CAVEAT

In health care dispute resolution, for the purposes of this class, you are a neutral. While many things go on that shock the conscience, this particular class is not about ethics or esthetics.

So, when we discuss alternative medicine, and insurers deciding that it is cheaper to give in to people who want vials of distilled water instead of medicine, and who just let them die on their own terms ...

Or, when we discuss abortion as social planning in order to reduce welfare loads ...

Or, when we discuss assisted "death with dignity" (and without the patient's consent or knowledge) ...

Or, when the topic of denying adequate pain management to terminal patients for cost saving or policy reasons ...

Or, when we discuss denying that AIDS is sexually transmitted as a tool of social planning (as is done in some African countries) ...

Or when we discuss public perceptions of hospital administrators (including one of my partners in my law firm) and nurses (including my wife and many friends) ...

These are discussed as trends or concepts or ideas that you should be aware of in the context of analyzing them as policy or as how they will affect conflicts and trends, not as my endorsement of the positions.

The reality in health care is that there are many, many moral decisions imposed by many people, all in conflict, from those who belive that there should never be a DNR to those who insist that anyone who has any compromise in their quality of life should not have that life continued.  We need not even discuss the conflict over abortion or suicide.

In order to deal with these conflicts it is important to see them from several perspectives:

1. As the people who espouse a position see themselves.
2. As those who resist a position see those who hold it.  (Consider the theraputic touch debate).
3. How the general public sees the issue (with the realization that this will affect, and may effect, policy, regardless of the accuracy of this perception).
4. How informed outsiders (who may be available as neutral referees) see the issue and the parties.
5. How patients see the issue.
6. How the issue might be seen with reframing.

You need not endorse any specific view (in fact, you probably cannot espouse most views) in a conflict by understanding it.  This point is one that the majority of Americans do not believe.  They believe a rule and its correllary: if you understand their position, you will agree with it -- and -- if you seek to understand or express understanding, you are expressing agreement or seeking to find agreement with that position.  Neither is true of a neutral and this is something that you may need to convey from time to time, especially in the health care setting.

Copyright 2000 by Stephen R. Marsh
http://adrr.com/smarsh/