Mediation of Medical Treatment Disputes: A Therapeutic Justice Model

本研究的核心目的是了解是否，如果是，调解的程度，可以和应该被视为一种形式的治疗正义在医疗纠纷。我的研究将建立一个治疗正义的模型，然后通过收集和分析原始经验数据来测试和完善。调解是一种替代性争议解决形式，通常比法庭诉讼更非正式和灵活，但通常与法庭案件一起或并行进行。促进性调解是这一领域最常用的调解方式，它是一种保密程序，由一个独立的第三方帮助双方自行解决部分或全部争端。调解员促进双方达成协议，而不是以特定的方式指导他们。这是因为主流调解理论认为，由当事人自己而不是外部第三方来指导调解过程是有益的。在讨论“医疗纠纷”时，我指的是患者、保健专业人员、家庭成员和其他人之间就向患者本人提供保健和护理而产生的分歧。患者通常是心智能力受损的成年人或16岁以下的儿童，因此他们在法律上没有能力自行决定是否接受治疗，因此需要医疗保健专业人员、家庭成员和法院的参与。纠纷最常发生在患者的家庭成员和医疗保健专业人员之间，但在某些情况下可能涉及患者本人。该研究将考虑是否有任何治疗，或愈合，使用非法院为基础的解决方法，如调解，以解决由医疗保健背景下产生的纠纷的好处，以及考虑调解可以成为一种更有治疗作用的干预方式。例如，通过改善当事人之间的沟通，提高在争议解决过程中的发言权或参与度，提高解决的速度。本项目建立在现有的调解和治疗正义研究的基础上，考虑调解在经常具有挑战性的医疗保健环境中的价值，同时也考虑到调解带来了许多风险，这些风险可能使其治疗效果不理想。例如，调解可以反映或加强当事人之间现有的权力不平衡，它可以限制诉讼主体的参与，它可能被视为一种节省费用而不是治疗的做法。由于调解的使用尚未通过医疗纠纷背景下的实证研究进行检验，也没有开发或应用于这一领域的治疗正义模型，本项目试图通过对医疗纠纷调解的定性分析，从经验上检验这些主张。私家侦探和项目顾问都对潜在的弱势参与者的法律和调解经历进行了研究。此外，我们还研究了调解在保护法院、司法审查和特殊教育需要纠纷中的作用。通过开展这项研究，我们希望通过确定调解可以用于治疗方式的方法，使调解的潜在用户受益，从而解决此类纠纷，同时承认调解在这一领域的潜在风险。例如，我们假设某些调解方法（包括风格和过程），调解的时间和非专业参与者的参与都可能影响治疗公正的程度。我们还将考虑是否存在特定于医疗保健环境的因素，使调解的治疗益处特别适合或具有挑战性。

The core aim of this research is to understand whether and, if so, the extent to which, mediation can and should be viewed as a form of Therapeutic Justice in medical treatment disputes. My research will develop a model of Therapeutic Justice which will then be tested and refined through the collection and analysis of original empirical data.Mediation, which is a form of alternative dispute resolution, is generally more informal and flexible than court proceedings, but often takes place alongside or in parallel with court cases. Facilitative mediation, which is the type most commonly practised in this area, is meant to be a confidential process whereby a third party, independent person helps the parties to resolve part or all of the dispute themselves. The mediator facilitates the parties to reach agreement, rather than directing them in particular ways. This is because mainstream mediation theory suggests that it is beneficial for the parties themselves to guide the process, rather than an external third party. When discussing 'medical treatment disputes' I mean disagreements that arise between patients, health professionals, family members and others regarding the provision of health and care to the patient herself. Usually the patient will be an adult with impaired mental capacity or be a child below the age of 16, such that they are legally incapable of making their own decision about medical treatment, hence the involvement of healthcare professionals, family members and the courts. The disputes most commonly arise between family members of the patient and healthcare professionals, but in some cases may involve the patient herself. The research will consider whether there are any therapeutic, or healing, benefits of using non-court based methods of resolution, such as mediation, to resolve disputes that arise from healthcare contexts, as well as considering the ways in which mediation could become more therapeutic as an intervention. For example, through improved communication between parties, improved voice or participation in the process of dispute resolution and speed of resolution. This project builds on existing research on mediation and Therapeutic Justice to consider mediation's value in often challenging healthcare environments, while also considering that mediation comes with a number of risks which may make it is less than ideally therapeutic. For example, mediation can reflect or reinforce existing power imbalances between parties, it can limit the participation of the subject of proceedings and it may be seen as a cost saving, rather than therapeutic, exercise. As the use of mediation has not yet been tested through empirical research in the medical treatment disputes context, nor has a model of Therapeutic Justice been developed or applied to this field, this project seeks to test those claims empirically through qualitative analysis of mediation in medical treatment disputes.The PI and Project Consultants have all conducted research in relation to potentially vulnerable participants' experiences of the law and mediation. Further, we have researched the role of mediation in relation to the Court of Protection, judicial review and Special Educational Needs disputes. By carrying out this research now we expect to benefit potential users of mediation to resolve such disputes by identifying ways in which mediation can be used in therapeutic ways, while acknowledging the potential risks of mediation in this area. For example, we hypothesise that certain approaches to mediation (including, style and process), times at which to mediate and the participation of lay participants may all impact upon the extent to which therapeutic justice can be achieved. We will also consider whether there is anything specific to the healthcare environment that makes it particularly amenable to, or challenging for, the therapeutic benefits of mediation.