1、PDF外文：http:/ Kevin Gibson. Mediation in the Medical Field .Is Neutral Intervention Possible? ,J, The Hastings Center Report,Vol. 29, No. 5 (Sep. - Oct., 1999), pp. 6-13. Mediation in the Medical Field .Is Neutral Intervention Possible? Abstract Neutrality is held to be the touchstone of
2、good mediation. True neutrality is elusive, however, and probably not even desirable, at least when applied to patient-provider disputes over medical care. In this context, mediators should not posture as “neutrals”； they should strive instead to protect their clients autonomy. Health care has great
3、 potential for conflict .Decisions often involve multiple paties,each with different interests,issues,values,and perspectives.These classes are often resolved by judicial rulings or executive decisions ,but increasingly,various methods of alternative disputes.One of the most highly regarded of these
4、 is mediation ,a model of ADR that involves intervention by a third party who lacks decision making power and instead facilitates negotiation between the disputants.ADR in general and mediation in particular have been advocated in the Health Security Act as an integral part of the future of the Amer
5、ican health care industry. Proponents of mediation claim that it is quicker,less expensive,and achieve a greater settlement rate than traditional methods of dispute resolution.It may also have modeling function,so that participants learn to resolve learn to issues without resorting to adjudication.
6、At the policy level,mediation could be used resolve disputes between managed care administrators and medical staff over what constitutes an experimental procedure.Alternatively,mediation is seen as a way to facilitate agreement at the beside among doctors,nurses,patients,and family.New York s Montef
7、iore Medical Center has been a pioneer in using mediation in bioethical disputes and produced a model program for the industry . This new emphasis on the mediation process has wide practical significance in the way disputes will be dealt with in the whole realm of health care.It is also philosophica
8、lly important because it greatly expands the scope of intervention by parties who strive to be nondirective.but while formal mediation sessions and techniques can be extremely useful in health care,there are crucial different in the medical setting that run counter to traditional mediation theory.In
9、 other areas,mediation adheres to a set of principles defending indifference to settlement,neutrality,and confidentiality.In contrast,a bioethics mediator may not stand by and watch the parties of a dispute agree to an unethical arrangement.What bioethics mediation should seek is a morally principle
10、d solution ,not just a mutually agreeable one ,and that may mean changing some of assumptions of tradition mediation. Practitioner Beliefs Mediators are experts in negotiation and help by facilitating agreements. Part of their job is to establish that there is room for agreement, and the
11、n to give the parties the best opportunity to reach a settlement. urface and integrated into an Negotiations are often partly distributive, in the sense that they can involve sharing a fixed resource like money, but they also have an integrative component, in that the parties have overlapping intere
12、sts that can be brought to the sy agreement. Suppose a worker demands a raise of an employer who only has a fixed sum to allocate to wages, but that the worker is actually looking for recognition and respect. If they become locked into positions over wages, they are likely to forgo a wide range of s
13、olutions that might be satisfactory to both of themselect parking, public plaques, or deferred bonuses. Or suppose a physician refers an elderly woman to a psychiatrist for treatment of her smoking addiction, and the patient refuses to go. If the physician believes that listening therapy is appropri
14、ate treatment, while the patient believes that a visit to a psychiatrist means she is mentally ill, there might be options that break the stalemate, such as a visit to a psychologist or psychiatric social worker. The mediator should help the parties communicate their underlying interests, reframe th
15、e positions they espouse, and generate satisfactory options. Significantly, unlike an arbitrator, who imposes a settlement in the manner of a judge, the mediator can only encourage voluntary resolution by the parties themselves. Mediators function largely by exploring the interests of the parties an
16、d reframing positions (“I won't consent to that operation”) into interests (“So you are worried about the potential side effects?”), and then generating options that are satisfactory to both parties. It is oriented to the future and to settlement. Mediation theory has generally claimed that at l
17、east three linked elements are important to the process: mediator neutrality in the sense of nonpartisanship in the process, neutrality in the sense of mediator indifference to outcome, and confidentiality. But each of these needs to be modified in the medical context because of overriding concerns
18、about patients rights and legal precedent. The Baseline of Acceptability In general, mediation accepts that individuals can craft their own settlements, even if they are unusual or less than ideal. Jay Folberg, a leading theorist, defines mediation as the process by which the participants, tog
19、ether with the assistance of a neutral person or persons, systematically isolate disputed issues in order to develop options, consider alternatives, and reach a consensual settlement that will accommodate their needs. Yet plainly, as one critic has charged, “The bright new ideas of client self
20、-determination and autonomy are consistent with letting one party freely choose to be the victim of exploitation.”5 Although this problem has been vigorously debated in the literature, it has not been a mortal blow to the process, and the merits of letting individuals craft outcomes for themselves h
21、ave been seen as outweighing the risks of unjust settlements. In his book The Mediation Process, Chris Moore offers a limited list of appropriate reasons for intervening, including settlements that are vastly inequitable, unlikely to hold over time, likely to result in a renewed conflict later, or i
22、n which the terms are so loose as to make the deal impractical. It is also appropriate to intervene, in Moore's view, if there is the potential for violence by one or both parties. The background conditions for medical mediation are distinct, though. The stakes are often much higher, and decisio
23、ns may result in death, long-term distress, or impoverishment. Parties may have very different power bases, and patients and families may be too intimidated by caretakers to assert their rights even when they are aware of them. Moreover, there is a rich backdrop of settled law and philosophical lite
24、rature that has led to recognized constraints on actions affecting patients. Hence the mediator has to be more than just a process manager and look beyond the immediate acquiescence to an agreement. Mediators often refer to themselves as “neutrals” and take neutrality to be axiomatic of their practi
25、ce, even though it is, at best, an ambiguous term. Mediators emphasize that they are neutral both in that they do not intervene in the negotiation, and in that they are indifferent as to the outcome. At least in the medical context, however, mediation is better served by emphasizing the demand for c
26、lient autonomy than by pursuing an elusive neutrality. The claim that a mediator must be neutral is based on two beliefs: that neutrality promotes trust, and that it reveals to the parties the presence of a middle ground fertile with options for settlement. Neutrality is usually thought of as more t
27、han impartiality； while impartiality implies evenhandedness and lack of bias, neutrality involves distance from the substance of the dispute and the values involved. But whatever definition is adopted, discussions of neutrality in mediation have often assumed that the mediator can intervene neutrall
28、y and that the crux of the issue is the degree of intervention employedin effect, how “hands-on” or “hands-off” the mediator should be. Leonard Marcus strikes the usual stance. In his examination of mediation in the medical field, Marcus argues that the issue of neutrality is critical. He takes neutrality to be a stance
