外文翻譯--在醫(yī)療領(lǐng)域的調(diào)解,是中性的干預(yù)可能嗎

1、<p>　　Kevin Gibson.《Mediation in the Medical Field .Is Neutral Intervention Possible? 》,[J], The Hastings Center Report,Vol. 29, No. 5 (Sep. - Oct., 1999), pp. 6-13.</p><p>　　Mediation in the Medical Fi

2、eld .Is Neutral Intervention Possible?</p><p><b>　　Abstract</b></p><p>　　Neutrality is held to be the touchstone of good mediation. True neutrality is elusive, however, and probably

3、not even desirable, at least when applied to patient-provider disputes over medical care. In this context, mediators should not posture as “neutrals”; they should strive instead to protect their clients’ autonomy.</p&

4、gt;<p>　　Health care has great potential for conflict .Decisions often involve multiple paties,each with different interests,issues,values,and perspectives.These classes are often resolved by judicial rulings or e

5、xecutive decisions ,but increasingly,various methods of alternative disputes.One of the most highly regarded of these is mediation ,a model of ADR that involves intervention by a third party who lacks decision making pow

6、er and instead facilitates negotiation between the disputants.ADR in general</p><p>　　Proponents of mediation claim that it is quicker,less expensive,and achieve a greater settlement rate than traditional me

7、thods of dispute resolution.It may also have modeling function,so that participants learn to resolve learn to issues without resorting to adjudication.</p><p>　　At the policy level,mediation could be used re

8、solve disputes between managed care administrators and medical staff over what constitutes an experimental procedure.Alternatively,mediation is seen as a way to facilitate agreement at the beside among doctors,nurses,pat

9、ients,and family.New York s Montefiore Medical Center has been a pioneer in using mediation in bioethical disputes and produced a model program for the industry .</p><p>　　This new emphasis on the mediation

10、process has wide practical significance in the way disputes will be dealt with in the whole realm of health care.It is also philosophically important because it greatly expands the scope of intervention by parties who st

11、rive to be nondirective.but while formal mediation sessions and techniques can be extremely useful in health care,there are crucial different in the medical setting that run counter to traditional mediation theory.In oth

12、er areas,mediation adhere</p><p>　　Practitioner Beliefs</p><p>　　Mediators are experts in negotiation and help by facilitating agreements. Part of their job is to establish that there is room fo

13、r agreement, and then to give the parties the best opportunity to reach a settlement. urface and integrated into an Negotiations are often partly distributive, in the sense that they can involve sharing a fixed resource

14、like money, but they also have an integrative component, in that the parties have overlapping interests that can be brought to the sy agreement. Suppos</p><p>　　Mediators function largely by exploring the in

15、terests of the parties and reframing positions (“I won't consent to that operation”) into interests (“So you are worried about the potential side effects?”), and then generating options that are satisfactory to both

16、parties. It is oriented to the future and to settlement. Mediation theory has generally claimed that at least three linked elements are important to the process: mediator neutrality in the sense of nonpartisanship in the

17、 process, neutrali</p><p>　　The Baseline of Acceptability</p><p>　　In general, mediation accepts that individuals can craft their own settlements, even if they are unusual or less than ideal. Ja

18、y Folberg, a leading theorist, defines mediation as the process by which the participants, together with the assistance of a neutral person or persons, systematically isolate disputed issues in order to develop options,

19、consider alternatives, and reach a consensual settlement that will accommodate their needs.</p><p>　　Yet plainly, as one critic has charged, “The bright new ideas of client self-determination and autonomy ar

20、e consistent with letting one party freely choose to be the victim of exploitation.”5 Although this problem has been vigorously debated in the literature, it has not been a mortal blow to the process, and the merits of l

21、etting individuals craft outcomes for themselves have been seen as outweighing the risks of unjust settlements. In his book The Mediation Process, Chris Moore offers a limite</p><p>　　The background conditio

22、ns for medical mediation are distinct, though. The stakes are often much higher, and decisions may result in death, long-term distress, or impoverishment. Parties may have very different power bases, and patients and fam

23、ilies may be too intimidated by caretakers to assert their rights even when they are aware of them. Moreover, there is a rich backdrop of settled law and philosophical literature that has led to recognized constraints on

24、 actions affecting patients. Hence th</p><p>　　Mediators often refer to themselves as “neutrals” and take neutrality to be axiomatic of their practice, even though it is, at best, an ambiguous term. Mediator

25、s emphasize that they are neutral both in that they do not intervene in the negotiation, and in that they are indifferent as to the outcome. At least in the medical context, however, mediation is better served by emphasi

26、zing the demand for client autonomy than by pursuing an elusive neutrality.</p><p>　　The claim that a mediator must be neutral is based on two beliefs: that neutrality promotes trust, and that it reveals to

27、the parties the presence of a middle ground fertile with options for settlement. Neutrality is usually thought of as more than impartiality; while impartiality implies evenhandedness and lack of bias, neutrality involves

28、 distance from the substance of the dispute and the values involved. But whatever definition is adopted, discussions of neutrality in mediation have often ass</p><p>　　Leonard Marcus strikes the usual stance

29、. In his examination of mediation in the medical field, Marcus argues that the issue of neutrality is critical. He takes neutrality to be a stance that favors neither side and that therefore allows the parties to admit t

30、he potential for a middle ground. He believes the mediator will have biases, but will be able to effectively mask them:</p><p>　　the mediator is conscious of the fact that pure neutrality is a mix of myth an

31、d professional credo; people bring their own biases and history into any dispute. Mediators competently distinguish what they think from what they say and do. The proof is in the outcome.</p><p>　　There are

32、two problems here: First, the claim that quality of outcome correlates with the neutrality of the mediator is neither necessarily true nor self-certifying, at least without much more discussion. A medical intervention wo

33、uld not be thought effective on the evidence that the patient got better unless there had been studies that controlled for unrelated factors, and similarly we cannot automatically accept that a dispute was effectively me

34、diated based on the outcome alone. A mediator coul</p><p>　　Second, mediator neutrality seen from this perspective relies on the personal qualities of the mediator. Extensive evidence from social psychology

35、suggests that mediators are rarely immune to biases, while at the same time they routinely overestimate their ability to avoid them.8 Distinguishing personal from professional opinion about what comments to stress or avo

36、id in mediation is much harder than Marcus suggests, even for experienced mediators.</p><p>　　Extensive evidence from social psychology suggests that mediators are rarely immune to biases, while at the same

37、time they routinely overestimate their ability to avoid them.</p><p>　　Yet there is a tension here: if one side tends to dominate, for example, and if the mediator apparently works to give equal “air time” t

38、o both, then the mediator seems to be acting on behalf of one side and constraining the other. I believe this is appropriate, but in such a case, the espousal of neutrality appears misleading. If a mediator is to do anyt

39、hing in shaping the process, then this will inevitably involve favoring some comments, choosing which elements to draw out or suppress, and aski</p><p>　　Mediation and Autonomy</p><p>　　A more a

40、ppropriate frame for dis- cussing mediator action is as intervention that preserves or enhances participant autonomy, understood as the individual's power of self-determination, or, as described by Dworkin, as “the c

41、apacity to reflect upon one's motivational structure and to make changes in that structure.” Dworkin asserts that autonomy is central to the nature of personhood because it is the locus of choice and responsibility.

42、It is more than decisionmaking power, since the autonomous a</p><p>　　Autonomy requires voluntary choice—that is, choice that is not dictated by others. It may be contrasted to influence, which Ruth Faden an

43、d Tom Beauchamp have suggested may be thought of in three senses: coercion, manipulation, or persuasion. Coercion, they say, occurs “if one party intentionally and successfully influences another by presenting a credible

44、 threat of unwanted and avoidable harm so severe that the person is unable to resist acting to avoid it.”</p><p>　　Manipulation involves influence that “noncoercively alters the actual choices available to t

45、he person or… nonpersuasively alter[s] the person's perceptions of those choices” (p. 261). These conditions are uncontentious. However, it seems mistaken to say that persuasion necessarily detracts from autonomy. Pe

46、rsuasion is restricted to influence by appeal to reason, whereas manipulation involves bad reasons or poor arguments masquerading as good ones. In the words of Claudia Mills,</p><p>　　Persuasion, understood

47、in its ideal form, is influence that appeals only to the best reasons, broadly understood, for forming beliefs and desires, and so leading a person to a targeted conclusion. To persuade someone to do x—whether by explici

48、tly offering arguments or even by implicitly acting in various ways—is to say (explicitly or implicitly): “There are good reasons for you to do x.”</p><p>　　Presenting reasons does not by itself violate auto

49、nomy, since the individual is still the arbiter of choice. For example, if a woman with a heart condition wants to go bungee jumping, it would be appropriate to ensure that she is aware of the potential consequences of h

50、er decision, but it would be inappropriate to refuse her request once it had been established that she was fully aware of her actions. Similarly, someone at risk of a stroke may be counseled to give up smoking; once educ

51、ated about</p><p>　　However, if the mediator's job is to act as an educator, this naturally begs the question of whether education can take place in a value-neutral way. Any presentation by one individua

52、l to another is likely to be tempered by a point of view. Thus even the most evenhanded exposition will probably betray the values held by the author and color the views of a receptive audience. Given these facts, it mig

53、ht be thought that any form of education of a client in mediation is tantamount to implicit advoc</p><p>　　It might be charged that there is a paradox in attempting to clarify a client's values in a valu

54、e-neutral way. But the seeming inconsistency arises because it is inherent in the liberal veneration of value neutrality: the veneration of neutrality in itself could be described as highly value-laden. To deal with this

55、 criticism, we can look to educational philosophy. In the 1970s, schools were concerned that they should not teach particular values to students. It was felt that at most teachers coul</p><p>　　If we urge cr

56、itical thinking, then we value rationality. If we support moral reasoning, then we value justice. If we advocate divergent thinking, then we value creativity. If we uphold free choice, then we value autonomy or freedom.

57、If we encourage “no-lose” conflict resolution, then we value equality…. Called before the committee, we can only say that values clarification is not and never has been “value-free.”15</p><p>　　In Amy Gutman

58、n's words, “Proponents of values clarification can admit without fear of self-contradiction that they are morally committed to the pedagogical position that teachers should not impose their views on students.”16 Inde

59、ed many teachers do hold that forceful advocacy of positions is appropriate and necessary in order to confront dogmatic beliefs that students may hold, as long as the intent is not to impose a particular view but rather

60、to encourage critical reflection of the arguments p</p><p>　　The stress on mediator neutrality encounters another problem when mediators are confronted with manifest power imbalances between the disputants.

61、Consider an example Alan Montefiore gives in which he suggests that there is more than one kind of neutrality, and that sometimes neutrality, from the point of view of the less powerful party, would ideally involve redre

62、ssing the balance of power:</p><p>　　Two children may each appeal to their father to intervene … in some dispute between them. Their father may know that if he simply “refuses to intervene” the older one, st

63、ronger and more resourceful, is bound to come out on top … [I]n other words, the decision to remain neutral, according to the terms of our present definition, would amount to a decision to allow the naturally strong chil

64、d to prevail. But this may look like a very odd form of neutrality to the weaker child.</p><p>　　The implication is that neutrality as nonintervention allows the more powerful party to exploit his or her adv

65、antage, and that there may be occasions in which it would be appropriate for the mediator to work to “l(fā)evel the playing field.”</p><p>　　Mediation codes and commentators are divided on this issue. The argume

66、nt goes that the credibility of a mediator is at stake when he or she attempts to alter the power balance between disputants. Should the mediator take one party aside and “coach” him or her, the other disputant is likely

67、 to feel that there is an unholy alliance forming.</p><p><b>　　中文翻譯</b></p><p>　　在醫(yī)療領(lǐng)域的調(diào)解.是中性的干預(yù)可能嗎？</p><p><b>　　摘要</b></p><p>　　好的調(diào)解，被認(rèn)為是中立的試金石

68、。然而，真正的中立是難以捉摸的，可能不會(huì)甚至是可取的，至少在應(yīng)用到患者提供醫(yī)療糾紛。在這種情況下，調(diào)解員不應(yīng)為“中立國(guó)”的姿態(tài)，他們應(yīng)該努力來保護(hù)他們的客戶的自治。</p><p>　　健康保健具有很大的潛在沖突，要做出的決定往往涉及多個(gè)方面，各有不同的利益，問題，價(jià)值觀，和觀點(diǎn)。這些問題往往可以通過司法判決或行政決定來得到解決，但是出現(xiàn)了越來越多的各種方法替代性的糾紛解決方式。其中一個(gè)最值得高度認(rèn)可的是就是一種

69、稱為ADR的調(diào)解模式——涉及通過缺乏決定權(quán)的第三方進(jìn)行干預(yù)來替代原先的促進(jìn)雙方之間的協(xié)商的方法。一般來說，ADR和調(diào)解特別是一直提倡健康安全法作為未來美國(guó)醫(yī)療保健體系中的一個(gè)組成部分。</p><p>　　調(diào)解的支持者聲稱，它相比于傳統(tǒng)的解決爭(zhēng)議方法，其速度更快，更便宜，并實(shí)現(xiàn)了更大的結(jié)案速率。它也可以有造型功能，讓參與者學(xué)習(xí)解決學(xué)習(xí)問題，而不訴諸裁決。在政策層面上，調(diào)解可以用來解決那些組成的一個(gè)實(shí)驗(yàn)程序管理保健

70、管理人員和醫(yī)務(wù)人員之間的糾紛。另外，調(diào)解被看作是一種途徑來促進(jìn)協(xié)議旁邊的醫(yī)生、護(hù)士、患者和家庭之間的調(diào)解。紐約的Montefiore醫(yī)療中心一直是使用生物倫理糾紛調(diào)解的先驅(qū)者，并為該領(lǐng)域制作了模型方案。</p><p>　　這種新的將重點(diǎn)放在調(diào)解過程的方式并實(shí)現(xiàn)了糾紛將在整個(gè)醫(yī)療保健領(lǐng)域的被解決掉的方式，是具有廣泛的現(xiàn)實(shí)意義的。這也是非常的，因?yàn)樗ㄟ^各方努力成為非指導(dǎo)性的從而大大擴(kuò)大了干預(yù)范圍。但當(dāng)正式的調(diào)解會(huì)

71、議和技術(shù)可以在保健領(lǐng)域發(fā)揮巨大的作用，關(guān)鍵的是存在不同的醫(yī)療環(huán)境將導(dǎo)致傳統(tǒng)調(diào)解理論背道而馳。在其他方面，調(diào)解堅(jiān)持一組包括解決問題、中立和保密的原則，這與冷漠是背道而馳的。相比之下，一個(gè)生物倫理學(xué)中介可能受不了，并認(rèn)為要看看爭(zhēng)議各方是否同意一個(gè)不道德的安排的。生命倫理學(xué)調(diào)解應(yīng)該尋求的是一個(gè)道義上的原則性的解決方案，而不僅僅是一個(gè)雙方都同意的一個(gè)，這可能意味著改變一些傳統(tǒng)調(diào)解的假設(shè)。</p><p><b>

72、;　　從業(yè)信念</b></p><p>　　調(diào)解員是一些談判專家，并幫助促進(jìn)協(xié)議的達(dá)成。他們工作的一部分，是建立有余地的協(xié)議，然后給當(dāng)事人達(dá)成和解的最好機(jī)會(huì)。融入一個(gè)談判往往是部分分配，在這個(gè)意義上，他們可以涉及共享一個(gè)固定的資源，如金錢，但他們也有一個(gè)綜合性的組成部分，在各方有重疊的利益，可以帶來系統(tǒng)協(xié)議。假設(shè)一個(gè)工人要求加薪的雇主只有一個(gè)固定金額分配給工資，但工人實(shí)際上是承認(rèn)和尊重。如果他們成為鎖

73、定為超過工資的位置，他們可能放棄了廣泛的可以使雙方滿意的解決方案，可能是他們選擇停車場(chǎng)，公共斑塊，或遞延花紅。或者，假設(shè)醫(yī)生是指一個(gè)老婦，她吸煙成癮心理醫(yī)生進(jìn)行治療，患者拒絕去。如果醫(yī)生認(rèn)為，聆聽療法是適當(dāng)?shù)闹委?，而病人認(rèn)為訪問心理醫(yī)生表示，她是精神病患者，這就有可能成為打破僵局的選項(xiàng)，如心理學(xué)家或精神科社工訪。調(diào)解員應(yīng)有助于各方溝通，他們的相關(guān)權(quán)益，重新塑造他們信奉的位置，產(chǎn)生令人滿意的選項(xiàng)。值得注意的是，不同的仲裁員，還是規(guī)定了結(jié)算

74、方式的法官，調(diào)解員只能鼓勵(lì)由當(dāng)事人自己自愿解決。</p><p>　　調(diào)解員的功能主要是由利益各方探索和重新規(guī)劃成權(quán)益（“所以你擔(dān)心潛在的副作用嗎？”）的位置（“我不會(huì)同意該業(yè)務(wù)”），然后生成滿意的選項(xiàng)雙方。它是面向未來和結(jié)算。調(diào)解理論一般都聲稱至少三個(gè)相互聯(lián)系的要素是很重要的過程：在這個(gè)意義上的無黨派中立調(diào)解人在這個(gè)過程中，中立的調(diào)解員的冷漠感，結(jié)果，和保密。但是，這些需求進(jìn)行修改，在醫(yī)療方面，因?yàn)椴∪说臋?quán)利和

75、法律的先例壓倒一切的擔(dān)憂。</p><p><b>　　可接受基線</b></p><p>　　在一般情況下，調(diào)解可以接受甚至是個(gè)人確定的地點(diǎn)，即使它們不尋?；蛐∮诶硐?。領(lǐng)先的理論家JAY Folberg，他是這樣定義的，在調(diào)解的過程中，其中的參與者，加上一個(gè)中性人或數(shù)人的協(xié)助下，系統(tǒng)地隔離有爭(zhēng)議的問題，以便制定備選方案，考慮替代方案，并達(dá)成雙方同意的解決，將容納雙方

76、的需求。</p><p>　　但說白了，作為一個(gè)批評(píng)家充電，“明智的新客戶端自決和自治的想法是一致的，讓一方自由選擇被剝削的受害者。”雖然這個(gè)問題已經(jīng)在文獻(xiàn)中被熱烈討論，一直沒有一個(gè)致命的打擊過程中，已經(jīng)看到了自己的優(yōu)點(diǎn)，讓個(gè)人的工藝成果抵銷了風(fēng)險(xiǎn)不公正的定居點(diǎn)。在克里斯摩爾他的書中寫道，在調(diào)解過程中，提供適當(dāng)?shù)睦碛蛇M(jìn)行干預(yù)的有限列表，包括定居點(diǎn)，有很大的不公平，不可能舉行，隨著時(shí)間的推移，可能導(dǎo)致新的沖突后，或

77、該條款是如此寬松，因?yàn)樽龀鼋灰资遣磺袑?shí)際的。它也是適當(dāng)介入，在摩爾定律的觀點(diǎn)，如果有一方或雙方是潛在的暴力。</p><p>　　盡管醫(yī)療調(diào)解的背景條件是不同的，賭注是往往高得多，而且決定可能會(huì)導(dǎo)致死亡，長(zhǎng)期困擾，或陷入貧困。締約方可能有非常不同的權(quán)利基礎(chǔ)，以及病人和家屬可能因害怕管理者而不能維護(hù)自己的權(quán)利，甚至當(dāng)他們意識(shí)到他們。此外，有豐富的關(guān)于糾紛處理法律和哲學(xué)文獻(xiàn)，會(huì)導(dǎo)致了公認(rèn)的行動(dòng)影響患者，因此調(diào)解員不僅

78、僅是一個(gè)進(jìn)程管理器，并期待超越眼前的默許的協(xié)議的約束。</p><p>　　調(diào)解員經(jīng)常稱自己為“中立國(guó)”，并采取中立措施，他們的做法是不言自明的，即使它是在一般情況下最多是一個(gè)含糊的字眼。調(diào)解者強(qiáng)調(diào)的是，它們是中性的，因?yàn)樗鼈儾唤槿朐谡勁校覍?duì)調(diào)解結(jié)果漠不關(guān)心。然而，至少在醫(yī)療方面，調(diào)解是更好的服務(wù)，強(qiáng)調(diào)為客戶自主性的需求，而不是追求一個(gè)可望而不可及的中立。</p><p>　　有一個(gè)聲稱

79、，它是基于兩個(gè)信念：一名調(diào)解員必須是中性的，中立促進(jìn)信任，在于它揭示各方存在一個(gè)中間地帶肥沃解決空間的選項(xiàng)。通常被認(rèn)為是公正余中立而公正意味著霸道，缺少的偏見，中立涉及距離之爭(zhēng)的實(shí)質(zhì)和價(jià)值觀。但是，在任何采用的定義中，討論的中立調(diào)解往往認(rèn)為，調(diào)解員可以介入中立，問題的癥結(jié)是雇用的效果，如何“動(dòng)手”或“放手”的干預(yù)程度調(diào)解員應(yīng)掌握好。</p><p>　　倫納德?馬庫(kù)斯罷工通常的立場(chǎng)。在他的調(diào)解在醫(yī)療領(lǐng)域的檢查，馬

80、庫(kù)斯認(rèn)為，中立的問題是至關(guān)重要的。他采取中立立場(chǎng)，有利于任何一方，因此允許當(dāng)事人承認(rèn)一個(gè)中間地帶的潛力。他認(rèn)為，調(diào)解員有偏見，但同時(shí)其將能有效地掩蓋它們。</p><p>　　調(diào)解員意識(shí)到純中立的事實(shí)，是一個(gè)綜合了神話和專業(yè)信條的混合體，人們把自己的偏見和歷史帶入到任何爭(zhēng)議中。調(diào)解員能夠勝任分清哪些他們認(rèn)為他們?cè)谡f什么以及在做什么。證明就在結(jié)果之中。</p><p>　　這里有兩個(gè)問題：首

81、先，索賠的結(jié)果，質(zhì)量與調(diào)解員的中立性是既不一定是真實(shí)的，也不需要進(jìn)行自我證明，至少?zèng)]有更多的討論。醫(yī)療干預(yù)不會(huì)被認(rèn)為是有效的病人會(huì)得到了更好的證據(jù)，除非有控制無關(guān)因素的研究。同樣，我們也不會(huì)自動(dòng)接受，糾紛得到有效調(diào)解的基礎(chǔ)上單獨(dú)的結(jié)果。調(diào)解員能夠保持專業(yè)的距離甚至霸道，但客戶仍然達(dá)到最理想的結(jié)果，一個(gè)強(qiáng)有力的干預(yù)和黨派調(diào)停人可以大力鼓勵(lì)（或“肌肉”）一個(gè)很好的結(jié)果。因此，調(diào)解員的中立的質(zhì)量不能被追溯診斷通過簡(jiǎn)單地檢查的結(jié)果。</p

82、><p>　　其次，從這個(gè)角度來看，調(diào)解的中立性依靠的是調(diào)解員的個(gè)人素質(zhì)。從社會(huì)心理學(xué)的大量證據(jù)表明，調(diào)解人是很少的免疫偏差，而在同一時(shí)間，他們經(jīng)常性地高估自己的能夠避免它們的能力。區(qū)分個(gè)人專業(yè)意見，強(qiáng)調(diào)有什么意見或避免在調(diào)解比馬庫(kù)斯表明的更難，即使是對(duì)于經(jīng)驗(yàn)的調(diào)解員。</p><p>　　社會(huì)心理學(xué)的大量證據(jù)表明，調(diào)解員是很少的免疫偏差，而在同一時(shí)間，他們經(jīng)常性地高估自己避免它們的能力。&l

83、t;/p><p>　　然而，有一種張力：如果一方往往占據(jù)主導(dǎo)地位，例如，如果調(diào)停顯然給予同等的“空中時(shí)間”給兩者，然后調(diào)解員若似乎代表一方并制約另一方。我相信這是合適的，但在這種情況下，中立遵奉出現(xiàn)誤導(dǎo)。如果調(diào)解員是做都是在塑造過程，那么這將不可避免地涉及有利于一些意見，選擇一些支持或者抑制的元素，并要求在某一特定方向引導(dǎo)討論的問題，這將只能是意味著“過程管理”，它不可避免地涉及調(diào)解充滿價(jià)值判斷。因此，它似乎中立的概

84、念在理論上是困難的，幾乎是不可能的。</p><p><b>　　調(diào)解和自治</b></p><p>　　一個(gè)顯示的更合適的框架來進(jìn)行謾罵調(diào)停行動(dòng)，就是保留或提高參與者的自主權(quán)，理解為個(gè)人的權(quán)力自決，或者，如德沃金所說，“能力來反映一個(gè)人的動(dòng)機(jī)的結(jié)構(gòu)后，并做出的干預(yù)在該結(jié)構(gòu)中的變化。“德沃金斷言，自主性人格的性質(zhì)，因?yàn)樗俏稽c(diǎn)的選擇和責(zé)任。這是決策權(quán)多，因?yàn)樽灾螀^(qū)的演

85、員也一定有辦法把那些決定。只是決定選擇醫(yī)學(xué)作為一種職業(yè)或選擇手術(shù)，而不是藥物治療，沒有誰擁有的權(quán)力，以幫助實(shí)現(xiàn)這些決定他人的同意和協(xié)作是一個(gè)空洞的選擇。調(diào)解員的工作，因此，其中的一部分可能會(huì)確保任何決定是可以實(shí)現(xiàn)的。</p><p>　　自治需要自愿選擇，不是由別人的選擇。這可能是影響力，露絲和湯姆?比徹姆建議可以被認(rèn)為是在三個(gè)感官脅迫，操縱或說服對(duì)比。威逼利誘，他們說，發(fā)生“如果一方故意，并成功影響另一個(gè)不必要

86、的和可避免的危害如此嚴(yán)重，人是無法抗拒采取行動(dòng)，以避免它提出一個(gè)可信的威脅?！?lt;/p><p>　　操作涉及影響改變實(shí)際可供選擇的人或改變?nèi)说目捶?，這些選擇”（第261頁(yè)）。這些條件是沒有爭(zhēng)議的。然而，它似乎誤以為是說，勸說必然有損自主權(quán)。說服限制訴諸理性的影響，而操作涉及偽裝成好的不好的原因還是貧窮的參數(shù)。在克勞迪婭?米爾斯的話，</p><p>　　勸說，理解其理想的形式，是影響，呼吁

87、只有最好的理由，大致的理解，形成信念和欲望，并因此導(dǎo)致一個(gè)人有針對(duì)性的結(jié)論。要說服別人做是否明確提供的參數(shù)，甚至暗中行事以各種方式（明確或暗示）說：“有你做的很好的理由?！?lt;/p><p>　　呈現(xiàn)的原因本身并不違反自主權(quán)，因?yàn)閭€(gè)人仍然是首選的仲裁者。例如，如果一個(gè)女人與心臟狀況想去蹦極，這將是適當(dāng)?shù)?，以確保她知道她的決定的潛在后果，但是一旦被建立，這是不合適的，拒絕了她的請(qǐng)求，她充分認(rèn)識(shí)到她的行動(dòng)。同樣，有人在

88、中風(fēng)的風(fēng)險(xiǎn)可勸告放棄吸煙，一旦教育可能造成的后果，吸煙仍然是一個(gè)個(gè)人選擇。</p><p>　　但是，如果調(diào)解員的工作是作為一個(gè)教育工作者，這自然引出了一個(gè)問題教育是否可以發(fā)生在一個(gè)價(jià)值中立的方式。任何一個(gè)人到另一個(gè)演示文稿是由一個(gè)觀點(diǎn)可能得到鍛煉。因此，即使是最公允的論述可能會(huì)背叛由作者和顏色接受觀眾的意見所持的價(jià)值觀。鑒于這些事實(shí)，可能會(huì)認(rèn)為任何形式的教育調(diào)解中的客戶端是無異于隱倡導(dǎo)。不過，我不認(rèn)為這有是：不

89、需要任何背書鋪設(shè)事實(shí)暗示。當(dāng)然，本屆博覽會(huì)將體現(xiàn)一個(gè)觀點(diǎn)，但有很多方法，其中一個(gè)特定的角度來看，可以靜音電源。某些口頭公式可以幫助確保，特定的表示是不是說教：“以此什么是值得的”，“有些人已經(jīng)說...也有人說......，”或“論證的緣故，讓我扮演魔鬼代言人在這里?！半m然不能否認(rèn)調(diào)解員值，關(guān)鍵的是，這些價(jià)值不被強(qiáng)加在客戶端上。</p><p>　　可能會(huì)收取試圖澄清客戶的價(jià)值，在價(jià)值中立的方式，有一個(gè)悖論。但似乎

90、矛盾的產(chǎn)生是因?yàn)樗逃械膬r(jià)值中立的自由崇拜：，中立本身可以被描述為高價(jià)值載貨崇拜。為了應(yīng)對(duì)這種批評(píng)，我們可以看看教育理念。在20世紀(jì)70年代以來，學(xué)校擔(dān)心，他們不應(yīng)該教給學(xué)生特定的值。有人認(rèn)為，大多數(shù)教師能幫助個(gè)人澄清自己的價(jià)值觀和評(píng)估值的一致性和連貫性。沒有試圖做出道德判斷的任何位置。運(yùn)動(dòng)被批評(píng)，因?yàn)樗坪蹩梢源龠M(jìn)某些自由主義價(jià)值觀的幌子下，價(jià)值中立的批評(píng)類似的批評(píng)價(jià)值中立的調(diào)解。一個(gè)典型的回應(yīng)承認(rèn)，在這個(gè)過程中隱含值分別為，但不同意

91、這一進(jìn)程積極促進(jìn)這些價(jià)值觀。</p><p>　　如果我們敦促批判性思維，那么我們更看重的合理性。如果我們支持的道德推理，那么我們珍視正義。如果我們提倡發(fā)散思維，那么我們珍視創(chuàng)造力。如果我們堅(jiān)持自由選擇，然后我們重視自主或自由。如果我們鼓勵(lì)“不輸”解決沖突，那么我們看重平等....呼吁委員會(huì)之前，我們只能說，是不是和價(jià)值澄清從未有過“價(jià)值”。</p><p>　　艾美古特曼的話，“價(jià)值澄清

92、的支持者也承認(rèn)，他們都在道義上致力于教學(xué)的地位，教師應(yīng)該不施加他們對(duì)學(xué)生的意見自相矛盾沒有恐懼。”事實(shí)上，很多老師做保持位置，有力的宣傳是適當(dāng)?shù)暮捅匾?，為了?duì)抗教條的信仰，可容納學(xué)生，只要意圖是不是強(qiáng)加一個(gè)特定的觀點(diǎn)，而是鼓勵(lì)在各方面提出的論點(diǎn)的批判性反思。即使是約翰?斯圖亞特?穆勒，舉行個(gè)人選擇是至關(guān)重要的，不可侵犯的，不許別人“勸諫，說服或懇求”有人為他或她的福祉著想。平行持有守著客戶端自主權(quán)收取的中介。</p>&

93、lt;p>　　調(diào)解員的中立性上的壓力，遇到的另一個(gè)問題，當(dāng)調(diào)解員面臨著明顯的爭(zhēng)議雙方之間的權(quán)力失衡?？紤]一個(gè)例子，阿蘭?蒙蒂菲奧里給他認(rèn)為有一種以上的中立，有時(shí)中立，不那么強(qiáng)大的一方的角度來看，最好將涉及糾正的權(quán)力平衡。</p><p>　　言下之意是，中立，不干涉允許更強(qiáng)大的一方利用他或她的優(yōu)勢(shì)，并有可能成為調(diào)解員的工作“公平的競(jìng)爭(zhēng)環(huán)境，這將是適當(dāng)?shù)膱?chǎng)合?！?lt;/p><p>　　兩