from a non-maleficent basis, that there is no reason why that child should be denied such treatment provided it is privately financed. At this point I want to emphasise that I am only saying that experimental treatment should be acceptable according to the principle of non-maleficence, I’m not saying such a decision is a good decision.

What are the implications of the above in the case of Charlie Gard?  Should the wishes of his parents matter? When a court decides on what is in the welfare of a child the decision is based on what is in the child’s best interests. Accepting the above means that the wishes of Charlie Gard’s parents should play no part in the court’s decision. However, I have suggested that in cases such as that of Charlie Gard it is sometimes impossible to reach a decision based on best interests. Courts are concerned with practical matters and must make decisions. If a court cannot make a genuine decision based on beneficence then it might make a decision based on the futility of treatment in the belief that this equates with best interests. The two are not identical. Perhaps in these circumstances it would better not to fudge any decision and instead rely on the older principle of non-maleficence. It might even be argued that in these circumstances that a court deciding in a non-maleficent manner to limit a child’s suffering is also acting in a manner which might be loosely described as beneficent. I believe it would be more credible in these circumstances to simply admit acting on the principle of non-maleficence. If we accept the above, then certain questions need to be asked. Is Charlie suffering? Would any proposed experimental treatment cause him further suffering? Would moving him to receive any proposed experimental treatment cause him to suffer? Let us assume that Charlie is suffering then we must now ask whether any proposed experimental treatment likely to reduce or eliminate his suffering. If the answer is negative Charlie should be allowed to die peacefully. Let us assume Charlie isn’t suffering. It seems to me provided that the second and third questions above can be answered negatively that the wishes of his parents should matter and they should be free to seek experimental treatment provided it is privately funded. Accepting the above does not imply seeking such treatment is wise or desirable but only that it should be permissible.

In the light of the above discussion when dealing with difficult treatment options for seriously ill children we should ask the following questions when considering whether we should and if we should how to apply the principle of non-maleficence.

1. Is it possible to ascertain what is in a child’s best interests? Not just what we want to believe is in the child’s best interests. If the answer is no we can move on to apply the principle of non-maleficence.
2. Is the child suffering? If no we can move onto 4
3. Can this suffering be relieved? If yes we can go onto 4.
4. Will this proposed treatment cause further suffering which cannot be relieved. If no then such treatment is permissible according to the principle of non-maleficence even if others believe it to be futile