Charlie Gard and the Attack on Obamacare: Why Every Country Needs Healthcare Mediation

 “Doctors are men who prescribe medicines of which they know little to cure diseases of which they know less in human beings of whom they know nothing.”  Voltaire

For those who followed the Charlie Gard crisis in the UK, or attacks on Obamacare in the US, or similar healthcare conflicts in other countries, the level of emotional outrage and apparent intractability have been obvious, and to many, appalling and unnecessary. 

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Illness and injury intimate death, and as a result, elicit intense emotions -- not only among patients and family members -- but healthcare professionals and those who work in the organizations responsible for saving lives. 

At the same time, few patients, family members, doctors, nurses, hospital staff and administrators, are highly skilled in responding to these intense emotions, or adequately trained in empathetic communication, problem solving, collaborative negotiation, consensus building, mediation, systems design, and other conflict resolution skills. 

Healthcare facilities experience chronic conflicts occur between doctors, nurses, staff, administrators, patients and families, flowing not from substantive disagreements over medical goals, but disrespectful communication, cultural differences, divergent personalities, misunderstandings, misuse of language, personal difficulties, emotional issues, miscommunications, differences in personal styles, insensitivity to feelings, lack of skill in responding to abrasive or manipulative behaviors, disappointments, and unmet expectations, most of which are preventable, manageable and resolvable. 

These conflicts directly impact the quality of health care.  They undermine teamwork and morale, increase resistance to improvements, raise costs, waste time, and occupy the conscious and unconscious attention of everyone involved, creating additional burdens on a system already groaning under the weight of reduced resources and highly stressful work. 

Yet it is possible to imagine extending the injunction, “do no harm,” to cover not just medical interventions, but how healthcare conflicts are handled.  For example, in the Charlie Gard case, a mediator might have asked each side to tell the others why they felt so passionately about these issues; or why they cared about him; or what they most wanted to hear from each other; or what they thought they could have done better; or what they learned from the conflict that might prevent future children from experiencing the same issues; or what they might still do to give his death meaning, so he will not have died in vain; or agree to create and contribute to a fund in Charlie Gard’s name to help educate healthcare professionals in ways of responding more skillfully to these issues.

Over the last 37 years I have mediated thousands of disputes, including many concerning wrongful death, medical malpractice, patient care, hospital operations, management of healthcare organizations, doctor-patient communications, doctor/nurse and nurse/nurse disputes, intensive care issues, nursing home conflicts, cultural differences regarding treatment and similar topics. 

What has become clear to me as a result is that conflict resolution can play a critical role in every country -- not only in responding to the intense emotions and apparent intractability of healthcare disputes, but managing stress, reducing the costs of healthcare, designing preventative systems, and most importantly, helping people heal physically, emotionally, relationally and socially from the traumas caused by disease and chronic conflict.  By doing so, step-by-step, person-by-person, conflict-by-conflict, we make the world a little better than it was before. 

How to Talk about Immigration, Race, Same Sex Marriage, Climate Change, Abortion, Religion, and Other Hot Political Topics Without Yelling and Screaming

“Genuine politics – politics worthy of the name, and the only politics I am willing to devote myself to – is simply a matter of serving those around us: serving the community, and serving those who will come after us.  It's deepest roots are moral because it is a responsibility … [T]here is only one way to strive for decency, reason, responsibility, sincerity, civility, and tolerance, and that is decently, reasonably, responsibly, sincerely, civilly, and tolerantly.  I’m aware that, in everyday politics, this is not seen as the most practical way of going about it.” 

Vaclav Havel

We have all watched political conversations degenerate into angry quarrels, pointless personal attacks and antagonistic power contests.  We have all seen people sink into screaming matches, shaming and blaming, and personal viciousness, often over the loftiest ideas, deepest passions and most profound political principles.  We all know that these tirades can easily descend into senseless violence and appalling acts of brutality.  And we have all participated in these arguments, fanned the flames, or stood passively by and done nothing.

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Yet political conversations matter; they concern our future, our values and integrity, our ethics and morality, our beliefs and behaviors, not only as individuals and nation states, but as human beings who are responsible for the world our grandchildren, and our grandchildren’s grandchildren, will inherit.  As the Greek statesman Pericles remarked nearly 2500 years ago, “Just because you do not take an interest in politics doesn’t mean politics won’t take an interest in you.” 

Successful political decision-making requires not silence or pointless rage, but dialogue; not apathy or aggression, but collaborative negotiation; not passivity or accommodation, but courageous, constructive, creative contention.  Silence in the face of critical issues signifies not merely the absence of speech, but the loss of learning and integrity, and therefore of self, of values, of citizenship, of democracy, of community, of humanity.  As Dr. Martin Luther King, Jr. presciently warned, “Our lives begin to end the day we become silent about things that matter.”

Why Dialogue in Politics?

The most difficult issues we face in life, whether as couples, families, organizations, societies, nation-states, or human beings, cannot be resolved by individuals acting alone, by elites acting autocratically, or by factions acting in their own distinct and exclusive self-interest.  They can only be resolved by coming together across our differences, listening and talking to each other, exploring our disagreements, working collaboratively, reaching consensus, deciding what to do democratically, resolving our differences, and acting jointly in the interest of the whole. 

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Yet working collaboratively with those who are different, those we dislike, those with whom we disagree, even those whose actions we find repellent, requires higher order listening, dialogue, negotiation, and conflict resolution skills, each of which requires more time and greater effort than acting alone.  It can be exhausting, irksome, messy and galling to listen openly and honestly engage opinions and interests that diverge sharply from our own.  As a result, most often we act unilaterally, ignoring the needs and desires of those who do not agree with us. 

But when we act individually or unilaterally and in our own exclusive self-interest in matters that directly and significantly impact others, often without including or even informing them, they feel disrespected, as we would, and are more inclined to resist, undermine our solutions, and respond in ways that trigger costly chronic conflicts.  Indeed, our history as a species is replete with examples of problems made far worse by refusals to listen, rejections of communication, dismissals of dialogue, isolations from participation, constrictions of collaboration, and exclusions from decision-making.

On the Dangers and Opportunities of Mediation

Below is an excerpt from the Preface of Mediating Dangerously about the risks involved in inviting and supporting transformation by getting to the heart of what is not working.

"Conflicts are immense sources of stress and pain, which we try to avoid. At the same time, they are indicators of areas in our lives and organizations that require immediate attention, deep thinking, and a willingness to change.  In facing our conflicts, opening our hearts, and locating the center of what is not working, we pass through to the other side, uncovering hidden choices and transformational opportunities that ask us to develop, grow, and learn more about our inner selves.

By personal transformation, I do not mean forcing people to change or be someone they are not, but helping them become more authentically who they really are.  Transformation works on the undeveloped, rejected parts of the self.  By organizational transformation, I mean bringing group cultures and systems into congruence with the wishes and desires of the people who work in them, who are served by them, and who are the true reasons for their existence.  By transcendence, I mean that a conflict no longer bothers us and that we must now address conflicts at a higher level.  

Because every conflict is an opportunity for transformation that can fundamentally impact our lives, it is dangerous for mediators to uncover hidden choices and reveal transformational openings.  People easily become addicted to their conflicts and to the dysfunctional systems that generate them.  This makes it frightening to even suggest the possibility of recovery to someone locked in conflict, because it means every rationalization and accommodation they have relied on to support their addiction is now at risk. This is what I mean by meditating dangerously. "

Frontiers of Conflict Management

This is an excerpt from a 2007 interview with Gini Nelson for Mediate.com
It was published under the title of Spirit in Life and Practice. 

Gini Nelson: What do you think are the big questions to be answered next in the conflict management field?

Ken Cloke: The frontiers, as I see them, are both internal and external. The internal frontiers include a deeper understanding of the neurophysiology of conflict and how to respond to it (reading Antonio Damasio’s Looking for Spinoza is a good start) and exploring the ability to explore caring (heart) and energy (spirit) as sources of deep understanding, powerful techniques, and fresh approaches to resolution. The external frontiers include coming to terms with the systemic sources of conflict, especially their chronic social, economic, and political causes; taking responsibility for helping to resolve international disputes through the United Nations; developing a program I call “Mediators Beyond Borders;” and applying conflict resolution systems design principles – not only to organizational disputes, but to social and political institutions on all scales. It is becoming increasingly clear that we will not survive long as a species, or an ecosystem, unless we learn how to communicate, solve problems, negotiate, and resolve our conflicts peacefully across cultural, religious, and national boundaries, without resorting to enmity and warfare.