Dear Sir
I am delighted that Meller and Barclay have echoed my call for
mediation to be considered when the beliefs or views of parents are so at
variance with those of the paediatricians that conventional clinical
relationships break down, and matters are taken to Court. In 'Conflicts
of Care - Could mediation help?' [1] I and my co-author highlighted the
cases of Charlotte Wyatt who was severely disabled following premature
birth, and Luke Winston-Jones who had trisomy 18, both of which resulted
in legal proceedings. In each case the clinicians' views of the child's
best interests were in conflict with the wishes of the parents.
There are two principal barriers to the wider use of mediation in
conflicts between parents and paediatricians. One is awareness, and it is
to be hoped that this will be raised by publications in peer review
journals as well as in the wider media. The other is cultural: when
parental-medical conflicts occur, Trusts take advice from their legal
teams whose main expertise still lies in countering litigation, and whose
comfort zone lies in the Courts. However, as financial pressure becomes
more acute, it is likely that this will become an additional incentive to
the use of mediation before recourse to Court proceedings. It is worth re
-iterating a comment from our article in Archives in 2005 that "... even
if mediation is ultimately unsuccessful in achieving resolution of a
problem, it can be of immense value in allowing the parties to define the
issues more clearly, and it may uncover issues that have not been apparent
on the surface. At an earlier stage than legal proceedings, even
apparently polarised attitudes can be susceptible to skilful
mediation."[1]
Mediators with appropriate skills can be hard to find, although there
are private providers who, with additional awareness of the specialist
medical and legal issues, could become proficient in this area. There are
also conciliators trained through the NHS with experience in healthcare
complaints whose skills could be adapted to the proposed role. I explored
these and related issues more deeply in my book "Conciliation in
Healthcare: managing and resolving complaints and conflict"[2]. I also
highlighted the value of taking a proactive approach where there were
signs of a deterioration in the clinical relationship.
The prospect of a funded evaluation for mediation is greatly to be
welcomed, as relevant research in all age groups is scarce[3], but I hope
that the location of the Medical Mediation Foundation (London NW2) does
not mean that its scope will be confined to the south-east of England.
References
1.Ward Platt M, Ward Platt A. Conflicts of care. Arch Dis Child
2005;90:331.
2.Ward Platt A. Conciliation in Healthcare: Managing and resolving
complaints and conflict. Oxford: Radcliffe Publishing, 2008.
3.Mpinga EK, Chastonay P, Rapin CH. End of life conflicts in palliative
care: a systematic review of the literature. Rech Soins Infirm.
2006;86:68-95.
Conflict of Interest:
None declared
Dear Sir
I am delighted that Meller and Barclay have echoed my call for mediation to be considered when the beliefs or views of parents are so at variance with those of the paediatricians that conventional clinical relationships break down, and matters are taken to Court. In 'Conflicts of Care - Could mediation help?' [1] I and my co-author highlighted the cases of Charlotte Wyatt who was severely disabled following premature birth, and Luke Winston-Jones who had trisomy 18, both of which resulted in legal proceedings. In each case the clinicians' views of the child's best interests were in conflict with the wishes of the parents.
There are two principal barriers to the wider use of mediation in conflicts between parents and paediatricians. One is awareness, and it is to be hoped that this will be raised by publications in peer review journals as well as in the wider media. The other is cultural: when parental-medical conflicts occur, Trusts take advice from their legal teams whose main expertise still lies in countering litigation, and whose comfort zone lies in the Courts. However, as financial pressure becomes more acute, it is likely that this will become an additional incentive to the use of mediation before recourse to Court proceedings. It is worth re -iterating a comment from our article in Archives in 2005 that "... even if mediation is ultimately unsuccessful in achieving resolution of a problem, it can be of immense value in allowing the parties to define the issues more clearly, and it may uncover issues that have not been apparent on the surface. At an earlier stage than legal proceedings, even apparently polarised attitudes can be susceptible to skilful mediation."[1]
Mediators with appropriate skills can be hard to find, although there are private providers who, with additional awareness of the specialist medical and legal issues, could become proficient in this area. There are also conciliators trained through the NHS with experience in healthcare complaints whose skills could be adapted to the proposed role. I explored these and related issues more deeply in my book "Conciliation in Healthcare: managing and resolving complaints and conflict"[2]. I also highlighted the value of taking a proactive approach where there were signs of a deterioration in the clinical relationship.
The prospect of a funded evaluation for mediation is greatly to be welcomed, as relevant research in all age groups is scarce[3], but I hope that the location of the Medical Mediation Foundation (London NW2) does not mean that its scope will be confined to the south-east of England.
References 1.Ward Platt M, Ward Platt A. Conflicts of care. Arch Dis Child 2005;90:331. 2.Ward Platt A. Conciliation in Healthcare: Managing and resolving complaints and conflict. Oxford: Radcliffe Publishing, 2008. 3.Mpinga EK, Chastonay P, Rapin CH. End of life conflicts in palliative care: a systematic review of the literature. Rech Soins Infirm. 2006;86:68-95.
Conflict of Interest:
None declared