By Annie Daley
The Democracy Disconnect
We’ve all been there, bemoaning the gap between what we want and what the people we elect to represent us do. A library everyone wants to keep open still loses hours. Housing projects that have broad public support get stuck in mindless zoning battles. Abortion restrictions tighten even as consistent polling shows most Americans oppose them. Policies at all levels of government frequently fail to align with the needs and preferences of the public. This misalignment often leads to ineffective or unpopular policies, undermining trust in government decision-making and weakening the legitimacy of democratic institutions in ways that threaten the long-term health of democracy itself.
Democratic innovations give citizens opportunities outside of elections to help shape laws and policies, offering a promising response to the disconnect between public will and political action. Around the world, approaches such as citizens’ assemblies, participatory budgeting, and public consultation-style opinion surveys have shown how community members, when given the right information and the opportunity to deliberate and discuss, can provide clear and balanced input that makes policies more representative and strengthens public trust in government.
This article begins by examining the distinct but interconnected reasons politicians might act against public will. Next, it uses Maryland’s long-running debate over the issue of medical aid-in-dying to illustrate how these forces can reinforce each other and keep even broadly supported policies from moving forward. Finally, it shows how democratic innovations can break that cycle, closing the gap between citizens and their government and turning public support into meaningful political action.
Mapping the Gap
When public opinion and policy decisions don’t line up, it inevitably raises the question: why? The reasons matter, because they reveal not only how lawmakers make choices but also why the public so often feels unheard. Sometimes the answer is clear. Other times it’s complicated. Too often, the results threaten not only the issue at hand but also functional democracy.
The most charitable explanation for lawmakers acting against the wishes of their constituents is the simplest: they just don’t know what their voters want. Whether it’s incomplete, incorrect, or absent public opinion, an uninformed lawmaker cannot legislate in line with public will. They often default to anecdotal input and are overly influenced by highly mobilized and outspoken minorities rather than seeking out structured, representative methods that capture their constituents’ true preferences. In practice, the loudest voices often drown out the broad but quieter consensus. Frustrating as it is, this explanation isn’t unique to politics; it’s a common feature of collective decision-making by humans in other settings, too.
Even when lawmakers do have accurate information about public opinion, they may still act against it because they are guided instead by their own determination of what is best. Sometimes this stems from deeply held pre-existing values or moral beliefs; other times, it reflects the influence of moving personal stories or expert testimony that shapes their perspective during deliberations. Lawmakers may also view themselves as wiser and better informed than the general public, using that belief to justify acting against popular opinion. Patterns like this help explain why policy gridlock so often persists despite strong and well-documented public preferences—because too often, personal conviction, not public consensus, drives the outcome. This tension raises a classic question in democratic theory: should representatives serve as delegates, faithfully carrying out the preferences of their constituents, or as trustees, weighing those preferences against their own judgment of the public good?
The third explanation is the most cynical in its assumption that lawmakers act to advance their own political interests. These interests can take many forms—maintaining party loyalty, appeasing wealthy donors, cultivating influence with leadership, or avoiding backlash from powerful lobbies. In these cases, the calculation is less about what voters want, or what politicians believe would be best for their constituents, and more about what will minimize their political risk or maximize advantages in the next election cycle. When lawmakers appear to prioritize political advantage over public preference, regardless of whether that’s the real reason for their choice, it erodes public confidence in government and fuels a cycle of distrust. The more citizens see officials as self-serving, the less confidence they place in the system’s capacity to meet their needs.
The Gap in Action: Maryland’s Paralysis on Medical Aid-in-Dying
As the debate in Maryland over medical aid-in-dying shows, these explanations are not mutually exclusive. In practice, they often overlap and reinforce one another, revealing how gaps in information, competing judgments, and political calculation interact to keep policymakers from acting in line with the popular will. When all three forces converge, legislative action stalls and confidence in the democratic process erodes.
The term “medical aid-in-dying” refers to the practice of allowing physicians to prescribe a lethal dose—usually of barbiturates—to qualifying terminally ill patients. To be eligible, a patient must be an adult with a prognosis of less than six months to live, be mentally capable of making the decision, and receive confirmation of that prognosis from more than one physician. The law also requires multiple requests, reminders that the patient may change their mind, and procedures for safely disposing of any unused medication. These safeguards are standard across every state where aid-in-dying is legal and have been included in every version of the legislation introduced in Maryland.
In states that allow the practice, studies show that patients who choose medical aid-in-dying are motivated less by physical suffering than by their desire to retain autonomy, dignity, and control. Patients who choose this path describe the fear of losing independence, no longer finding joy in daily life, becoming a burden to the people they love, and the crushing financial strain that can come with prolonged treatment as the principal considerations driving their decision. In jurisdictions where this practice is legal, it is only used by a small number of patients, but for many, just having the option brings a sense of comfort and peace of mind.
While ten states and the District of Columbia now permit medical aid-in-dying, Maryland has struggled for decades to enact such a law. For a bill to become law in Maryland, it must be introduced in either the state Senate or House of Delegates, approved in committee, passed by a majority, and then “cross over” to undergo the same process in the other chamber before being sent to the governor for signature. Legislation to legalize medical aid-in-dying was first considered by the General Assembly in 1995 and has been regularly reintroduced since 2015. Despite widespread and growing popularity, though, most proposals for medical aid-in-dying have not advanced beyond committee.
The closest Maryland has come to legalizing aid-in-dying was in 2019, when a bill passed the House of Delegates and was sent to the Senate for consideration. In its only vote on the issue to date, the Senate Judicial Proceedings Committee voted favorably 8–3, with one Republican joining all Democrats in support, only for the bill to stall on the Senate floor by a single vote. In other years, bills have been introduced in both the House and the Senate but failed to make it out of committee in either chamber. This means that despite broad public support, the full state legislature has considered the issue only once in three decades of debate.
The legislative stalemate reflects the outsized influence of well-organized opposition. Numerous religious institutions and certain disability-rights advocates have lobbied aggressively against legalization, warning of the possibility of coercion, inequity, and ethical breaches. These groups, though smaller in number than the public majority, are highly visible in Annapolis, the state capital, and exert disproportionate influence in committee hearings and private meetings with lawmakers. Their testimony is often moral in tone and emotionally charged, so some legislators, especially those wary of alienating powerful constituencies, treat the issue as too politically risky to push forward. In this way, Maryland’s experience reflects a common democratic imbalance: when highly mobilized minorities dominate the conversation, they can stall action on issues where the majority has already reached consensus.
Public support in Maryland for medical aid-in-dying as a compassionate option that should be available with strict safeguards has grown stronger over the years. In 2015, a Goucher College poll measured support at 60 percent. In 2023, a Gonzales Research poll found that 70 percent of Marylanders favor legalizing medical aid-in-dying. This ten-point increase shows that strong support among the citizens of Maryland has evolved into a two-thirds supermajority that includes many in demographic groups that lawmakers might assume to be strongly opposed.
The 2023 survey showed not only strong backing among Democrats and Independents, but also majority levels of support among Republicans, people of faith, and those living with disabilities—communities often presumed to be opposed. The consensus spans racial and gender lines, with solid majorities across Black, White, male, and female respondents. Even amongst Marylanders who identify as pro-life, 42 percent support legalizing aid-in-dying. Professional and medical associations have also increasingly accepted the practice. This widespread and well-documented support underscores an unusually strong popular consensus, making the legislature’s inability to act all the more difficult to reconcile with the views of its constituents.
What stands out in Maryland’s legislative record is not just the repeated failures to legalize aid-in-dying but also the undemocratic manner in which this has occurred. Democratic leaders have generally expressed support but avoided pressing members of their own caucus to take a vote on record that might make it harder for unsupportive committee members to rethink their positions in future sessions by framing the choice as a matter of personal conscience. In 2024, a key sponsor even withdrew support at the last moment, raising questions about political deal-making at the cost of honoring the expressed will of the people. The exact political calculations are impossible for Marylanders to know, but the result is the appearance of the legislature circling the issue rather than confronting it head-on. This dynamic—committee bottlenecks, strategic avoidance, and the outsized power of a few legislators—has left an issue with overwhelming public backing repeatedly sidelined before most lawmakers ever have a chance to weigh in.
The cost of this inaction is not abstract. Each year that aid-in-dying legislation fails, terminally ill Marylanders are left to endure their final months without access to an option available to their neighbors in the District of Columbia and New Jersey. Patients with the means to travel out of state may do so, but those with fewer resources lack that option. Furthermore, patients and families have watched a widely supported promise of relief dangled before them for many years, only to collapse under repeated legislative inaction. The result is not only prolonged suffering but also a steady erosion of confidence in the General Assembly’s willingness to reflect the views of its constituents.
Maryland’s impasse over medical aid-in-dying makes the stakes plain: popular support is frequently not enough to move policy forward in the face of powerful but minority opposition. In these cases, new approaches are needed, and democratic innovations can open a path to aligning decisions with the will of the majority, making policies that are both more representative and sustainable.
Bridging Public Opinion and Policy
This gap between what people want and what a representative government delivers is not the natural order of politics, nor an inherent flaw in democracy we must simply accept. Around the world, communities have experimented with new ways of bringing citizens into the policymaking process to more closely align policies with public priorities. These democratic innovations channel scattered voices into structured guidance, giving citizens influence beyond elections and granting leaders the mandate to act definitively.
Citizen assemblies are a democratic innovation in which a representative cross-section of the population is brought together to hear from experts and advocates on all sides of an issue, deliberate with one another, and ultimately produce recommendations for policymakers. In Ireland, a citizens’ assembly on abortion gave legislators undeniable evidence of strong, informed public support on an issue that had long seemed politically untouchable and led to a subsequent national referendum in which citizens voted to amend their constitution.
Another type of innovation, consultation-style opinion surveys, offers another structured way to capture informed public opinion about a complex topic when policymakers ignore public opinion on the grounds that the average citizen lacks necessary knowledge. Public consultation-style surveys can be done online at an affordable cost. Participants read balanced background materials and arguments on both sides of an issue before giving their views, yielding a far more accurate picture of what informed citizens think than traditional polls do. In Canada, the MAP Centre for Urban Health Solutions used a national public consultation-style survey to collect citizen priorities for primary care reform and convert them into policy recommendations.
The Program on Public Consultation at the University of Maryland has shown that providing context and pro/con arguments often strengthens respondents’ convictions rather than causing them to change their mind quickly. Maryland lawmakers have already used public consultations to engage with their constituents on morally charged issues, like the addiction crisis, and found more common ground across party lines than expected. Since many Marylanders start with limited knowledge of unfamiliar policy questions such as aid-in-dying, running a public consultation on this topic would likely show that once they understand the safeguards and choices involved, support becomes both stronger and more consistent.
Democratic innovations can be especially valuable when lawmakers acknowledge public opinion yet choose to set it aside in favor of their own judgment. One such tool is the citizens’ jury, smaller and more focused than a citizens’ assembly but still designed to give a representative group of residents the opportunity to hear evidence, deliberate, and issue recommendations. A recent example in England illustrates the point: soon after a citizens’ jury recommended legalizing medical aid-in-dying, Parliament passed a bill it had previously rejected. No politician openly credited the jury with shifting the outcome, but the timing is difficult to ignore.
Even when lawmakers know where their constituents stand, and even when they are willing to set aside their own personal judgments, political incentives can still get in the way. France’s Citizens’ Convention on Climate shows how democratic innovations can change a politician’s own political calculus. By putting citizens at the center of debate and producing widely publicized recommendations, this citizens’ assembly gave climate policy a visibility and legitimacy that leaders could not easily ignore without looking blatantly self-interested. That visibility allows democratic innovations to transform diffuse public support into action, bridging the gap between what people want and what government delivers and laying the foundation for a stronger, more responsive democracy.
From Impasse to Action
Maryland’s stalemate on medical aid-in-dying is more than a policy failure, it’s a warning sign about democracy. When overwhelming public support can’t move a broadly backed reform, it shows how quickly public consensus can be drowned out by legislative caution and political calculation. Democratic innovations offer a way to renew the core promise of representative government. By giving citizens a voice through structured processes such as assemblies, deliberative surveys, or consultation processes, they turn diffuse opinions into an observable mandate lawmakers can’t easily ignore.
Maryland could benefit from a carefully designed combination of democratic innovations to address the aid-in-dying debate. A public consultation-style survey would be an especially cost-effective first step. It would capture a broad cross-section of Marylanders, prompt deeper reflection, and generate a clearer, more accurate picture of informed public opinion.
If legislators remained hesitant, the consultation survey could be used as a pilot to demonstrate both public demand and the feasibility of structured engagement in order to raise the funds needed to convene a citizens’ jury or a more costly full assembly. The results of such a survey could then inform a citizens’ assembly, where a smaller, demographically representative group of Marylanders would meet over several weekends, hear from experts, deliberate together, and issue recommendations. The survey provides breadth, while the assembly adds depth: participants can weigh trade-offs, explore values, and craft detailed proposals that carry the mandate of citizen deliberation. Together, they would offer a more complete picture of informed public will than either could provide alone.
Using democratic innovations can increase lawmakers’ political confidence while reaffirming their role not as trustees imposing personal judgment but as delegates charged with carrying out the will of the people. In Maryland and many other states, some elected officials are even formally titled “Delegate,” a reminder that their mandate is to represent the people’s will, not impose their own values on their constituents.
The lesson goes beyond one state or one issue. Across democracies, legitimacy depends on elected officials faithfully representing the people who put them in office. Democratic innovations won’t end gridlock overnight, but they can shift incentives, rebuild trust, and remind both citizens and leaders of democracy’s most basic promise: that government reflects the will of the governed. Public will is not a nuisance to be ignored or managed, it’s the mandate of democracy itself.
Annie Daley is a public policy professional based in Washington, DC, and a recent graduate of the University of Maryland School of Public Policy. She focuses on health and social policy and is passionate about using evidence-based solutions to address complex challenges and strengthen community well-being. This article is drawn from her master’s degree capstone project.
