Family Mediation in End-of-Life Disputes: The Role of Bioethics Mediation Blog #3

Procedures Unique to Bioethics Mediation

As bioethics mediation is a unique form of family mediation, Waldman (2014) has outlined tasks

that bioethics mediators must perform prior to mediation. First, the mediator must review the

patient's medical chart and meet with the healthcare team to gather relevant medical facts and

learn about the treatment recommendations. At this time, the mediator should determine if there

are any disagreements among the healthcare team regarding the recommendations. The

mediator can also bring in additional medical experts and other outside support to help support

them and the family.

The healthcare team can also help the mediator understand any psychological or capacity

concerns regarding the patient. In addition, Waldman (2014) suggest the mediator must review

the case history and ask the following questions:

• Has this patient been in and out of healthcare institutions for the past several years?

• Who has been the primary family contact throughout this period?

• Is there a clinician who has a long-term relationship with this patient and could shed

light on her social and clinical history?

•Have there been any seminal events that have shaped the parties' expectations and

may be contributing to the current conflict?

The mediator should also learn which family members have actively participated in the patient's

care and who plans to participate in the mediation. They should also seek to gain insight into the

family dynamics. Lastly, the mediator should meet with the patient and family to determine their

level of understanding about the patient's medical condition and prognosis (Waldman, 2014).

At the start of mediation, Waldman (2014) further suggests that the mediator must clarify the

medical information and establish legal and ethical norms of bioethics mediation. The

healthcare team plays an essential role by providing detailed information about the benefits,

limitations, and drawbacks of the advanced medical treatment available during the patient's

end-of-life care. Family members and the patient often have an incomplete understanding of the

medical condition and treatment options. A review of medical facts in language understandable

to the patient and family is necessary. In addition, it must be emphasized that a medical

prognosis is a matter of probabilities. There is no guarantee that treatment will extend the

patient's life. Any effort to predict how treatment will work, what capacities the patient will gain or

retain, and how much physical suffering lies in wait are all speculative. Some medical concepts

are more difficult to comprehend by families. For example, in end-of-life cases, one issue that

may arise is the concept of brain death.

Thank you for your continued interest in this series of blog postings on Bioethical Mediation. The next blog will discuss further the difficulty of family interaction in the case of diagnosed brain death.

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 the Academy of Professional Family Mediators (APFM).

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

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.