Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 61 that negatively impacts end-of-life care within acute hospitals? “The problem-solving mind- set can be adequate for technical problems. But it can be woefully inadequate for complex human systems where problems often arise from unquestioned assumptions and deeply habitual ways of acting” (Senge, Scharmer, Jaworski, & Flowers, 2005, pp. 51-52). Structural and cultural violence persist when erroneous assumptions remain unquestioned and become accepted ways of acting. Therefore, taking a problem-solving approach to surface and identify structural and cultural violence is ineffective in altering an unjust status quo . Conflict practitioners can provide an important service by unveiling power structures that are an obstacle for patients to have their end-of-life wishes honored. This can happen through dialogue processes that raise awareness about the importance of discussing end-of- life goals of care, explore the social forces that operate in healthcare institutions that are oppressive to dying patients, and empower clinicians and patients to alter unequal social structures. Awareness of these social forces and the skills to change the power structures are very rarely taught to clinicians (Farmer, et al., 2006). However, there is some evidence that it is possible to address structural violence in healthcare, by way of structural interventions without the need of tackling more complex issues such as eliminating racism or a lack of national insurance (Farmer, et al., 2006). For example, a group of researchers and clinicians in Baltimore were able to reduce significantly the racial, gender, and socioeconomic disparities in HIV treatment within the group being studied by posing the following question: “what would happen if race and insurance status no longer determined who had access to standard of care?” (Farmer et al., 2006, p.1688). Exploring the answer to this question allowed clinicians to address issues of structural violence by first being able to “see” these injustices as they surface throughout the conversation and subsequently removing obvious economic barriers such as transportation costs, providing community-based care that allowed for better access, and educating the community to decrease stigma against patients with AIDS (Farmer et al., 2006). The World Café is a conversational process that surfaces deeper assumptions and network patterns through which people can have intimate exchanges, discover shared meaning, engage in disciplined inquiries, cross-pollinate ideas, and think about what is possible (Brown & Isaacs, 2005; Brown, Homer, & Isaacs, 2007). The emphasis is on collective understanding and not problem-solving. In a World Café several small round tables that sit four to five participants are placed in a welcoming space and in each table they explore questions that matter to them (Brown et al., 2007). Questions are discussed in