ABSTRACT

                      The present dissertation is a qualitative research characterized by descriptive method, applying content analysis of the texts from Tipitaka, Atthakathā, related textbooks, researches, documents, and case studies including in-depth interview with scholars and experts. Three objectives of this research comprise: (1) to analyze concepts and processes of Western peaceful conflict management in Thai and Western health care systems; (2) to analyze concepts and processes of Buddhist peaceful conflict management in the Buddha’s period; and, (3) to develop a model of Buddhist peaceful means on conflict management in the Thai health care system.

                    The results of the research are as follows:  

                     A model of Buddhist peaceful means on conflict management in Thai health care system was developed by the integration of Buddhist and Western peaceful means on conflict management.  With this integration, the researcher reviewed concepts, processes, methods, tools and case studies of conflict management in both the Buddhist and the Western means with the results shown hereafter.

                     In the Western means on conflict management in health care system, five major causes of conflict include structure, data, relationship, value, and interest.  Mediation is a process and a method that can be used for successful management of such conflict leading to mutual agreement satisfied at particular level by both parties.  The process can terminate the problem and bring about an agreement between parties to refrain from any legal actions against one another.  However, doctor-patient’s relationship, trust, and revisit to hospital services might take time or even not recur. Key principles, adopted in the management of Thai and Western health care conflicts, provide guidelines for the process of analysis and management of conflicts. The guidelines consist of, first, the concept for understanding the conflict.  Most of the case studies in health care system, analyzed the cause of conflict based on the circle of conflict that demonstrates five aspects of interest: structure, data, relationship, value, and interest. Second, the school of thought for management of health care conflict conducive to good relationship is mediation with main focus on the cycle of interaction between parties. Third, it involves adhering to interest-based approach as a solution or resolution for ending the conflict.

                   These three guidelines will serve as key principles in mediation process for management of Thai and Western medical and health care conflicts.

                    Buddhist means of conflict management can be described in to two important parts, i.e. understanding the rationale of Buddhist means for problem solving, and understanding Buddhist tenet to be used for problem solving. The rationale for problem solving by Buddhist means is to resolve the causal factors for which individuals are required to solve the problem themselves.  The Buddha guided individuals to look at their own problems, look upon themselves, not at any other causes or places, or to solve the problem at other points. The Buddha suggested solving problems by reasonably undertaking it with perseverance.  The other part, Buddha’s teachings used for solving problem are to solve both internal and external, or mental and social problems. However, most of the teachings focus more on wisdom or mental than on externals. As for human nature, the mental problem is totally concerned with human regardless of times and periods. Human nature remains the same with greed, anger, delusion, happiness, and suffering.  In addition, solving problem in human’s mind receives less attention from instructors. While the Buddha saw that it requires increased attention.  This is a subtle issue difficult to understand. Most importantly, mind and wisdom are the essence of human life, so they should be learned for profound understanding.  Applying Buddhist concept in social suffering is therefore appeared to be the approach focusing mainly on resolving the internal factors of human. 

                    It can be concluded that the principles of Buddhist means for solving problems are 1) the concept for understanding the problem of human suffering is to understand the interaction of causal factors in human’s mind, how the social context or event of external society effect internal factors, by considering through Paticcasamuppāda that allows for well observing the revolving of inner causal factors. When internal causal factors revolve so many rounds affected by external factors, the cycle of Akusala-Mūla will rise and becomes increasingly complex, hence difficult to resolve. 2) the process and method of problem solving adopted the analysis approach and seeking ways to resolve the problem mainly through the logic of effect (Dukkha), causes (Samudaya), ways (Nirodha), and means (Magga) or Ariyasacca. 3) The tool to successful resolution is to apply suitable Buddhist Dhamma that fosters the parties’ awareness of inner self or to move the Cycle of Paticcasamuppāda backward, hence raising their compassion toward human fellows which in turn ending the suffering or the conflict, and restoring positive relationship. This is the distinctive point of Buddhist means.

         Due to the analysis of Western and Buddhist peaceful concepts and processes for management of conflict in health care system, integration of both approaches based on the distinctive point of Buddhist means augmented with the strengths and opportunities feature of Western means, provide an integrated model of Buddhist means for management of conflict in Thai health care system, containing the three coherent and inter-complementing  sub-systems below:

  Sub-System 1: Understanding with Buddhism (The Paticcasamuppāda in Health Care System)

        This provides the starting point for employing the concept to resolve the conflict problem from the inside.  The parties are encouraged to become aware of various internal causal factors through the Cycle of Paticcasamupāda, and the five external stimulating causal factors appeared in the Western’s circle of conflict.  Once these externals attack the doctor-patient in the Cycle of Paticcasamupāda at the stages of Tanhā and Upādāna, it will revolve toward Avijjā of treatment  of disease and recovery from disease, then rises the cycle of Akusala-Mūla (Lobha, Dosa, Moha).  Finally, with awareness of these factors, the parties themselves will find the ways out without attachment to these factors.

  Sub-System 2: Managing the Origin (The Ariyasacca in Health Care System)

        The system applies Buddhist concepts and processed to medical and health care conflicts.  It requires that the parties work out together to make clear understanding about the problem, its causes, the solution, and the method to solve the problem but without regarding themselves as the center.  The resolution relies on the Noble Truth or Ariyasacca and it might include the western’s interest-based approach to facilitate the successful process.

  Sub-System 3:  Reframing the Management Method (The Noble Eightfold Path in Health Care System)

                     The system attempts to find means that correspond to particular causal factors or means to move the cycle of Paticcasamuppāda backward so that Kusala-Mūla grows in mind of the doctor and patient.  It applies the Buddhist’s Noble Eightfold Path such as the right view, right thought, right action etc., through the profound talk, and also the Western conceptual reframing approach as a facilitation to respond the parties’ internal and external needs, so the conflict ends, and hence the recovery of doctor-patient relationship .

          The researcher suggested that the application of this concept using the model of Buddhist means on conflict management in health care system should require further investigation by trying out in training course among mediators or conflict resolvers in Thai health care system so that the handbook for practice is developed  for fruitful utilization.