Ethics

Ethics in healthcare is a matter that needs to be given a lot of priority as well as a keen approach. This is because what one person might consider being an ethical issue another one may treat it just like any other normal occurrence (Mayer 39). Therefore, it is ideal that ethical issues are clearly understood and universally agreed upon to avoid a conflict of the nature demonstrated in this case. Health care issues are particularly sensitive because they border between life and death of the people involved.

Case Analysis
The case presents Mrs. Cranberry, an 84 year-old married woman, who has been living with her husband as her primary home-care provider, and her medical power-of-attorney before she suffered severe abdominal pain which got her admitted in a local hospital.  She suffers from dementia, and a decline in her health and cognitions has been reported recently. In her efforts to get out of the bed one time, she fell and broke her hip and ever since her health has been deteriorating. Following this deterioration she was admitted at the local hospital where other tests were carried out which helped in diagnosing her with bowel obstruction. The hospital in which Mrs. Cranberry was referred to do not give privileges to her primary-care physician, thus the hospital had to admit and assign attending physicians. The surgery was carried out effectively, but even after several attempts to remove her from the ventilator, four days after the operation she still relied on it for her continued survival. Her husband opted for removal of the ventilator and subsequent death, but the pulmonologist and attending physician were not up to the idea, as they argued the dependency on ventilator could be reversed as it was a complication of the surgery.

Potential Sources of Conflict
As individuals live in the society, they interact freely with other people through social institutions. In a society where interaction is common, potential for conflict is definite. Conflicts come as a result of competition for power and resources, basic human instincts, structure of institutions and society that are created by people, and the unavoidable struggle among classes. There are many forces which push individuals into conflict behaviors and an understanding of such forces as potential sources of conflict can help in conflict resolution. Considering the wheel of conflict, human needs are placed at the centre as they are the centre of all conflicts. People engage in conflict because of inconsistence of needs among individuals, or because the conflict process is capable of meeting the needs.

Since needs can not exist at the centre as vacuum, there are other forces in which the needs are embedded. In the healthcare setting, conflict usually results from the history, structures in which people interacts, values, emotions and mode of communication. In such emotionally difficult circumstances, it is difficult for individual to communicate effectively about complex matters as humans are imperfect communicators. Ineffective communication is affected by environment, class, age, and gender.

The Wheel of Conflict can be used as a framework for understanding the possible sources of conflict, and can act as a guide through the conflict resolution process. Conflicts arise when individuals have needs they believe will not be met adequately, and moving towards a resolution means that they have to accept that a perfect solution is difficult to achieve, and that meeting all the needs may fail (Mayer 39). Using the Conflict Wheel, it is easy to come up with the potential conflicts in this case. First, emotions play a critical part because the patients children and their wives believe that the patient ought to be allowed to die. This is simply because they cannot stand to see her in this condition (emotional cause). The husband, having seen her through past suffering, would rather she dies to rest from the suffering. Therefore, the main conflict here is whether or not the patient should be let to die, and it brings into perspective the issue of who ought to determine the fate of the patient in the event the patient is not able to speak for oneself.

 While the family members are of the opinion that she should be able to be let off the ventilator and then die, the health practitioners believe this is not the right way to go because the patient has only been four days in this conditions and also there are chances that only a minor complication might be delaying her recovery  which will likely be overcome sooner or later (historical and structural cause). They thus need the patient to remain a lot longer on the respirator (Mayer 38). Then the family seems to have a lot of trust only in their family doctor and will have no-one else. The fact that the doctor was not allowed in the hospital is potentially fueling their emotions. The other possible source of conflict could be the fact that the husband to the patient feels that being the closest relative he must be allowed to have his way in the determination of the fate of her wife (value causes). In addition, he believes that being her medical power-of-attorney also makes him the legal custodian of her wife life decisions, and, maybe, life might just be one of them Then poor communication between the family and the health practitioners is complicating the case. There ought to be an understanding of what is driving the differences. For instance, the nurses ought to make the family understand that they are not required under their ethical code of conduct to allow a patient to die pr to put the life of a patient at risk that because of the wishes of her closest family members (Wagona 71).

The fact that the family of the patient met and discussed their legal option with their lawyer illustrates behavioral conflict. This is in accordance with the fact that actions taken by individuals to articulate their perceptions, to express their feelings and to have their needs met in ways that are likely to interfere with the other peoples ability to met their needs influences behavioral conflict. It involves use of direct force to have something done at the expense of other peoples needs. The force can be violent, exercise of power or destructive and conversely the behavior can be constructive, conciliatory and even friendly. In this case, the family of the patient used the lawyer to exercise legal power in order to have the life sustaining treatment discontinued at the expense of physicians needs.

The Role of a Potential ConsultantMediator
 Resolving conflict involves mediator as the central tool. This form of conflict resolution involves visible expression of the resolution through development of training protocols, and soliciting the clients. Basically, the conflict resolution discipline stand as the professional foundation of mediation, but the mediation practice is presented to the community in a more concrete way. When using the mediation approach in conflict resolution, a third party is introduced to help the two parties (Beer  Stief 3). The role of mediator in conflict resolution is to help the disputants in their way through the conflict. Mediators neither impose solution to the conflict, nor give decisions. Based on many studies on mediation and the increasing use of mediators in different situations and circumstances, mediation is an effective approach to conflict resolution. Mediation helps individuals to move through difficult conflict situation or circumstance thus maintaining their power over significant issues. Mediators facilitates in limiting the destructiveness of conflict by effective resolution efforts (Beer  Stief 3).

There is no constructive communication mechanism between the disputant and in most cases direct communication bears no results, leaving inappropriate third parties, formal letters, public hearings and court filings as the means of communication. Mediator is involved in redesigning or creating a new arena for negotiations or communication. Mediators bear the responsibility of getting the parties to participate in mediation process through guilt, persuasion, and telling of the advantages of mediation and the consequences of failure to participate.
 
In order to succeed in the conflict resolution process, mediators manage communication and emotions. They encourage the parties to express their feelings or emotions fully, while managing the flow of communication. They help individual participants in exploring the issue at the most relevant level of depth and later they ensure the needs contained in every level of every participant are discussed. When the disputants reveal their concerns, raise a conflict, agree to negotiate, suggest a solution, express their feelings or provide information, they become vulnerable. Too much of these risks have the potential to escalate the conflict. The mediators intervene to build the trust through taking incremental and reciprocal risks by encouraging sharing of significant data or tentative concession and subsequent reciprocal information and concessions (Wagona 70).

In cases of rampant emotions and intense conflict, creativity suffers. Mediators strive to create a relaxed, comfortable environment that can support rising of ideas and discussions without personal attacks. In such cases, the mediators consider the parties as joint or integrative gain possibilities that need to think about the conflict in more creative ways.

In some point of conflict, potentials can fall apart, but the mediation does not fail as the mediators helps individuals to think through their choices. Despite the fact that mediators are process oriented or facilitative,   the nature of mediators work need to use some form of pressure to encourage individuals to come into a resolution.

Conflict Resolution in Ethical Consultation
In authoritarian approach consultant are key moral decision maker unlike in pure facilitation approach which aims at forging consensus among disputant. Ethics facilitation approach identifies and analyzes value and nature of the conflict underlying the consult and strives to facilitate a consensus between the disputants. Mediation is an ethic consultant modality. Bioethics literature has given mediation a significant consideration on ethics consultation. Apart from helping disputants getting a resolution in intractable cases where moral consensus is difficult, it can be used as a modality in ethics consultation (Walker 36).

Recently, ASBH issued a consensus report acknowledging the benefits of core competencies in intractable cases where consensus is impossible (ASBH 12). Core competencies have endorsed ethics facilitation which is characterized by a stage of collecting and sharing facts from the interviews and chart reviews, after which the consultant applies the bioethics concepts and knowledge to establish a number of ethical options capable of resolving the conflict, and a stage of giving the participants chance to comment about the options. This is followed by the clarification of the participants views and values concerning the options using interpersonal facilitation skills, followed by a consensus to select one option (ASBH 13).

The configuration of mediation process is similar in both traditional and bioethics mediation as the mediator is impartial in order to transform the disputants from their stances to a conflict into a joint opportunity for resolution in order to generate a consensus solution based on common interests and in accordance to recognized and established legal and ethical standards. Just like in the traditional mediation, the mediators ensure that all participants understand the situation, they have a comprehensive account of the facts depending on individual participants understanding, and they are comfortable to express their concerns and views. This is achieved by allowing the participants to relate their individual perspectives of conflict freely and fully using their own words and without being interrupted. Any emotive content is acknowledged and communicative techniques such as mirroring represent the content to other participants (Dubler and Marcus 38).

Review of literature relates narrative with moral thinking. Narratives provide sufficient description of the moral experiences of individuals, judgment, perception, rationality, and blending emotion. Unlike other authors that have presented ethics consultation model on the bases of mediation, Walker describes morality as the mutual understanding and exchange of divergent moral narratives. This degrades the application and theoretical concern of morality to specific cases with more concern on progressive adjustment and acknowledgement among people in habitable and common moral environment (Walker 35).

Conclusion
The case provided should consider the ethics facilitation approach as it identifies and analyzes value and nature of the conflict underlying the consult and strives to facilitate a consensus between the disputants. Ethics consultation does not seek conflict resolution or consensus rather it recognizes legal, ethical, moral, and institutional boundaries that need not be crossed to build a consensus.