Bioethics Mediation

Nancy Neveloff Dubler, Carol B. Liebman

Description

Bioethics Mediation offers stories about patients, families, and health care providers enmeshed in conflict as they wrestle with decisions about life and death. It provides guidance for those charged with supporting the patient's traditional and religious commitments and personal wishes. Today's medical system, without intervention, privileges those within shared cultures of communication and disadvantages those lacking power and position, such as immigrants, the poor, and nonprofessionals. This book gives clinical ethics consultants, palliative care providers, and physicians, nurses, and other medical staff the tools they need to understand and manage conflict while respecting the values of patients and family members.

Conflicts come in different guises, and the key to successful resolution is early identification and intervention. Every bioethics mediator needs to be prepared with skills to listen, "level the playing field," identify individual interests, explore options, and help craft a "principled resolution" -- a consensus that identifies a plan aligned with accepted ethical principles, legal stipulations, and moral rules and that charts a clear course of future intervention.

The organization of the book makes it ideal for teaching or as a handbook for the practitioner. It includes actual cases, modified to protect the privacy of patients, providers, and institutions; detailed case analyses; tools for step-by-step mediation; techniques for the mediator; sample chart notes; and a set of actual role plays with expert mediator and bioethics commentaries. The role plays include:

- discharge planning for a dying patient

- an at-risk pregnancy

- HIV and postsurgical complications in the ICU

- treatment for a dying adolescent

- dialysis and multiple systems failure
Expanded by two-thirds from the 2004 edition, the new edition features two new role plays, a new chapter on how to write chart notes, and a discussion of new understandings of the role of the clinical ethics consultant.

Sujets

• Geriatrics
• Health care
• Bioethics
• Education
• Health

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 01 décembre 2013
• Nombre de lectures: 0
• EAN13: 9780826519689
• Langue: English

Extrait

Bioethics Mediation
Bioethics Mediation
A Guide to Shaping Shared Solutions
Revised and Expanded Edition
Nancy Neveloff Dubler and Carol B. Liebman
Special Student Edition
A United Hospital Fund Book
Vanderbilt University Press Nashville
Special student edition
ISBN 978-0-8265-1968-9
Published 2013
© 2011 by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2011
First edition © 2004 by the United Hospital Fund of New York
This book is printed on acid-free paper made from 30% post-consumer recycled content.
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data
Dubler, Nancy N.
Bioethics mediation : a guide to shaping shared solutions / Nancy Neveloff Dubler and Carol B. Liebman.—Rev. and expanded ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8265-1771-5 (cloth edition : alk. paper)
ISBN 978-0-8265-1772-2 (pbk. edition : alk. paper)
1. Medical care—Decision making. 2. Mediation. 3. Medical ethics. I. Liebman, Carol B. II. Title.
[DNLM: 1. Bioethical Issues. 2. Ethics Consultation. 3. Negotiating. 4. Professional-Family Relations. 5. Role Playing. WB 60]
R723.5.D83 2011
174.2—dc22
2010047204
To our grandchildren
Contents
Foreword by James R. Tallon Jr.
Preface
Acknowledgments
PART I
A Framework for Understanding Bioethics Mediation
1. Why Mediation?
THE ANGRY FAMILY ACTING AGAINST THE BEST INTEREST OF THE PATIENT: Clarence Corning’s Case
THE ISOLATED WIFE ADJUSTING TO LOSS: Edward Davidoff’s Case
Managing Conflict in the Contemporary Medical Context
What Is Bioethics?
What Is Clinical Ethics Consultation?
Mediation
Mediation in Health Care Settings
Principled Resolutions
The Limitations of Mediation
Mediation and Consultation Distinguished
The Case for Mediation
A DYING PATIENT AND THE ISSUE OF SCARCE RESOURCES: Alex Barlow’s Case
2. What Makes Bioethics Mediation Unique?
The Bioethics Mediator Is Generally Employed by the Hospital
The Bioethics Mediator and Members of the Treatment Team Are Repeat Players
The Bioethics Mediator Provides Information, Enforces Norms, and Ensures That Resolutions Fall within Medical Best-Practice Guidelines
Deciding Not to Reach a Resolution Is Not an Option
The Playing Field Is Usually Uneven for Patients and Their Families
Confidentiality Is Limited to Information Not Relevant to Patient Care
Time Is of the Essence
Bioethics Mediations Involve Life-and-Death Issues
Facts Play a Different Role
The Person with the Greatest Stake in the Dispute, the Patient, Is Often Not at the Table
There May Be a Sequence of Separate, Prior Meetings in Addition to the Group Mediation
Bioethics Mediations Are Almost Always Multiparty Events
The Parties Usually Do Not Sign an Agreement to Mediate
The Physical Setting May Not Be in the Mediator’s Control
Bioethics Mediators Are Often Involved in Following Up on Implementation of the Agreement
The Clinical Ethics Consultant Enters a Detailed Account of the Mediation in the Patient’s Chart
All Participants in a Bioethics Mediation Have a Common Interest in the Well-Being of the Patient
PART II
A Practical Guide to Bioethics Mediation
3. Before You Begin a Bioethics Mediation Program
What Bioethics Mediators Should Know
Who Should Conduct Bioethics Mediations
Who Can Request a Bioethics Mediation and Who Must Participate
4. The Stages of Bioethics Mediation
Overview of the Stages of Bioethics Mediation
HOW THE PROCESS WORKS: Jennifer’s Case
Stage 1: Assessment and Preparation
Stage 2: Beginning the Mediation
Stage 3: Introducing the Patient
Stage 4: Presenting and Refining the Medical Facts
Stage 5: Gathering Information
Stage 6: Problem Solving
Stage 7: Resolution
Stage 8: Follow-up
5. Techniques for Mediating Bioethics Disputes
STADA
Summarizing
Reframing
Questioning
Looking beyond Labels
Dealing with Power and Power Imbalances
AN “OLD LADY” AND HER TWELVE CATS
Generating Movement
PART III
Chart Notes
6. How to Write a Bioethics Mediation Chart Note
Introduction
The Chart Note
Typical Ethical Issues and Analysis
PART IV
Case Analyses
7. Mediation with a Competent Patient: Mr. Samuels’s Case
8. Mediation with a Dysfunctional Family: Mrs. Bates’s Case
9. A Complex Mediation with a Large and Involved Family: Mrs. Leonari’s Case
PART V
Role-Plays: Practicing Mediation Skills
10. Discharge Planning for a Dying Patient: A Role-Play
11. An At-Risk Pregnancy: A Role-Play
12. HIV and Postsurgical Complications in the ICU: A Role-Play
13. Treating the Dying Adolescent: A Role-Play
14. She Didn’t Mean It: A Role-Play
15. Don’t Tell Mama: A Role-Play
PART VI
Annotated Transcripts of Bioethics Mediation Role-Plays
16. An At-Risk Pregnancy: A Role-Play Transcript
17. HIV and Postsurgical Complications in the ICU: A Role-Play Transcript
18. She Didn’t Mean It: A Role-Play Transcript
19. Don’t Tell Mama: A Role-Play Transcript
Afterword
References
Suggested Reading on Mediation
Index
Foreword
The great promise of health reform is better-coordinated and more effective patient care, which fundamentally means more collaboration among health care providers, patients, family caregivers, and payers, over time and in different settings, to achieve the best possible outcomes. Improved information technology will help foster the necessary communication and information sharing this promise demands, but it won’t eliminate the difficult and complex choices—and serious disagreements—that are inevitable given the complexity of medical care, particularly when it comes to grim prognoses and approaching death.
Our American health care system has struggled for decades to develop better ways to deal with conflict in medical settings. This book by Nancy Neveloff Dubler and Carol B. Liebman is the result of years of deliberation and experience, dating from the 1980s when Nancy Dubler developed one of the nation’s first bioethics consultation services at Montefiore Medical Center in the Bronx. By the early 1990s, Dubler realized that most cases referred to the service were not bioethics dilemmas but conflicts among professionals, patients, and families over difficult care-planning options. This insight led to another: that mediation and its associated set of dispute resolution skills could be as helpful in the hospital setting as it has proved in resolving complex labor disputes, child custody cases, and even international conflicts.
With grant support from the United Hospital Fund, Nancy Dubler went about figuring out how to apply the mediation model to the medical setting. She enlisted the assistance of expert mediators from around the country for intensive training. The lessons of that early effort were described in Mediating Bioethical Disputes by Nancy Dubler and Leonard Marcus, published by the United Hospital Fund in 1993.
In 2004, after another decade of experience, Nancy Dubler and Carol Liebman, a professor of law at Columbia University and herself an expert mediator, set out to produce a detailed practical guide for mediating the wrenching, often life-and-death disputes that entangle patients, family members, physicians, and other health care professionals. The United Hospital Fund was pleased to again support this work and to publish the first edition of Bioethics Mediation: A Guide to Shaping Shared Solutions , which was widely acclaimed and provides the foundation for this expanded and updated volume, published as a United Hospital Fund Book by Vanderbilt University Press.
The United Hospital Fund’s mission is to shape positive change in health care for the people of New York. Since our founding in 1879, we have worked to im prove the quality of health care and to support health care professionals as they work to provide the best possible care. Through our research and analytic work and program support for projects that envision positive change, the Fund seeks to shape a health care system that is committed to the highest standards of care and excellence for all.
James R. Tallon Jr., President
United Hospital Fund
Preface
The Evolving Nature of Bioethics Mediation
This book is designed to help bioethics committees and clinical ethics consultants move to more effective clinical ethics consultation. The idea in the first edition of this book that mediation skills should be at the core of clinical ethics consultation (CEC) and that the process offers the best chance of reaching principled resolutions to difficult conflicts has now evolved into the mainstream of CEC.
This view is reframed in the latest edition of Core Competencies for Health Care Ethics Consultation: The Report of the American Society for Bioethics and Humanities (ASBH, in press):
Health care ethics consultants also should help to address the value uncertainty or conflict by articulating the specific ethics conflict or question, and facilitating a resolution that respects the appropriate roles of the involved parties (e.g., patients, families, surrogates, health care providers)