This book, written between March and May, during ‘lockdown’ in the UK, is a spontaneous analysis of a disturbing global drama that continues to disrupt normal standards of science, public health, human rights and medical ethics in ways few people thought possible at the start of 2020.

Civil liberties have been cast aside by a handful of people obsessed with a single risk, unable to think beyond the narrowest conception of health. For weeks, in the initial stages of the pandemic, the only focus of most governments was to ‘defeat’ a virus. They took advice almost exclusively from like-minded epidemiologists and public health doctors, who claimed to be ‘guided by the science’ yet whose predictions turned out to be wildly wrong. This small collection of establishment people simply disregarded entirely predictable negative impacts on so many other aspects of social life, myopically sacrificing countless lives, livelihoods and national economies to ‘battle’ a virus no worse than seasonal ‘flu. There was no attempt at democratic consultation, and governments had few if any qualms about using propaganda to terrify people into compliance.

The assumption that we live in accountable democracies, with unalienable rights, was erased with Orwellian disdain. It quickly became clear that it is impossible for citizens to challenge governments, even in the face of unprecedented restrictions on personal freedoms: if the government says you cannot leave your house they can force you to stay in, as millions from Melbourne in Australia to Lima in Peru now know. The cherished notion of informed consent to health measures has been replaced by a slew of hastily drafted legislation which has made previously normal, innocent actions criminal offences.

The Case for Democracy includes many examples of the failure of decision-makers to understand the meaning of evidence, to balance risks of disease with multiple other risks, and to follow the advice of their own professional bodies about what to do if there is a pandemic: for example, using repressive measures without public involvement flatly contradicts advice from the Centers for Disease Control in the USA, which consistently points to the importance of balancing individual liberty with combating disease.

However, cataloguing unfounded decision-making is not the main purpose of the book. After all, any competent person with internet access and a little determination can discover the deluge of errors, unethical laws and false reasoning for him or herself. Rather the book tries first to understand how apparently sane people could possibly think it made sense to implement such massively damaging policies, and secondly asks how we, the public, might ensure that such a disastrous episode can never happen again.

Seedhouse’s explanation is simple: the ‘experts’ are subject to biases and errors of thought well-known to every first-year psychology student, yet none of them seem to realise it. The text-book examples of mistaken thinking include: ‘social amplification’ where new risks are falsely perceived as worse than existing dangers; ‘attentional bias’ where only very specific things are noticed while other relevant matters are ignored; and ‘confirmation bias’ in which only information that strengthens one’s prior view is valued - making it extremely difficult to assess alternatives fairly, and even harder to admit when you are wrong.

‘Group think’ amongst politicians has been ubiquitous. Apart from Sweden and South Korea, politicians right, left and centre have rushed either to copy or outdo each other, without seeming to question the sense of this. The ‘Dunning-Kruger Effect’, in which people with low ability at a task overestimate their competence while feeling superior to others has been equally widespread; as has the tendency to predict more extreme outcomes than actually happen, and the simple, atavistic enjoyment of power and control.

Seedhouse uses the notion of ‘rational field blindness’ to illuminate these elementary mistakes. This lack of vision occurs when it’s assumed that the evidence speaks for itself (it never does) and that scientific analysis is value free (it never is). Rational fields do involve evidence, logic, and science, but these factors are always selected and interpreted according to values, human instincts, linguistic classifications, and the physical and social environment. When policymakers are blind to this, their reasoning, choices, and actions inevitably become dangerously skewed and short-sighted.

Because the backgrounds of their advisers are so limited, no-one seems to have explained these elementary psychological errors to the politicians, who believe they are making rational, objective decisions, when really their behaviours are classic case studies in delusion.

These factors underpin the book’s argument for inclusive, participatory democracy: if the chief problem has been an unduly limited number of options for action, an obvious alternative is to broaden decision-making processes to include diverse voices, knowledge, values, experiences and cultures – as a practical, effective way to arrive at well-informed consensus.

Since our values-blind leaders are unable to see beyond their biases, they need to be better educated. And the best way to do this is via properly organised and funded Citizen’s Assemblies, with decision-making powers, where policies like lockdown can be properly debated. Our current leaders would, of course, be invited to present their viewpoints, which would then be subject to scrutiny from Assembly members with wide and varied expertise, from many walks of life. In these Assemblies our leaders would have to defend and justify their points of view and would, in the process, learn about and be able to reflect on intelligent and compassionate alternatives.

The Case for Democracy not only explains why this is so desperately needed, but gives examples of many existing inclusive, democratic initiatives around the world; including an extensive exercise in the USA where citizens considered what to do in preparation for a ‘flu epidemic and came to the sensible conclusion that vulnerable people should be protected, though not at the expense of normal social functioning.

Wide-reaching participatory democracy is already happening. While it will be a challenge to extend these examples to involve many thousands of us, it is by no means impossible. It can and must be done.

By David Seedhouse Read More


Our book, USING PERSONAL JUDGEMENT IN NURSING AND HEALTHCARE, clarifies decision-making in nursing and healthcare. It explains that personal judgement is essential in everyday practice, and offers realistic scenarios for personal reflection and group debate.

The book is designed for nursing students and lecturers from first year undergraduate to postgraduate and advanced practitioner, as well as students and lecturers in any other clinical and allied health discipline. It is particularly effective in programmes on critical thinking, decision-making, reflective practice and ethics.

As writers and thinkers, who wish to use our minds and experience to support and improve healthcare education and practice, we were most definitely aware that we faced a massive challenge in writing this book. We’re operating in a rule-based culture that’s advocated by every official body, is promoted in most texts for students, and is comprehensively validated in accredited health professional education. Yet despite its popularity, this culture fails to properly appreciate, or possibly is even afraid of, the free-thinking human factor.

Consequently, we decided that we must engage in an honest exploration of personal judgement, and that this must include pointing out the limitations of the present drive for more and more regulation and uniformity. Personal judgement happens constantly in healthcare. It often conflicts with or is quite different from the rules. But this does not mean that the rules and standards are unimportant, rather they are genuine attempts to encourage health professionals to be the best they can be - it’s just that we feel that to achieve this we need standards AND we need self-awareness, creativity and personal engagement as well.

We’re looking, we suppose, for the best of both worlds. Therefore we encourage readers to research evidence-based practice (EBP), learn and apply the many professional standards if they wish, while reflecting on what they mean to them personally, using examples from experience wherever possible. And we also encourage readers to understand the power of personal judgement, to appreciate how essential to good practice it is, and to use this book’s ideas and concrete examples to boost self-awareness, awareness of others, and awareness of life’s complexities and differences.

There are encouraging signs that both shared standards AND deep personal reflection will increasingly be officially acknowledged, and will therefore form a vital part of future education and practice. For example, in 2019 the NMC began to recommend that:

‘At the point of registration, the registered nurse will be able to:

1.8 demonstrate the knowledge, skills and ability to think critically when applying evidence and drawing on experience to make evidence informed decisions in all situations

1.10 demonstrate resilience and emotional intelligence and be capable of explaining the rationale that influences their judgments and decisions in routine, complex and challenging situations

1.14 provide and promote non-discriminatory, person-centred and sensitive care at all times, reflecting on people’s values and beliefs, diverse backgrounds, cultural characteristics, language requirements, needs and preferences, taking account of any need for adjustments

1.17 take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop their professional knowledge and skills

1.18 demonstrate the knowledge and confidence to contribute effectively and proactively in an interdisciplinary team’ (21)

While these requirements still lack exact guidance (how do you actually ‘reflect on people’s values and beliefs’? And if you find they are not the same as yours, can you really be ‘non-discriminatory’) we believe that this is as it should be. It would be impossible and pointless to write specific instructions for every set of circumstances, so we applaud these latest official attempts to encourage personal judgement. And we hope very much that our book will help connect these thought-promoting guidelines and attributes with the complexities and unknowables of everyday practice.

We think that critical thinking and careful reflection is needed now more than ever before.
By David Seedhouse Read More