A second-order investigation of unintended consequences

In my previous post I talked about how we should think about the unexpected outcomes of our actions, and how we should expect those consequences to play out. If you haven’t read that post yet, it might be worth checking it out just to get the background. That said, let’s pave the way for a situation that I think is analogous to the issue at hand.

Suppose I am in the presence of someone who is experiencing a medical crisis, but with whom I cannot communicate clearly (perhaps he or she is too catatonic due to illness, or speaks a different language). I can see signs of several symptoms: the patient is clearly in distress and is in pain, sweating, has a high fever, along with many other indicators of trouble. But against all odds, a mad philosopher has locked me and this person together in a room that happens to be the world’s largest warehouse for medical supplies. Every possible medication and form of medical equipment you can think of is available to me. So here’s the question: should I try to use the vast supplies at my disposal to treat this person?

The takeaway: Something is clearly wrong. This person is sick, injured and suffering. If I can offer them help, I should. It would be terrible of me to simply ignore the problem when I could be doing something to help.

The case against: Despite having watched a significant portion of it House, MDI’m not a doctor. I do not have enough knowledge to intervene properly. I can kind of tell what the different symptoms are – the presence of fever and vomiting is obvious, their heart rate is faster, etc., but I don’t have any reliable way to determine what is causing these symptoms. And I have no way of knowing which of the medications available to me would be helpful. I also have no insight into the medical history of this person and the complications this entails. Perhaps they are already on some form of medication that would interact terribly with something else I might give them. I simply cannot know what the consequences of my efforts would be.

Now someone might suggest at this point that because I cannot know what the results of my intervention would be, I cannot know whether the outcome would be better or worse. Technically that’s true – I can’t know That. But in this case, do I have good reason to think that my efforts are more or less likely to result in harm or good?

It seems extremely clear in this case that I am much more likely to do harm than good if I intervene. Michael Huemer does described a similar thought experiment, in which he points out that for most of human history, doctors usually did more harm than good. This is because for most of human history we understood virtually nothing about how the body works. Huemer explains how George Washington received ineffective treatment from the doctors of his day who were meant to help him, and that almost certainly contributed to his death. As he put it, “The doctors in Washington were respected experts and used standard medical procedures. Why couldn’t they help him? Simply put, they couldn’t help because they had no idea what they were doing. The human body is an extremely complex mechanism. Fixing this usually requires a detailed and precise understanding of that mechanism and the nature of the condition it affects – knowledge that no one possessed at the time. Without such insight, virtually any significant intervention in the body will be harmful.” That is, when you act from a state of ignorance when performing medical interventions, it is technically possible that the unknowable results of your intervention power be positive, but it is much more probably that the outcome will be negative.

This is due to the fact that there are simply many more ways to harm the human body than to heal it. In the same way and for the same reasons, there are many more ways to increase the disorder of a complex system than there are to increase order. There are many more ways to disrupt the natural balance of an ecosystem than to stabilize it. This is why most new ideas are terrible. When you intervene in a complex adaptive system that you do not understand, there is a good chance that unexpected consequences will be negative rather than neutral or positive.

But you could say that not everyone shares my ignorance of medicine. What about a trained medical professional, with years of experience? Wouldn’t medical intervention be a good idea if they were the ones doing the intervention?

That certainly changes things. Clearly, the intervention of such a person would be justified. This, of course, does not depend on the doctor’s claim to possess it perfect knowledge and their attempts guaranteed to be a success – that’s an absurdly high standard. Doctors can still make mistakes and sometimes there are unexpected complications that they could not reasonably have anticipated. The standard here is not perfection. What makes the difference is that a doctor can rightly believe that is their intervention considerably more likely than not to help the patient recover. They won’t get it right in every case, but more often than not they will.

At the risk of testing the reader’s patience, however, I can add another layer to this thought experiment. While I’m not a medical expert, I do know a few things about basic first aid. Nothing special, but things that I can use usefully if necessary. For example, I could bandage a wound to stop the bleeding, or clear a blocked airway – simple things like that. Those are interventions I can legitimately participate in – but if I try to go further, I could inject the patient with a huge amount of warfarin and melt the whole skin off, because hey, since I don’t know whether the outcome of using this drug will be bad or good, it’s all indeterminate, so there’s no reason not to try it!

The relevant question here is whether technocrats, politicians and policymakers are analogous to skilled medical professionals treating a patient whose condition and medical history they thoroughly understand, or whether they are in a position more like me, locked in a warehouse with the hypothetical patient. , or George Washington’s doctors.

Michael Huemer argues that policymakers “are in the position of medieval physicians. They hold simple, prescientific theories about the workings of society and the causes of social problems, from which they deduce a variety of remedies—almost all of which prove to be ineffective or harmful. Society is a complex mechanism whose recovery, if at all possible, would require an accurate and detailed understanding of a kind that no one possesses today.” I think this overstates the matter somewhat. I would say that policy makers in the warehouse with the patient are more like me than medieval doctors. That is to say, there are really some basic things that are understood well enough to be implemented – things at the level of general rules such as the protection of property rights, a system of stable laws, prohibitions on violent crime, etc.

These kinds of basic, general rules are the equivalent of my ability to provide basic first aid. But proponents of technocratic policies are more likely to see themselves as skilled medical professionals with a detailed understanding of their patient, able to deliver complex interventions in a complex system in a way that reliably produces beneficial outcomes.

That mentality is of course not new; that level of overconfidence has always been present. And that mentality is part of what was shocking Edmund Burke to the ideas that inspire the animation French Revolution. Burke also used an analogy of someone who was sick and in need, and felt that our approach to social problems should reflect the way we would approach “the wounds of a father, with pious awe and trembling solicitude.” And he saw those who were motivated by the pretext of their imagined knowledge as if, like me, they were rushing to the patient with a syringe full of warfarin, and described such people as “children of their country who incited to hastily dismember that elderly parent and smash him to pieces. into the cauldron of magicians, hoping that by their poisonous weeds and wild incantations they can regenerate the paternal constitution and renew the life of their father.