Mediation of Medical Treatment Disputes: A Therapeutic Justice Model

这项研究的核心目的是了解调解是否以及在多大程度上可以而且应该被视为医疗纠纷中的一种治疗正义。我的研究将开发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该模型。调解是替代纠纷解决的一种形式，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与之并行进行。促进性调解是这一领域最常用的调解方式，是一种保密的程序，由第三方、独立人帮助当事各方自己解决部分或全部争端。调解人帮助各方达成协议，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，由当事人自己引导调解过程是有益的，而不是外部第三方。在讨论医疗纠纷时，我指的是患者、卫生专业人员、家庭成员和其他人之间在向患者本人提供健康和护理方面出现的分歧。通常病人是智力受损的成年人或16岁以下的儿童，因此他们在法律上没有能力自行决定医疗，因此需要医疗专业人员、家庭成员和法院的参与。纠纷最常见的发生在患者家属和医护人员之间，但在某些情况下，也可能涉及患者本人。这项研究将考虑使用非法院的解决方法(如调解)来解决医疗保健方面的纠纷是否有任何治疗或治愈的好处，并考虑将调解作为一种干预措施变得更具治疗性的方式。例如，通过改善当事各方之间的沟通，提高在解决争端过程中的发言权或参与度以及解决的速度。这个项目建立在现有关于调解和治疗正义的研究基础上，以考虑调解在经常具有挑战性的医疗环境中的价值，同时也考虑到调解伴随着一些风险，这些风险可能使其不那么理想的治疗。例如，调解可以反映或加强当事人之间现有的权力失衡，它可以限制诉讼主体的参与，而且它可能被视为一种节省费用的做法，而不是一种治疗方法。由于调解的使用尚未通过医疗纠纷的实证研究得到检验，也没有治疗正义的模型被开发或应用于这一领域，本项目试图通过对医疗纠纷中的调解进行定性分析来对这些主张进行实证检验。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求纠纷中的作用。通过现在开展这项研究，我们希望通过确定调解可用于治疗的方式，同时认识到调解在这一领域的潜在风险，使调解的潜在使用者能够解决此类纠纷。例如，我们假设，某些调解方法(包括调解方式和程序)、调解的时间和非专业参与者的参与都可能影响实现治疗正义的程度。我们还将考虑是否有任何特定于医疗环境的因素，使其特别容易接受或挑战调解的治疗益处。

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.