Bioethics Mediation: A Guide to Wrenching Health Care Decisions
Bioethics Mediation: A Guide to Wrenching Health Care Decisions
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New York, Oct. 11, 2011—Every day, wrenching decisions about patient care are made in hospitals by medical staff and families.
How those decisions are made is often critical. As a book co-authored by Columbia Law School Professor Carol Liebman reveals, using a mediation process allows families and the medical team to work together, sharing the burden of end of life decision making.
“So often, there are breakdowns in communication between the medical staff and families, or within the medical team that isolate patients and their loved ones at a time of crisis, when they most need to be supported and validated,” said Liebman, founder of the Law School’s Mediation Clinic and its Negotiation Workshop. “Mediation allows all parties to agree on a treatment plan that honors the values and wishes of the patient, levels the planning field for family members, and is medically and ethically appropriate.”
Bioethics Mediation: a Guide to Shaping Shared Solutions is a revised and expanded edition of a book Liebman wrote in 2004 with Nancy Neveloff Dubler, senior associate at the Montefiore-Einstein Center for Bioethics and Professor Emerita of Bioethics at the Albert Einstein College of Medicine.
The book is designed to give medical professionals an understanding of how to manage conflict and respect the needs and values of those in their care. This includes issues linked to end-of-life decisions, or the advisability of a medical procedure for a seriously ill patient.
Bioethics is a set of principles that support the therapeutic relationship and trigger physician and caregiver obligations, explains Liebman. But she says it is also about people: lives and deaths within the context of family and loved ones, and their attitudes, feelings, and fears.
What place does mediation have in these disputes? In bioethics mediation, a member of the hospital clinical ethics team serves as an impartial third-party helping the medical staff and the family reach consensus on a treatment plan.
While bioethics mediation has much in common with traditional mediation, there are several important differences. One is that the mediator will likely be an employee of the health-care institution that is the site of a dispute. “But to be effective, the mediator must remain impartial,” Liebman said. “In a setting where the medical facts constantly change and decisions are urgent, having the mediators on staff can enable them to respond quickly and better understand the needs of both providers and patients.”
Bioethics mediation, according to Liebman, is also unique in that deciding not to reach a resolution is not an option, time is of the essence, and the playing field is uneven for patients and their families. Most importantly, the person who has the greatest stake in the outcome—the patient—is often not at the table.
Liebman points out that modern medical care is complex, often uncertain and can provide interventions which would have been considered miracles only decades ago.
“As a result, patients live longer but, sadly, also may be forced into prolonged and unpleasant deaths,” Liebman said. “At a time when politicians cynically sow fear by talk of death panels, we hope this book will give support to physicians, nurses, patients and families as they have the difficult and painful conversations about the daunting decisions about end of life care.”
The book is published by Vanderbilt University Press.
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