Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 60 making process and what this means is that priority should be given the patient’s values and wishes, and their choices must be supported (Dubler & Liebman, 2004). The principle of beneficence “underlies obligations to provide the best care for the patient and balance the risks or burdens of care against the benefits” (Dubler & Liebman, 2004, p. 37). Non- maleficence requires that the benefits of treatment outweigh the possible harm and the patient should not be harmed (Dubler & Liebman, 2004). Finally, distributive justice is defined as providing to each individual what is due or owed, “what is fair” (Dubler & Liebman, 2004, p. 37). The role of a bioethics mediator is to remain neutral while equally empowering all of the participants to engage in problem-solving within the limits of the accepted dominant medical norm, as delineated by the four ethical principles listed above. Neutrality, in the context of bioethics mediation, is usually defined as not having a stake in the outcome and not favoring any side (Gibson, 1999; Marcus, Dorn, & McNulty, 2011), and not taking a stand as to the legitimacy of a moral position (Fiester, 2012). The mediator remains neutral as to the participants’ final agreement, but is not neutral when it comes to how the process is managed; the mediator is an advocate of the process not the participants (Dubler & Liebman, 2011; Fiester, 2012). I am not implying that bioethics mediators using a problem-solving methodology and principled-based approach are ignoring the end-of-life goals of minority patients and their cultural values by privileging the dominant medical culture. Dubler (2005) has argued, and I agree, that while bioethical analysis usually privileges the “dominant medical culture,” the mediation process may deal better with addressing cultural differences than non-facilitated discussions (p. S24). The mediation setting provides a space in which the voices of disempowered groups can be amplified and diverse cultural values are honored (Dubler & Liebman, 2011). Nevertheless, there are serious limitations in the bioethics mediation model in terms of addressing structural and cultural violence. For example, during a bioethics mediation session, if agreement is not reached, the dominant medical, legal, and ethical culture will be imposed (Dubler & Liebman, 2011). I submit that conflict practitioners should take a more active role in addressing healthcare inequalities within healthcare institutions through other processes such as World Café conversations. In other words, what would happen if conflict practitioners move beyond their traditional “neutral” and problem-solving approaches? What if conflict practitioners were willing to use dialogue processes to raise awareness regarding unequal power structures