The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 2015
Because ethics consults are often more about conflict than moral puzzlement, the skills of confli... more Because ethics consults are often more about conflict than moral puzzlement, the skills of conflict resolution and communication facilitation are now deemed a core competency for ethics consultants. Those skills range beyond the traditional ambit of "bioethics mediation," as illustrated here by a recent mediation regarding a difficult discharge. As conflict permeates healthcare, often spawning downstream ethical issues, conflict resolution services might be deemed a genre of preventive ethics suitably offered by ethics committees. If so, a strong distinction must be made. "Bioethics mediation" as historically defined is a curious amalgam between a consultant who recommends, and a mediator who facilitates consensus among the parties at the table. On closer examination this approach is problematic, particularly in the clinical setting. A mediator who acts as consultant, telling parties what they should do or directly circumscribing the limits of an "acceptable...
Conflicts in the clinical setting can spiral downward with remarkable speed, as parties become ev... more Conflicts in the clinical setting can spiral downward with remarkable speed, as parties become ever more incensed and entrenched in their positions. Productive conversations seem unlikely at best. Nevertheless, such situations can sometimes be turned into collaborative problem solving with equally remarkable speed. For this to happen, those providing conflict-resolution services such as mediation need to bring, not just a set of skills, but also some key norms: the process must be voluntary for all; the mediator must abjure giving advice or taking sides, and must honor the privacy of privately offered thoughts. This article describes a conflict that had reached the point of a hospital's requesting judicial coercion. However, a conflict-resolution process was then initiated that, in the end, led to amicable resolution and mended relationships, obviating the need for court orders. This article describes that conflict and the resolution process in detail, along the way annotating s...
ABSTRACT One of the causes of the recent upheaval in health care is health plans' adoptio... more ABSTRACT One of the causes of the recent upheaval in health care is health plans' adoption of the concept of "medical necessity" as the limit of their coverage -- i.e., that the plans will cover the cost of procedures that are "medically necessary." The concept has caused hardships for the plans, physicians, patients, and coverage purchasers because medical necessity has proven to be legally vague, clinically artificial, and both unreliable and restrictive for patients. To avoid those problems, plans should jettison medical necessity and the notion that they will provide "all of the care someone needs." Instead, the plans should turn to guidelines-based contracting: They should lay open to consumers the clinical guidelines by which they make benefit determinations, and make those guidelines the explicit basis on which the plans contract with enrollees. That way, people would have a clearer idea of what coverage the plans provide.
The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics, 2015
Because ethics consults are often more about conflict than moral puzzlement, the skills of confli... more Because ethics consults are often more about conflict than moral puzzlement, the skills of conflict resolution and communication facilitation are now deemed a core competency for ethics consultants. Those skills range beyond the traditional ambit of "bioethics mediation," as illustrated here by a recent mediation regarding a difficult discharge. As conflict permeates healthcare, often spawning downstream ethical issues, conflict resolution services might be deemed a genre of preventive ethics suitably offered by ethics committees. If so, a strong distinction must be made. "Bioethics mediation" as historically defined is a curious amalgam between a consultant who recommends, and a mediator who facilitates consensus among the parties at the table. On closer examination this approach is problematic, particularly in the clinical setting. A mediator who acts as consultant, telling parties what they should do or directly circumscribing the limits of an "acceptable...
Conflicts in the clinical setting can spiral downward with remarkable speed, as parties become ev... more Conflicts in the clinical setting can spiral downward with remarkable speed, as parties become ever more incensed and entrenched in their positions. Productive conversations seem unlikely at best. Nevertheless, such situations can sometimes be turned into collaborative problem solving with equally remarkable speed. For this to happen, those providing conflict-resolution services such as mediation need to bring, not just a set of skills, but also some key norms: the process must be voluntary for all; the mediator must abjure giving advice or taking sides, and must honor the privacy of privately offered thoughts. This article describes a conflict that had reached the point of a hospital's requesting judicial coercion. However, a conflict-resolution process was then initiated that, in the end, led to amicable resolution and mended relationships, obviating the need for court orders. This article describes that conflict and the resolution process in detail, along the way annotating s...
ABSTRACT One of the causes of the recent upheaval in health care is health plans' adoptio... more ABSTRACT One of the causes of the recent upheaval in health care is health plans' adoption of the concept of "medical necessity" as the limit of their coverage -- i.e., that the plans will cover the cost of procedures that are "medically necessary." The concept has caused hardships for the plans, physicians, patients, and coverage purchasers because medical necessity has proven to be legally vague, clinically artificial, and both unreliable and restrictive for patients. To avoid those problems, plans should jettison medical necessity and the notion that they will provide "all of the care someone needs." Instead, the plans should turn to guidelines-based contracting: They should lay open to consumers the clinical guidelines by which they make benefit determinations, and make those guidelines the explicit basis on which the plans contract with enrollees. That way, people would have a clearer idea of what coverage the plans provide.
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Papers by Haavi Morreim