Deliberation and Legitimate Decision-Making: The Use of Depoliticised Management in Rationing Healthcare

Central to the ideal of deliberative democracy is the claim that the quality of public opinion-formation benefits from a diverse and lively public debate. Further, it is assumed that the more informed and impartial the participants are in deliberation, the better the quality of the deliberation and the better the outcomes are likely to be. The values of deliberation and participation may conflict: While transferring powers to experts may improve the quality of decisions, thereby contributing to epistemic justification, the rise of non-majoritarian forums seems to undermine the intrinsic value of democratic procedures. It has been suggested that this tension weakens once it is realized that deliberative democracy may require various degrees of depoliticisation. By establishing a “buffer zone” between politicians and certain policy fields, contestation and deliberation may retain a central place in government. The present paper seeks to explore this argument further by offering a case study of the depoliticisation of Norwegian healthcare priority setting. The paper describes how Parliament has adopted a model of depoliticisied management by means of judicalisation and institutional delegation. The discussion falls in two parts. First, it is argued that this model may contribute to the quality of rationing decisions by constraining considerations of “popular passion” or of political advantage from denouncing patterns of rationing scarce resources, thereby letting loose a rule of emotional politics that works systematically against the common good. Second, the adoption of this model may, however, justify a specific form of health-economic scientisation of priority setting decisions. Seemingly technical criteria are used to neutralise political and moral controversies. As a result, public expectations about the responsibilities of politicians may change. It is argued that depoliticisation by scientisation undermines the scope for legitimate decision-making by forestalling public contestation and deliberation.