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Br J Gen Pract. 2010 July 1; 60(576): 544–545.
PMCID: PMC2894398

The Wizard, the Gatekeeper, and the Watchman: a fairy tale of resources and decisions

Once upon a time there lived a Gatekeeper and a Wizard whose tale has been told by learned scribes in highly respected scrolls.13 The Wizard lived in a white castle and owned a powerful crystal ball that could tell him why people fell ill, and, when he had determined the cause, he would cure them with powerful magic potions. He had spent many years training to become such a clever Wizard and was highly revered by the people. At the entrance to his castle lived a Gatekeeper who would decide which of the many people who came with their illnesses should go on to see the Wizard. He too had great learning, but he had a less powerful crystal ball, less powerful potions, and he cured less serious conditions (so that not everybody who came to the Gatekeeper needed to see the Wizard). Over time many more people saw the Gatekeeper than the Wizard, but this balance was shown to be necessary for all concerned.13

What has not been told before is the tale of the Watchman. He too was a learned Wizard but his was a different task. It fell to him to survey the land from the castle wall to see all of the people in the Kingdom, understand their ways, and judge why they came to the Gatekeeper, and why some needed the Wizard’s strong potions. He used such spells as he possessed to change people’s ways so that they would suffer less and the Gatekeeper and the Wizard would not be so greatly burdened. He could see far and wide across the Kingdom with his enchanted looking glass and his advice was valued by many.

One morning, the Watchman was looking from the wall as was his usual custom, when he heard footsteps on the stairs.

‘Greetings Sire,’ said the Stranger.

‘Greetings Stranger,’ said the Watchman, ‘what brings you hither?’

‘I come in humility and respect Sire,’ said the Stranger, ‘for I wish to learn the craft of the Watchman.’

‘How came you to this decision?’ enquired the Watchman, eyeing the Stranger closely, ‘for I warn you, it is not an easy art.’

‘I will tell you my story,’replied the Stranger, ‘so that you understand my request.’

‘Very well’responded the Watchman, ‘pray sit and I will listen to your tale.’

And so the Stranger began.

‘For many years I have been a Gatekeeper at a distant castle, serving the needs of the people. As I toiled in the gatehouse, I became downcast, for many seek the Wizard’s help, but only some really need it, and sometimes their use of strong potions did not make sense, and there seemed little I could do. Then one day I met a Watchman like yourself who told me of his work; how he looked from the walls, saw the whole land, and brought reason to decisions about who needed Wizards and strong potions. When I heard this was possible, I longed for this knowledge and discernment. However, opportunities to leave my work at the Gatehouse were few, and many years have passed before this moment. Yet I have not made this decision lightly, and am determined, if you are willing to guide me.’

The Stranger lapsed into silence and waited upon the Watchman who had listened intently, stroking his long white beard and frowning slightly.

‘Very well,’he said finally, ‘I will do as you ask, for I see that you have come to this with sincerity and depth of thought.’

‘Oh thank you sir …’ began the Stranger enthusiastically.

‘But first,’ the Watchman cut in, ‘I must tell you the truth. This work demands all of my wisdom and plumbs the very depths of my heart’

‘How can this be, Sire?’ enquired the Stranger, ‘Yours is not like the work at the gatehouse where matters of life and death unfold right before our eyes?’4

At this, the Watchman smiled and stretched out his hand.

‘Look,’ he instructed the Stranger, who duly looked out at the land. At that moment the Watchman must have used a powerful spell, for things were revealed to him that he had not noticed before. He saw that some people who saw Wizards did not get better, though they took powerful potions. He saw that Goblins kept inventing costly potions that did not always work. And he saw, as he had suspected, that the demand for Wizards and potions could never be met, and seemingly impossible decisions were needed about whom to turn away. Great sorrow filled his heart and he begged the Watchman to show him no more.

After some time the Stranger asked, ‘What can be done?’

‘I think perhaps your question is the wrong one’, replied the Watchman, ‘for sometimes there are several things to be done, the problem lies in choosing correctly.’

‘But it’s obvious,’ retorted the Stranger hotly, ‘Stop the Goblins inventing these useless and expensive potions, and stop people who bother the Wizard unnecessarily to make room for those in genuine need.’

The Watchman smiled gently, ‘Look again,’ he said.

The Stranger then saw a dwelling where a sick man lay, whose condition could not be cured. Then he saw a Goblin who had invented a costly potion that he claimed could prolong the dying man's life.

‘Do we give it to him?’ he heard himself ask.

Not answering, the Watchman held up his enchanted mirror, and the Stranger saw an angry crowd who were demanding justice for the dying man, and then wise scrolls saying that the potion did little in such cases.

Then he said, ‘… and that crowd does not see this.’

And the Stranger looked and saw some other ill people, not as sick as the dying man.

‘Who are they?’ he asked.

‘Those who will not get to see the Wizard, though he could help them, if we buy the Goblin's new potion. Our gold is finite, and every benefit also has a cost.’5,6

‘So will this man get the Goblin's potion?’ he asked.

‘Probably.’ said the Watchman, a little sadly, ‘The minister often overrules.’

The Stranger was silent, abashed at his previous outburst.

‘I see that you have thought long on these things, wise Watchman, and I now see why your work is indeed full of heartache, though in different ways from mine. How do you decide … ’he tailed off.

‘Believe me, I have studied many scrolls, met many wise people, and debated long on these things, and it remains very difficult.’ replied the Watchman, ‘Some believe we should bring the most good for the most people, others feel treating people equally is paramount, even if the outcome is not optimal for everyone.7 Others say people's rights come first, and some promote ‘the common good of the people’, whatever that is …6 And what about need? How to define it, and weigh one need against another …’8

He paused. ‘So this is how I make decisions. I first remember who I am; neither the maker of laws nor the judge of good and evil. I represent all the people, not just some. I recognise that many choices are moral in nature and may cause harm. I try to fully understand the facts of each case, and think carefully about different possibilities and their consequences. I seek the wisdom of Wizards, Gatekeepers and others. We must work together, for ‘a Kingdom divided against itself will not stand’, and we need to consider many perspectives.9 After all of this, I make a decision and act on it, for it may be worse to do nothing than something. Having acted, I am duty bound to reflect both why and how I made the decision. The way we distribute the gold is often as important as the distribution itself. Our methods must be beyond reproach. We are accountable to the people, so we must act publicly; our decisions may be disputed so must leave room for revision and appeal, and we must be regulated, for fear that our own desire for power eclipses our desire for the good of the people.’1013

‘And having done all this,’ interjected the Stranger, ‘do you always feel assured of doing right?’

‘Often not.’ replied the Watchman ‘Profound responsibility brings much uncertainty.’

The Stranger looked pensive. ‘Do you wish to reconsider your decision?’ asked the Watchman quietly.

‘No Sire,’ replied the Stranger, ‘but you have truly opened my eyes. Tell me, what do you consider the single most important thing in making such decisions?’

The Watchman paused, ‘The most important thing,’ he replied, ‘is to wrestle with it, both within yourself, and with others. It is a fool who believes that these things can be solved with a simple formula.’

And so it was that the Stranger became apprenticed to the Watchman. He always remembered these words at their first meeting, and though it would not be true to say he lived happily ever after, he learned his ways and grew in wisdom and judgement.


This essay was written with gratitude to and respect for Nigel Mathers and his colleagues.13


1. Mathers N, Hodgkin P. The Gatekeeper and the Wizard: a fairy tale. BMJ. 1989;298:172–173. [PMC free article] [PubMed]
2. Mathers N, Usherwood T. The Gatekeeper and the Wizard revisited. BMJ. 1992;304:969–971. [PMC free article] [PubMed]
3. Herd B, Herd A, Mathers N. The wizard and the gatekeeper: of castles and contracts. BMJ. 1995;310:1042–1044. [PMC free article] [PubMed]
4. Willems DL. Balancing rationalities: gatekeeping in health care. J Med Ethics. 2001;27:25–29. [PMC free article] [PubMed]
5. Coleman CH, Bouesseau MC, Reis A. The contribution of ethics to public health. Bull World Health Organ. 2008;578:86. [PubMed]
6. Krebs J. The importance of public health ethics. Bull World Health Organ. 2008;86:579. [PubMed]
7. Rose G. Rose's Strategy of Preventive Medicine. Oxford: OUP; 2008. In search of health; pp. 141–161.
8. Dworkin R. What is equality? Part 2: Equality of resources. Philosophy and Public Affairs. 1981;10(4):283–345.
9. The Bible. Mark, Ch 3 v. 24 New International Version. London: Hodder and Stoughton; 2009.
10. Santa Clara University. Markkula Center for Applied Ethics. A Framework for Thinking Ethically. (accessed 10 June 2010)
11. Donnan S. Oxford Handbook of Public Health Practice. New York: OUP; 2001. Ethics in public health; pp. 118–123.
12. Kass NE. An ethics framework for public health. Am J Public Health. 2000;91(11):1776–1782. [PubMed]
13. Clayton M. Rationing in health care. J Health Serv Res Policy. 1998;3(1):58–59. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners