Bioethics Mediation: A Guide to Shaping Shared Solutions

Abstract

Nancy N. Dubler and Carol B. Liebman. New York, NY: United Hospital Fund of New York; 2004. Paperback. $39.95, 236 pages. ISBN 1881277704.The average person has a great deal of difficulty understanding our complex healthcare system, especially in the midst of conflict between healthcare providers, families, and payers. Until recently, few questioned any medical decision made regarding the care of a patient, leading to a lack of expertise on the healthcare providers’ part to deal with disagreement. Bioethics Mediation presents the theory, background, and practical application of applying a mediation model to the healthcare setting; it compares and contrasts traditional mediation with bioethics mediation, provides a step-by-step approach to the process, and includes annotated transcripts of mediation sessions.The target audience of this book includes bioethics committee consultants and clinical healthcare providers. The first 2 chapters (part 1) present the background for understanding and preparing to engage in bioethics mediation, using experiences from a bioethics consultation service of a large teaching hospital. The uniqueness of bioethics mediation as compared to other types of mediation is well discussed. Part 2 provides a detailed guide to preparing for and conducting effective bioethics mediation. Chapter 3 provides the theoretical background as it discusses basic ethical principles and principles of negotiation. Chapter 4 focuses on the stages of bioethics mediation. Techniques for mediating disputes are the focus of chapter 5, with particular emphasis on those that are especially pertinent to bioethics mediators.In part 3, the authors present 3 real case analyses from the Montefiore Medical Center Bioethics Consultation service that demonstrate the strengths and weaknesses of the mediation process. In part 4, the authors present 4 role plays that are designed to expose the challenges and configurations of bioethics mediation, including the multiplicity of players, variability of motives, and the complexity of management. This section can be a self-help guide for the experienced bioethics consultant as well as the structure for workshops and classes. Lastly, part 5 provides annotated transcripts of actual role-playing sessions used in the material presented in part 4, with the goal of calling the reader’s attention to the use of mediation skills.The book presents the necessity of using mediation in conflicts involving healthcare as well as a thorough review of theory, application, and numerous examples involving situations that are frequently encountered in everyday practice. Essential communication skills are emphasized as well as documentation of the situation in the medical record, keeping both free of emotion, while relaying essential information to all members of the healthcare team. The techniques presented can be used in the clinical setting to identify parties involved in the conflict; understand the interests of the participants; level the playing field to minimize disparities of power, knowledge, skill, and experience; maximize options for resolution of the conflict; search for common ground; ensure that consensus can be justified as a “principled resolution”; help implement the agreement; and conduct follow-up. Under certain circumstances these strategies could enhance the autonomy of the patient, support shared values of the patient and family, and strengthen the implementation of the healthcare plan.When a common ground cannot be found, it is typical to call the bioethics committee; however, not all disagreements involve ethical issues. The communication strategies outlined in this book will assist healthcare professionals to identify and resolve the discord. The book can also be used as a teaching guide to help facilitate communication skills and knowledge of bioethics mediation. Role-playing situations can help the novice feel more comfortable in situations involving conflict.