Respecting a parent’s choice in elder mediation: a case study through This is Us
Spoiler Alert: this article refers to scenes in NBC’s This is Us, specifically Season 4, Episode 17.
Elder mediation is a type of mediation that differs from other forms of dispute resolution. Rather than a process that centers on resolving conflict between two people, elder mediation often involves multiple individuals within and outside of a family unit. Tensions and disagreements revolve around family relationships and perspectives, which are often multi-layered and multi-generational. Conflict can easily flare up when there is a shift in family relationships and responsibilities. Often this occurs when the patriarch or matriarch of a family undergoes a change in mental and/or physical health, and children and relatives disagree on how to handle and respond to this change. An all-too-common scenario is that aging parent, Mom, is diagnosed with a cognitive impairment such as dementia. In an effort to rally, children and other family members express opinions on how handle the new diagnosis. While helpful, family members’ efforts can morph into efforts to control the situation. Strong personalities can clash, especially between siblings who each believe that what they are doing is “best.” Sometimes the resulting sibling rivalry overshadows Mom’s care and Mom’s voice, so that Mom’s own feelings about her experience are made irrelevant as her children argue around her.
This scenario has played out recently in the NBC drama, This is Us. For readers unfamiliar with the show:
"This Is Us" chronicles the Pearson family across the decades: from Jack and Rebecca as young parents in the 1980s to their 37-year-old kids, Kevin, Kate, and Randall searching for love and fulfillment in the present day. (Source: https://www.nbc.com/this-is-us)
Mom (Rebecca) has been diagnosed with Alzheimer’s Disease (AD), a progressive brain disease that causes problems with memory, thinking, and behavior (Source: Alzheimer’s Association). Mom’s children—Kevin, Kate, and Randall—each respond to this news in a different way and make efforts to help. Kate takes the opportunity to spend more quality time with Mom; Kevin spends more time with Mom as well, deferring to her wishes and preferences; Randall, fearful of losing Mom, offers suggestions for how to combat the diagnosis.
Randall proposes that Mom participate in a nine-month clinical trial out-of-state. This is an Alzheimer’s research study for qualifying individuals (i.e., persons diagnosed with early stage AD) that generally includes the testing of new medications to assess their efficacy in targeting the symptoms of AD. Randall’s brother, Kevin, opposes this. Kate bends to Randall’s wishes, though generally expresses little to no opinion.
Mom adamantly opposes the idea. She expresses her wish to simply enjoy life and be around family during this time. She has no desire to be part of an experimental trial, especially one that would take her far away from her family and home (she lives in Los Angeles, California while the trial is in St. Louis, Missouri).
Yet, her two sons, Randall and Kevin, disagree and argue about the clinical trial—and, more broadly, argue about the scope of Mom’s care; their responsibility as sons; and their role in the family and relationship to Mom throughout their lives and up until this point.
In the most recent development to this story, Randall (notably, without consulting his siblings or Mom’s husband), urges that Mom participate in the clinical trial. While Mom remains adamantly opposed to it, she nonetheless states that she will do the trial.
Now, imagine that this state of affairs comes before a mediator.
This is a type of case that is ripe for mediation: there is conflict between family members around an aging parent’s care, with the issue being whether or not Mom participates in a clinical trial. Relatively black and white, right?
Wrong. In mediations such as this, the surface issue is rarely ever the “issue.” In just these circumstances, there are hints of sibling rivalry and favoritism; different preferences amongst all parties; and underlying feelings of fear and desperation in the face of a medical diagnosis that has already affected the relationships between all family members. Elder mediation tends to involve various underlying concerns and perspectives that need to be addressed before the issue presented is ever discussed.
What is a mediator to do to resolve the conflict? This scenario poses the unique challenge of the aging parent, Mom, who expresses clear preferences for how she wants to live her life and manage her own care. Imagine that it is Mom, in fact, who has contacted a mediator. At this stage, Mom is fully capable of participating in a mediation. The mediator learns that Mom still opposes the clinical trial, but has agreed to it to appease her son. Her sons, meanwhile, continue to argue and conflict escalates around her.
Thus, the mediator here has Mom clearly expressing one point of view; one son siding with Mom; and the other son pushing Mom to change her point of view. The mediator becomes aware of these dynamics during the initial calls with each person, and therein faces a dilemma.
This is the academic dilemma of an elder-focused process. In the theory and pedagogy of elder mediation, the general thrust is that, while the process is objective and neutral, the mediator approaches it in a way that is elder-centric. That is, the mediator conducts the mediation with the elder’s wishes, preferences, and best interests at the forefront. With this philosophy, the mediator conducts the process with slight bias or slant towards the elder.
Understood literally, this means that the mediator takes the elder’s side in the mediation and steers the communication and decision-making towards in favor of the elder.
This is the dilemma. In mediation, we are supposed to have a neutral, impartial mediator who does not take the side of any one party. Yet, in elder mediation, there seems to be an invitation to break neutrality. What is the solution here to ensure that the participants—Mom and her sons—receive a fair and neutral process that allows for resolution of conflict?
The mediator’s skillset and toolbox here will ensure a fair process while still respecting the tenets of elder mediation. The key here is not looking at the conflict and its potential solutions in black-and-white terms. Indeed, the trap for mediators is to begin taking sides and adopt a right v. wrong mentality. This is not about right v. wrong: this is about allowing participants to reach mutually agreeable resolutions by discussing concerns and generating options that appease and deescalate conflict. The mediator’s role is to demonstrate understanding of each person’s story, facilitate communication, and assist with brainstorming and option-generating to reach a resolution that the parties reach together. The mediator can facilitate this with a respect for the elder’s position without deferring utterly and completely to the elder’s side.
To return to the scenario: in the mediation Mom states opposition to the clinical trial. Her sons are in disagreement about the trial. However, they do agree on their love for Mom and desire to do what is best for her given the AD diagnosis. Mom wants to appease both sons but finds it difficult when they are fighting.
The mediator can facilitate conflict resolution by asking questions and generating points of mutual agreement between Mom and her sons. For example, an effective strategy would be for the mediator to explore with Mom how she wants to live given the diagnosis, and how she wants her care managed. This communication will likely include how Mom relates to her family members (children and husband), and how she would like to relate to them moving forward. In this type of interaction, the mediator will gather useful information: 1) Mom’s preferences; 2) Mom’s underlying concerns; 3) Insight into the family dynamics.
The mediator can also explore similar questions with both sons. The result of these conversations will likely reveal the sons’ concerns and motivations. More likely than not, it is possible that the sons will have similar motivations—for example, a desire to care for Mom and make sure everything possible will be done to ensure her quality of life. The mediator here can further explore with the sons how they would like to see their relationship with Mom, and with each other, moving forward. Without going too in depth (i.e., without crossing into the territory of counseling or therapy), the mediator can reach a reasonable point when: mutual interests and goals are identified.
After asking questions and eliciting this information, a useful next step is option-generating based upon each person’s expressed interests. Here, the mediator may go into the scope of mom’s care; the extent of family interaction and contact Mom and sons will have; and how Mom and sons can effectively communicate and make decisions around Mom’s AD diagnosis.
Note that the mediator does not spend time discussing the merits of the clinical trial, which of course was the presented surface issue to the conflict. The mediator instead focuses on the underlying issues (family relationships, preferences, family communication) to soften the conflict and steer the participants towards a place where they can productively discuss options and solutions going forward.
The options and solutions to this conflict are myriad and many! They could include Mom going to the clinical trial, or could address other solutions entirely. The actual solutions reached are not of real importance to the mediator. Rather, the process and the resolving of interfamilial conflict is the primary drive of the mediation.
Approached in this manner, the mediator is not forced to choose between neutrality and taking sides. The mediator serves a facilitator, not a decision-maker, and thus is not made to discuss the merits of the clinical trial issue.
In the storyline of This is Us, the characters are right at a point of contention where mediation services, I believe, would serve a great benefit to preserve the relationships between Rebecca, Randall, and Kevin. How the conflict will work itself out remains to be seen. Still, it serves as an interesting case study of conflict surrounding elder care decisions and a realistic view of how family relationships are affected with a diagnosis of AD.
If you or someone you know is going through a similar situation and would like information on mediation services, feel free to email email@example.com.