Mediating Difference: Normative Conflict as Opportunity

Introduction

Catherine Myser's (2003) use of battle imagery captures the Zeitgest of our times. Her call for bioethicists to recognize their "whiteness" is couched in language calling less for reflection than armed rebellion. Myser charges that governing bioethics norms speak only to a white majority; she faults social scientists who import minority perspectives into the mainstream for failing to "displace" or "de-center" majority views. Diversity researchers thwart, rather than advance their pluralism, she argues, by failing to aggressively challenge majoritarian thinking. Such timidity, she warns, threatens to "inoculate difference" by "stimulating a kind of immune response," leaving the main body of traditional—and we may assume diseased—bioethics intact.

Strong stuff for a field professing to make peace, not war. Bioethics shares so many of mediation's basic premises that it is jarring to encounter such combative rhetoric in an essay devoted to bioethical reform. Consider the similarities. Like mediation, bioethics seeks to democratize decision making, giving voice to disputants who have not traditionally held a place at the table (Rothman 1991). Like mediation, bioethics reaches for collaborative resolutions that bring closure without violating stakeholders' deeply felt values (Waldman 1997). Like mediation, bioethics seeks to move emotionally charged disputes out of the adversary system and into more hospitable fora. And like mediation, bioethics searches for common ground, while acknowledging that individual allegiance to varying moral agendas frustrates easy resolution.

In the untidy negotiations that mediation and bioethics both encourage, win-win agreement must often be abandoned in favor of a resolution stakeholders can stomach, reached through transparent, respectful, and inclusive procedures (American Society for Bioethics and Humanities 1998).

What then are we to make of Myser's call to arms? From a mediator's perspective, Myser's pugilism functions as does much of the healthcare litigation filed in our courts today. It highlights important issues, exacerbates existing tensions, and misses opportunities for healing and amelioration.

Battling for Majority Status

Myser seeks to "color bioethics" by marking the essential whiteness of its epistemologies and precepts. Whites—meaning those at the top of the sociocultural hierarchy—obsess over autonomy, overemphasize truth telling, undervalue relationships, limit social obligations, shrink from emotion, and confine themselves to a desiccated rationality. American bioethics, according to Myser, does the same, and, in so doing ignores the more holistic and relationship-oriented worldviews of Blacks, Hispanics, Native Americans, and other ethnic groups.

Putting aside the ascription of certain traits as white or nonwhite, the criticisms Myser levels at American bioethics are hardly news. The story of bioethics over the last ten years has been one of revision and reconstruction of exactly these beliefs. Many commentators have pointed out that autonomy has loomed too large on the bioethics agenda, and principlism has served as the launch pad for a series of alternate methodologies grounded in attention to context, relationship, and feeling (Schneider 1998; Martin 1999).

Social scientists devoted to the exploration and elaboration of Black, Hispanic, and Native American norms have done much to encourage this proliferation of alternative approaches. Yet, Myser faults these researchers because they do not sufficiently "problematize" white norms and thus allow these norms to remain "in a position of flexible superiority." It would appear there can be only majority oppressors and the minority oppressed. Either we problematize and displace white norms or we "risk functioning as cultural colonizers who do violence to social justice concerns related to race and class."

Since when did the choices become so stark? Must we either eat or be eaten? Can't divergent normative frameworks be brought together in ways that inform and enrich one another. Understanding that many communities view medical decision making as a familial rather than an individual activity allows us to improve informed consent protocols available to all. Incorporating an ethic of care into principle-based reasoning calls our attention to relationships and interdependencies that might otherwise be lost in the analysis. This blending and mixing of varied...