Eubios Journal of Asian and International Bioethics - Eubios Ethics ...

22 Eubios Journal of Asian and International Bioethics 22 (January 2012)
as the meaning of RISK, HEALING, etc. Too often, we
take our background differences for granted and led into
assuming that we cannot really resolve the conflict.
Then, two approaches must be effective for the
successful resolution; the first approach is the
“Transformative” approach which has been put forward
by Bruch B. Bush and Joseph P. Folger in 1994/2005.
The second one is the “Narrative” approach that has
been introduced by John Winslade and Gerald Monk in
2000/2008. Both of the approaches have been used in
“Mediation.”
Based on these mediation approaches, we will
consider “Transformative Dialogue” for the concerning
parties in the pursuit of conflict resolution in bioethical
field.
Conflicts in the Healthcare Field
In recent years, conflicts between patients and Doctors
(healthcare professionals) are more and more frequent;
one of the reasons is an insufficient or inappropriate
communication or interaction with the healthcare
professionals (Tereanu and Quattrocolo, 2011).
Mediation
“Mediation” is one of the most appropriate methods for
peaceful conflict resolution. Mediation facilitates an
independent agreement making of the concerning
parties, which can be sustainable and satisfactory for
both of parties.
Christopher W. Moore (2003) defines mediation as,
“The intervention in a negotiation or a conflict of an
acceptable third party who has limited or no authoritative
decision-making power but who assists the involved
parties in voluntarily reaching a mutually acceptable
settlement of issues in dispute. In addition to addressing
substantive issues, mediation may also establish or
strengthen relationships of trust and respect between the
parties or terminate relationships in a manner that
minimizes costs and psychological harm.”
The mediator is defined as a third party, a person not
directly involved in the dispute (Moore, 2003).
Transformative Mediation
The concept for Transformative Mediation is shifts both
of “Recognition” and “Empowerment”. Dialogue process
that includes the interaction of both elements would
provide both of the concerning parties a “Transformation
from weakness to strength” toward re-building of the
relationship. Bush and Folger (2005) define conflict as
“crisis in human interaction”, and describes as,
“First, conflict generates, for almost anyone it touches, a
sense of their own weakness and incapacity. For each of
them, conflict brings a sense of relative weakness,
compared with their pre-conflict state, in their experience
of self- efficacy: sense of lost control over their situation,
accompanied, by confusion, doubt, uncertainty, and
indecisiveness.” “At the very same time, conflict
generates a sense of self-absorption: compared with
before, each party becomes focused on self alone ―
more protective of self, and more suspicious, hostile,
closed, and impervious to the perspective of the other
person.”
They suggest dynamic shifts with two elements for the
successful resolution.
“Empowerment” (Bush and Folger, 2005): “The
restoration to individuals of a sense of their value and
strength and their own capacity to make decisions and
handle life’s problems.”
“Recognition” (Bush and Folger, 2005): “The evocation in
individuals of acknowledgement, understanding, or
empathy for the situation and the views of other.”
In an empowerment shift, the party moves from selfabsorption
to greater strength, and in a recognition shift,
the party moves from self-absorption to greater
understanding of other (Bush and Folger, 2005). They
call them “Moving from weakness to strength” and
“Shifting from self-centeredness to responsiveness.”
Narrative Mediation
While Narrative Therapy has become relatively
mainstream in Family Therapy, Narrative Mediation is still
a relatively new and unexplored phenomenon in the field
of mediation (Hansen, 2003). Narrative Mediation is a
dialogue process with “Deconstruction” and
“Externalization” which provides both of the concerning
parties a cognitive transformation (new views or
meanings) and opportunity to re-build a new relationship
called “Alternative Story.”
The worldview of Narrative Mediation is that people live
their lives according to stories as socially and culturally
constructed, therefore, conflicts are considered as what
emerged by people’s shared social and cultural fabric
rather than people’s inner drives and interests (Winslade
and Monk, 2000). Thus, Narrative Mediation makes use
of “Deconstruction” and “Externalization.”
“Deconstruction (Deconstructive Questions)” (Winslade
and Monk, 2000): “Inviting the parties out of conflict story
and into learning how they have been caught in the web
of the dispute. Deconstructive conversation loosens the
authority of a dominant way of thinking and opens the
door for different ways of thinking.”
“Externalization (Externalizing Conversations)”
(Winslade and Monk, 2000): “Introducing a way of
speaking about the conflict that interrupts blame and guilt
and helps parties to dis-identify with the conflict itself. It
promotes a clear separation between people and
problems, and then invites a re-evaluation of their
relationship with problems.”
Transformation in Narrative Mediation can be
considered as “Transformation from a dominant way of
thinking to different ways of thinking.”
Conclusion
In the context of health-care ethics, the two kinds of
transformation are equally essential to conflict resolution.
However, these two kinds of transformation also have
their limitations – they must be difficult for healthcare
conflicts involved in the context of social-culture and
religion. The concepts of Transformative and Narrative
mediation are IDEAL to these conflicts. Therefore, we
need to conduct further research on how to improve and
modify the two concepts so that they could be applicable
in those contexts.