Acknowledging the growing attention being paid to constitutional engineering in post-conflict situations like Afghanistan, Iraq and the Sudan, among others, this article seeks to offer a new methodological framework through which to investigate the ability of democratic design to help manage conflict in fragile and divided societies. A theoretical construct rooted in theories of alignment and complementarities is outlined from which testable hypotheses can be drawn.The framework used to analyze the practice of constitutional design emerges from the lessons of medical diagnosis and treatment. (i) It is argued that designing a constitution to help stabilize a nation state is much like treating a sick patient — and failed political settlements are often born of poor diagnosis or mistreatment. (ii) There is a temporal aspect to constitutional engineering which follows the medical continuum of triage, emergency medicine, convalescence, and longer term health management. Thus there is a pressing need for political institutions to be flexible enough to adapt to the differing needs of differing stages of democratic development. (iii) Within the constitutional framework political institutions need to be holistically integrated and compatible; i.e., that must be properly aligned. (iv) There has been a pattern of both rushing to surgery (elections) before the patient was stabilized and then compounding the danger by discharging the patient (donor’s extrication) before the state is healthy enough for democracy to endure.