Consensus and Conflict in Health Care Delivery: Some Anthropological Thoughts

Abstract

Singly and together, the foregoing papers make a number of forceful points about the contemporary status of man's continuing struggle to cope with threats to his physical and mental well-being. They speak also to some of the conceptual and methodological problems of scientists who share a common humanity with subjects whose plight evokes sympathy. Scientific canons require us to abstract social structures and ideological patterns from the raw facts of daily existence and to dissect the participants into statistically significant bits of behavior. Yet the findings, perhaps especially in the health field, cry for a deeper interpretation of human aspirations and raise questions that can only be answered with intelligent, compassionate action directed to humanly desired and humanely desirable goals. The analytic approach leads to reliably verified theories of human behavior and social change. The activist approach goes beyond established theory and impartial assessments of feasibility to advocate what is right and just over what is wrong and iniquitous-matters that can be resolved only through a process of conflict and negotiation to reach consensus. In short, as these and numerous other studies demonstrate, health care is a moral and political as well as a technical and managerial issue. At present, the right to use the products of modern medicine is socially restricted and politically limited despite normative rhetoric to the contrary. Small wonder that conflict between the providers and potential users of health services often outweighs consensus or that consensus sometimes masks the coalition of some factions in order to exclude or control other factions.