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Family Mediation in End-of-Life Disputes: The Role of Bioethics Mediation

Updated: Mar 17, 2022

Blog #1 in a series.


This series of blog postings is a deeper dive into Bioethical Mediation. The tone is more academic and probably more detailed than some of my other blog posts. I hope readers will find this series interesting, helpful, and hopeful.


Recent advancements and innovations in medicine have changed the norms of end-of-life care for terminally ill patients. Physicians can now prolong a patient's life well beyond what it would be if the dying process were allowed to occur naturally. However, these advancements and innovations do not offer promises for recovery, nor do they promise a meaningful existence for the patient. Patients and their families are responsible for the critical decision of whether to accept medical intervention to extend life or to, instead, withdraw care. Several parties may be involved in end-of-life decisions: patients, family members, surrogates, and the healthcare team of physicians (Waldman, 2014). Patients, if competent, can speak for themselves or through their advanced directives outlining their wishes. Family members or other surrogates for the patient often assume the patient's voice if they cannot speak for themselves and do not have advance directives. In addition, the physicians involved in the care of the patient offer options that provide the most medically and ethically appropriate care (Waldman, 2014).

Approximately 78% of end-of-life decision-making leads to conflict within the family and with the healthcare team (Akah, 2016). The delicate and emotional nature of end-of-life disputes calls for a specialized type of family mediation, bioethics mediation, to address end-of-life conflicts. Bioethics mediation is a form of family mediation for resolving medical issues, including end-of-life decisions (Moorkamp, 2017).

Bioethics mediation combines the clinical substance and perspective of clinical ethics consultation with the tools of the mediation process, using the techniques of mediation and dispute resolution to help patients, families and healthcare providers enmeshed in conflicts as they wrestle with decisions about life and death (Avologiari et al., 2017).

In bioethics mediation, a successful resolution reflects a clinical plan of action agreed upon by all parties and chosen from multiple permissible options that are clinical, ethical, and legally acceptable options. The parties generally include the physician(s) providing care, other healthcare team members, the patient or an advocate for the patient, and family members. The patient may have chosen the advocate in advance and specified in their advanced directives or maybe a family member or friend who has assumed the role. Most end-of-life mediations are most often with an advocate because capacitated adult patients have the legal right to accept or reject medical treatment regardless of the positions of the healthcare team and family, and end-of-life disputes are avoided. Thus, bioethics mediation often addresses situations in which the adult patient is incapacitated, a minor, or legally compromised (Dubler, 2011).

This next series of blogs will discuss how bioethics mediation differs from traditional mediation, the skills you should expect of a bioethics mediator, the sources of conflict that occur with end-of-life decisions, the most common issues that arise with end-of-life care, the unique steps in bioethics mediation, and the limitations of bioethics mediation.


Thank you for your interest in this ongoing series of blogs on Bioethics Mediation. In my next blog, I’ll probe into some of the unique properties of Bioethics Mediation.


Michele M. Davda has a B.S in Psychology and an M.S. in Neuroscience. She taught Biomedical Science at the STEM secondary level for a decade. She is a member and committee member of the Montana Mediation Association (MTMA).


This blog is meant to promote and increase awareness of Mediation, as well as to discuss the role that Mediation plays in conflict resolution. This blog series does not provide legal, medical, or psychological advice, and it should not be taken as a substitute for professional advice or treatment.


Citations

Akah, H. (2016). Expanding the scope of bioethics mediation: New opportunities to protect the autonomy of terminally ill patients. Knowledge Base. Retrieved October 5, 2021, from https://core.ac.uk/display/161946911.


Avlogiari, E., Konsta, A., & Tzitzi, E. (2017, April 1). Bioethics mediation in health care settings: An innovative approachto shaping shared solutions in ethicsdisputes. ResearchGate.

Retrieved October 6, 2021, from https://www.researchgate.net/publication/343734458_Bioethics_Mediation_in_Health_Car e_Settings_An_Innovative_Approach_to_Shaping_Shared_Solutions_in_Ethics_Disputes.


Dubler, N. N. (2011). A "principled resolution": The fulcrum for bioethics mediation. Duke Law Scholarship Repository. Retrieved October 5, 2021, from https://scholarship.law.duke.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1639& context=lcp.


Moorkamp, A. (2017). Don’t pull the plug on bioethics mediation: The use of mediation in health care settings and end of life situations. Journal of Dispute Resolution. Retrieved November 4, 2021, from https://scholarship.law.missouri.edu/cgi/viewcontent.cgi?article=1779&context=jdr.


Waldman, E. A. (2014, June 11). Bioethics mediation at the end of Life: Opportunities and limitations. SSRN. Retrieved October5, 2021, from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2446758.



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