Family Mediation in End-of-Life Disputes: The Role of Bioethics Mediation Blog #2: Unique Properties
Comparison of Traditional Mediation with Bioethics Mediation
Bioethics mediation shares similarities with traditional family mediation. It involves the
interventions of a neutral, impartial mediator that helps the parties involved learn how to talk and
listen to one another and empowers all parties to share their viewpoint. As with traditional family
mediation, the bioethics mediator seeks to clarify misperceptions, diffuse emotions, identify
common interests, and encourage creative brainstorming. The ultimate goal of bioethics mediation is to create a solution that is
a. medically and ethically sound
b. is acceptable to all parties and resolves the end-of-life conflict.
However, there are some roles and tasks that are unique to bioethics mediation. According to
Dubler (2011), bioethics mediation has the following characteristics unique to the field:
1. The mediator is generally employed by the hospital or healthcare facility. In addition, the
bioethics mediator and healthcare team members have most likely worked together in
mediation previously. Although it is beneficial for the bioethics mediator to be a hospital
employee as it gives them an insider's view and knowledge of the facility, the
relationship with their employer and the staff can compromise the mediator's neutrality.
2. The bioethics mediator provides and explains medical information, enforces medical
ethical norms, and ensures resolutions fall within medical "best practice" guidelines. In
addition, not resolving the conflict is not an option because time is of the essence. After
all, the mediations involve life-and-death decisions. The mediation revolves around the
patient's welfare, and decisions must be reached about continuing or ending treatment,
whereas failing to reach an agreement in most mediation contexts is acceptable.
Mediator confidentiality is the core principle of traditional mediation. However, confidentiality in
bioethics mediation is limited to information not relevant to patient care. Bioethics mediation
requires all participants, including the healthcare team, to share all relevant information about
the patient's diagnosis and prognosis.
Another big difference from traditional mediation is that the major stakeholder in the dispute, the
patient, may not participate in the mediation. In many cases of end-of-life conflict, the patient
may be incapacitated and not able to participate. In addition, many patients do not have an
advance directive, and, therefore, their end-of-life wishes may not be known. Contrast this with
traditional mediation, where mediators often require all parties or agents to be present during
the mediation. In addition, not surprisingly, the life or death significance of the mediation often
brings powerful emotions to the table that must be addressed during mediation. This is not
always the case with traditional mediation.
Bioethics mediators usually meet with the healthcare team prior to mediation to obtain relevant
medical information and ask questions. In traditional mediation, the mediator typically has little
or no contact with the parties prior to mediation. Given the uniqueness of bioethics mediation, it
is not surprising that bioethics mediators need to have a particular set of skills to address the
unique role of bioethics mediation.
According to Youseff (2004), every bioethics mediator should have a general understanding of
medicine and the medical environment. Furthermore, in 2009, The American Society for
Bioethics' Task Force Report established that bioethics mediators should possess a strong
background in a number of fields/disciplines:
moral reasoning and ethical theory
bioethical issues and concepts
health care systems
knowledge of the local health care institution where consultation is occurring
the local health care institution's relevant policies
beliefs and perspectives of the patient and staff population
relevant codes of ethics and professional conduct
guidelines of accrediting organizations
relevant health care law (Moorkamp, 2017).
Thanks for your interest in this ongoing blog series on Bioethical Mediation. The next blog installment
will look at Procedures Unique to Bioethics Mediation. Stay Tuned!
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) and a member of the Academy of Professional Family Mediators.
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.
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.
Youssef, L. H. (2004). The art of resolving complex health care disputes. KnowledgeBank.
Retrieved October 5, 2021, from https://kb.osu.edu/handle/1811