A framework for evidence-based debate of contentious health issues

With the rollout of Obamacare, we are living in a moment in which there is no dearth of heated debates among friends, family, and co-workers.

And often times, these debates degrade to become emotion vs. emotion, or even ad hominem, and so these initially well-meaning conversations morph into heated arguments that lead nowhere. (Even Immanuel Kant advised debaters to out-shout opponents when more civil methods of discourse had failed.)

It is far more constructive to find common ground than to point out dissimilarities. So I decided to take a cue from my medical ethics course to create a simple outline for how to structure a debate intended to find solutions to large problems.

In true medical school fashion, I had to derive a mnemonic for this system: PEA CRV – parties, evidence, action, consequences, resources, violations.

1. Who are the parties involved? This includes Individuals, government, nature, and/or any other relevant players.

2. What reliable evidence do we have on all sides of the argument? This is the most important step, yet it is the one we often forget to include when we have political discussions. What are the biases of each study? Who funded the research? Are there any high-impact results? (e.g. a study funded by a pharmaceuticals company in which its drug is found to be ineffective). Are the studies applicable to our population of interest?

3. What are the possible courses of actionTo answer a broad question like, “How do we fix our health care system?”, we could generate an infinite number of potential actions, so it is best to initially consider a handful of solutions in the preliminary stages.

For each possible course of action:

4. What are the consequences for each party involved? Though human beings may not always be the best predictors of the future, it is imperative to make an estimate of the effects of an action, so this requires at least an ounce of creativity.  What is the magnitude of the consequences for each of the parties? How short-term or long-term are these consequences? What is the probability of each of these consequences?

5. Does this plan utilize resources effectively? Consider monetary, time, mental, physical, social costs.

This may sound overtly utilitarian, but no matter what decision you make, you must have some idea of potential immediate and far-reaching costs.

6. Does this course of action violate individual rights, moral/religious constraints or virtues such as compassion for the suffering, integrity, or honesty?

Hopefully through a simple framework like this, we can we can have structured discourses that are more objective – not just within health care, but within the larger system of politics and morals as well. Of course, it is impossible to remove all subjectivity from debate, which is at once a science and an art.

But by debating a set of facts instead of a set of feelings, we can we can come to compromises and maybe even find solutions — through arguments that are passionate and logical.

Joseph Allencherril is a medical student.
