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Embracing Ambiguity in a Polarized World

One of the most upsetting issues for me in our current world is the seemingly increasing tendency for people to hold absolutist and polarizing positions on anything and everything. These positions do not lend themselves to dialogue or even mutual respect. They seem to me to be zero sum positions that basically hold that, on any issue, one side must "win" and the other side must "lose".  They are black and white positions. You either believe that guns are bad or guns are good.   Apparently, believing that you are right is enough to deny someone else the right hold or to act on a contrary belief even if that action in no way impinges on your life or welfare.  Worse, people who hold these contrary beliefs are then not worthy of our respect.

In the March 15th issue of the New England Journal of Medicine, Dr. Lisa Harris, an OB/GYN at the University of Michigan published a very interesting Perspective called "Divisions, Old and New- Conscience & Religious Freedom at HHS"[i]. The genesis of the article is the recent formation of a Conscience & Religious Freedom Division within HHS which so far seems only to be interested in the rights of those who want to refuse to provide services like abortion and not at all interested in the rights of providers who want to provide those services.

Thankfully, Dr. Harris doesn't spend much time on the politics but moves to a discussion of whether we can hold seemingly polarizing positions in tension using abortion as an example.

 Is it possible, ... to hold in tension seemingly opposite ideas about abortion? Can we understand abortion as both something that “stops a beating heart” and a fundamental right, rather than insisting it’s only one or the other?

And then she singles out health care providers as those who might lead this effort.

The effort to hold this tension might begin with health care providers, because we hear the stories of our patients, who are experts at managing this balance, and because on-the-ground caregiving experiences are far more nuanced and complex than polarized rhetoric reflects. Insofar as health care providers edit and curate lived (real-life) experiences to fit the scripts of   political movements, we further polarize issues.

And finally, she points to research that supports the virtues of this nuanced approach.

As psychologist and conflict researcher Peter Coleman explains, in a world of            oversimplification, it takes moral courage to see things in complex terms. His research shows that complexity is an antidote to social conflict. Oversimplification of issues leads to vilification of those with whom we disagree. In Coleman’s words, “nuanced understanding of the issues can lead to better solutions, stronger relationships, and a more unified society.” It is courageous, morally speaking, to complicate our views, and such complication may in fact be needed, psychologically, for conscience to do its  job.[ii]

I think it is true that it is pretty much impossible to listen non-judgmentally to patients and their families with serious illness whose world is very complicated and often ambiguous and still believe that the world is black and white. Any time you think you have "seen it all" and you can draw absolute conclusions about the world, you very quickly come upon a situation you have never seen before. Good scientists are much more likely to talk about "theories" than "facts" because they are taught that nothing in the world should be considered true with 100% certainty. 

Good health care clinicians certainly must make judgments (i.e.) diagnoses in order to help those for whom we care but we must also not hold those judgments with such certainty that we cannot see the new evidence in front of us that calls those diagnoses into question. We do have the training and experience to appreciate the ambiguity in the world and live with it. However, we sometimes fail to use this experience in the wider world we live in. Instead we wind up contributing to the polarization as Dr. Harris suggests.

I encourage everyone to read, think, and talk about Dr. Harris's well-written article. But more, I encourage us to use the training and abilities we have to actively help counter the increasing polarization of our world and model living with ambiguity that leads to listening, respect, and collaboration.



[i] Harris, L. "Divisions, Old and New- Conscience & Religious Freedom at HHS", New England Journal of Medicine, March 14, 2018, DOI: 10.1056/NEJMp180115.

[ii] Coleman PT. The power of moral complexity. Psychology Today. September 172014



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