Conflict Resolution in the Clinical Setting: A Story Beyond Bioethics Mediation

Abstract

Rarely do ethics consults focus on genuine moral puzzlement in which people collectively wonder what is the right thing to do. Far more often, consults are about conflict. Each side knows quite well what is “right.” The problem is that the other side is too blind or stubborn to recognize it. And so the ethics consultant is called, perhaps in the hope that s/he will throw the weight of ethics toward one side and end the controversy so everyone can get on with other business. Perhaps the greater problem in these scenarios is that even if one side “wins” by gaining the power to dictate what happens next, the toxicity permeating the relationships often markedly worsens and other conflicts erupt, major and minor. Accordingly, where an ethics consultant cannot or should not declare an obvious winner on substantive grounds, the challenge often becomes largely procedural: how shall the situation be addressed in a way that acknowledges the legitimacy of diverse voices and strives to preserve, perhaps even to rebuild, the relationships on which good healthcare depends? At that point thoughtful negotiation and creative problem-solving are generally preferable to entrenched combat. This is the point at which “clinical-setting mediation” or other conflict management tools, such as coaching or facilitation, might be invoked. This article focuses on mediation. This paper broadens the conversation to encompass the conflict that permeates healthcare generally. Conflict resolution skills can readily address disputes and tensions throughout healthcare and, in the process, provide a kind of preventive ethics. Part I illustrates these broader conflict resolution opportunities by describing a recent mediation regarding a difficult discharge negotiation. Part II then outlines broader opportunities for conflict resolution across the spectrum of healthcare and describes several initiatives in that direction, particularly from the legal community. Finally, Part III discusses several ways in which clinical-setting mediation, as described in this article, differs significantly from bioethics mediation as it is often described in the literature, and offers a few suggestions for ethics committees interested in providing conflict resolution services.