The "Ladder of Inference" as a Conflict Management Tool: Working with the "Difficult" Patient or Family in Healthcare Ethics Consultations.

IF 1.3 4区 哲学 Q3 ETHICS
Hec Forum Pub Date : 2024-03-01 Epub Date: 2022-04-18 DOI:10.1007/s10730-022-09476-w
Autumn Fiester
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Abstract

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties' respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place.

Abstract Image

作为冲突管理工具的 "推论阶梯":在医疗伦理咨询中与 "难缠 "的病人或家属合作。
解决冲突是医疗伦理咨询(HEC)的核心内容,熟练掌握这项技能已得到国家生物伦理组织及其 HEC 认证程序的认可。临床团队与患者或其家属之间艰难的人际互动往往与规范性争议有着千丝万缕的联系,而规范性争议正是咨询的催化剂。伦理咨询师往往需要处理已经根深蒂固的具有挑战性的动态关系,并与已经破裂的患者-医护人员或家属-医护人员关系打交道。解决冲突的第一步是诊断冲突的根源。由于许多人际冲突和规范性冲突都建立在误解和错误描述的基础上,因此问题的诊断需要将冲突各方的实际立场和观点与对各方各自立场和观点的错误假设区分开来。推理阶梯(LOI)是在管理科学中发展起来的一种诊断工具,用于帮助利益相关者重新审视他们用来形成对冲突中其他人的看法的过程。LOI 可以检测出推理中的错误,包括隐性种族偏见,这些错误会导致错误的判断以及对这些判断做出适得其反的反应。LOI是一种工具,伦理顾问可以利用它来帮助解决有争议的床边冲突,但LOI也可以被医疗伦理顾问用作一种教学工具,培训临床工作人员如何从一开始就避免此类冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hec Forum
Hec Forum ETHICS-
CiteScore
3.70
自引率
13.30%
发文量
34
期刊介绍: HEC Forum is an international, peer-reviewed publication featuring original contributions of interest to practicing physicians, nurses, social workers, risk managers, attorneys, ethicists, and other HEC committee members. Contributions are welcomed from any pertinent source, but the text should be written to be appreciated by HEC members and lay readers. HEC Forum publishes essays, research papers, and features the following sections:Essays on Substantive Bioethical/Health Law Issues Analyses of Procedural or Operational Committee Issues Document Exchange Special Articles International Perspectives Mt./St. Anonymous: Cases and Institutional Policies Point/Counterpoint Argumentation Case Reviews, Analyses, and Resolutions Chairperson''s Section `Tough Spot'' Critical Annotations Health Law Alert Network News Letters to the Editors
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