Once, visiting the doctor was rather like interacting with the God of the Old Testament: if patients had an opinion, it didn’t matter; doctors made all the decisions (sometimes without explaining them), and any questions about this state of affairs were considered rude. Then, around 50 years ago, that started to change. A trend began that pushed for more for patient empowerment, and the idea of “patient autonomy” arose. Suddenly, the sick would have some say over their fate.
Trouble is, they didn’t much like it. Research since then has revealed that – at least when it comes to the larger, more terrifying decisions – many patients would rather not have a say at all. How on earth should they know what to do about their life-threatening condition? What if they got it wrong? Couldn’t the person with the years of medical training decide for them instead?
Modern doctors, trained to prevaricate in the name of ethics, merely ended up being trusted less. Because it turns out that when we’re really scared, we don’t want choice. We want a confident expert to guide us through the worst moments of our life, with reference to rules written in licensed textbooks, if not tablets of stone.
With that in mind let us turn to our leaders’ management of the coronavirus pandemic. The latest big policy decision – over how to manage the virus at our borders – has taken the government almost a full year to make. (A recent study found that the virus was introduced to the UK “well over a thousand times in early 2020”).
Now at last there is a plan: from 15 February, arrivals to the UK from a “red list” of high-risk countries will be quarantined in hotels. But it is hard to argue that the policy – in particular, its timing – is solely based on science and data. The announcement was made some weeks after new variants coming from other countries had been identified, and after airport quarantine had been in place for months in places like New Zealand and Australia.
Instead, the decision seems to have been made at least in part as a result of political pressure – from the opposition, from members of the Tory party, and from the public. That’s a problem – and it’s become a theme. Too many of the government’s decisions – when to lock down, when to close and reopen schools, whether or not to cancel Christmas – seem to be driven not by the data but by opinion poll. Asked why the UK’s early approach to the pandemic was so different from other countries in Europe, which ended up with lower death rates and fewer ongoing restrictions, Boris Johnson’s response was that Britain was a “freedom-loving country”. “It is very difficult to ask the British population uniformly to obey guidelines in the way that is necessary,” he said, absolving himself of responsibility. Britons simply didn’t want to lock down, so how in good conscience could a prime minister make them?
Schools were opened, then closed, then opened (at one point for the span of a single day), based not just on viral dynamics but on the reactions of the public. And as Covid-19 cases rose sharply before Christmas and scientists urged him to reconsider, Johnson kept one eye on the opinion polls. “We don’t want to ban Christmas” he said at a press conference. “I think that would be against the instincts of many people in this country”.
Do the festive instincts of voters really matter when it comes to making life or death decisions on their behalf? Apparently so. Revealingly, it was reported in May that a large operation in Downing Street was devoted to tracking public mood, with aides receiving “near-daily updates” gathered from focus group research on what people thought of the government, and its approach to the pandemic. But governing-by-focus-group came at a cost. Not only did it lead the government to make bad decisions – it failed even to boost their approval ratings. The more Johnson dithered and changed his mind to please them, the less people liked him. During a summer of U-turns, his personal ratings fell and fell – whereas in April, at the height of the lockdown, his popularity was soaring. People may not have liked the draconian new rules, but it turned out that the UK’s freedom-loving public liked the Prime Minister for making them – it read as firm government.
This is what our leaders are yet quite to grasp. In a pandemic, voters want to be governed differently. In normal times, we want choice, freedom, for our leaders to listen to what we want and (ideally) give it to us. But when decisions cost thousands of lives, that influence makes us uneasy. We may chafe at the restrictions, but we don’t like the idea that if we grumble too loudly they might be removed. Home schooling is a drag, but that doesn’t mean we want kids to be packed off back to classrooms if it isn’t safe. After all, what do we know? What if we get it wrong? Can’t the experts make those decisions for us?
In a real emergency, we don’t in fact want what we want. We want to trust our leaders to do what works, not just what’s popular.