Healthcare Conflict Resolution: Patient vs. Physician

Introduction

Conflict cannot be avoided — it is a part of being human. Disagreements or divergences of interest may emerge in a place of business, among family members, or even between two complete strangers on a subway car. Though the possible contexts in which individuals or groups may find themselves in conflict are infinitely varied, we may nonetheless look to the same path for resolution of nearly any scenario. Just as conflict is inherent, so too is the proclivity toward interpersonal communication — an airing of divergent perspectives and a balanced achievement of compromise. These are distinctive qualities of our species, endowing each of us with the tools to properly navigate conflict together.

Conflict, speaking in a general sense and with specificity to individuals or small groups (as opposed to conflict between nations or whole ethnicities), arises when there is a difference in desire, expectation, or need between two parties, and where this difference may result in a dichotomy of favorable and unfavorable conditions for those involved (Webne-Behrman, 1).

Bringing some semblance of balance to this difference is the purpose of conflict resolution, though this process must first encounter distinctly human obstacles. Such obstacles revolve around intellectual, emotional, and biological needs, as demonstrated by the healthcare field. Complex and fraught with philosophical and practical disagreement, the healthcare context gives rise to the case scenario discussed here, in which a patient in danger of death by pulmonary embolism has declined an exploratory procedure that could reveal an avenue for treatment. The scenario brings myriad ethical and practical considerations to bear, weighing the patient's desires against those of the physician who must treat him.

Content: What Each Party Wants

There is a clear conflict of interest that pits the responsibilities of the physician against the desires of the patient. The patient, who does not wish to be treated, has expressed a sense of hopelessness and an intent to allow his illness to overtake him through neglect. By contrast, the physician recognizes the prospects for treatment and bears an incontrovertible responsibility to do all within his power to treat the patient, relieve him of suffering, and prolong his natural life.

In an important sense, this points to a fundamental debate in healthcare concerning the so-called right to die. The right-to-death movement, which has gained greater notoriety in recent decades than ever before, is informed by the premise that it is within the constitutional body of rights for an individual to decide to end his or her own life. The purpose of this initiative has been to expand access — for those suffering from intractable pain or illness — to those who might help them achieve death with comfort and dignity. Its supporters typically include civil liberties organizations such as the ACLU, and many in the medical community view this as a natural right that should be accorded to all patients, fundamentally reflecting one of the most basic freedoms regarding one's own life (Young, 1). For a thorough philosophical treatment of this issue, see the Stanford Encyclopedia of Philosophy entry on voluntary euthanasia.

Thus, in the current scenario, the conflict facing the physician must also consider this philosophical perspective, which appears to align in some respects with the patient's desires. To what extent the physician's wish to provide observation and treatment may be said to override the patient's desire to forego it is not ethically clear.

Relational: The Network of Interested Parties

According to Marcus et al. (1995), the decision in this situation is not as simple as a conflict to be resolved between the desires of the patient and the priorities of the physician. There are far more parties and interests to be considered. As Marcus et al. explain, "health care work is accomplished via an intricately structured set of relationships. Formal and informal rules determine who speaks to whom, who makes what decisions, and who has what information. People are organized and decisions are aligned in a cautiously defined order. The most important or momentous information, person, or decision gets the uppermost attention first, and the rest trails behind. This sequence is intended to yield systematic decision making" (Marcus et al., 3).

This alludes to the idea that the relationship between an attending physician and a patient is also a conduit for a host of other relationships. These include the relationships associated with both parties: for the patient, family members, friends, and a broader support system will play into decisions being made by the healthcare facility; for the physician, there is a connection to a team of nurses and other attending specialists, to the healthcare facility, and to a broader healthcare system and medical community. In the context of a conflict over interests, these relationships form a network of interested parties.

Ultimately, the influence of the physician over the patient can be a dominant force. The interdependence of the parties extends to the fact that the physician requires the patient's consent in order to meet his professional and ethical responsibilities, while the patient requires the physician's attention in order to receive treatment.

Conclusion

By incorporating the network of relationships discussed above into a unified support system — comprising both healthcare specialists and members of the patient's personal network — it may be possible to appeal to both the rational and emotional interests of the patient. Combined, these forces may have the capacity to reassure the patient of his strength to endure a treatment that could ultimately relieve him of pain and prolong his life.

Works Cited

King, D. (2000). Four principles of interpersonal communication. Pellissippi State Technical Community College.

Marcus, L. J., Dorn, B. C., Kritek, P. B., Miller, V. G., & Wyatt, J. B. (1995). Renegotiating health care: Resolving conflict to build collaboration. Jossey-Bass, 1st Edition.

Webne-Behrman, H. (2005). Conflict resolution. Office of Quality Improvement & Office of Human Resource Development, University of Wisconsin.

Young, R. (2002). Voluntary euthanasia. In Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/euthanasia-voluntary/