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Family Mediation in End-of-Life Disputes: The Role of Bioethics Mediation Blog #4

Honoring Patient Autonomy

The last blog post ended with the topic of a family member who is legally pronounced brain


Brain death can be a challenging diagnosis to receive as a family member because the patient

often appears to exhibit signs of life due to the life support equipment sustaining the patient.

Confusion can exist when the patient visually appears alive yet is considered brain dead by

medical standards. To aid the family, the requirements for brain death as defined in the Uniform

Determination of Death Act approved by the American Medical Association in 1980 must be

enumerated precisely and consistently so that the family understands the concept (Moorkamp,

2017). The goal is to create a shared understanding of the risks, benefits, and uncertainty

surrounding different medical options (Waldman, 2014).

One of the most critical ways bioethics mediation differs from traditional family mediation is its

emphasis on social norms. Waldman (2014) further suggests the bioethics mediator will need to

identify and discuss the legal and ethical norms relevant to the dispute and ensure their

inclusion in any agreement the parties develop. For example, it is well established that legally

competent patients have the right to refuse any or all treatment, even if the result of such refusal

is death. If the patient is no longer medically capable of making a choice such as in the case of being legally brain dead, her autonomy is protected by honoring her advance medical directives if they have been completed. If no advance directive exists, family members or named surrogates are legally allowed to make decisions on the patient's behalf. These mechanisms for respecting patient autonomy are

established in the law and guide all aspects of end-of-life care.

The goal of the bioethics mediator is to help create an agreement that meets the interests of all

parties while respecting patient autonomy. Legal and ethical standards state that the patient's

autonomy and decisional authority supersede the family's wishes (or surrogate) and the

healthcare team. In light of this, the mediator would need to explain that neither financial strain

on the hospital or family, nor social stress, is appropriate grounds for treatment withdrawal. The

family or surrogate are required to make choices as they believe the patient would make them.

If no helpful information or understanding exists regarding the patient's preferences, the parties

must act in the patient's best interests. Thus, the mediator must also have a firm foundation in

the legal rules and ethical concepts that represent the best thinking on bioethics dilemmas to

date (Waldman, 2014).

Thanks for your interest in this ongoing blog series. In the next blog I’ll be discussing the STADA process, whereby the mediator endeavors to give the family a forum, and empower family members.

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 (AFPM).


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

Waldman, E. A. (2014, June 11). Bioethics mediation at the end of Life: Opportunities and limitations. SSRN. Retrieved October5, 2021, from

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