Bioethics: Mediating Conflict in the Hospital Environment - Dispute Resolution Journal - Vol. 59, No. 2
Nancy Neveloff Dubler is the director of the Division of Bioethics, Department of Epidemiology and Population Health, Montefiore Medical Center and a professor of epidemiology and population health at the Albert Einstein College of Medicine. Ms. Dubler founded the Bioethics Consultation Service at Montefiore Medical Center in 1978, as a support for analysis of difficult cases presenting ethical issues in the health care setting. She is the director of the Certificate Program in Bioethics and Medical Humanities, conducted jointly by Montefiore Medical Center/Albert Einstein College of Medicine with The Hartford Institute of Geriatric Nursing at New York University.
Carol B. Liebman is a clinical professor at Columbia Law School where she teaches professional ethics and is the Director of both the Mediation Clinic and the Negotiation Workshop. She has mediated many different kinds of conflicts and has designed mediation training for a variety of groups including the Certification Program in Bioethics of Montefiore Medical Center, Albert Einstein College of Medicine; New York’s First Department, Appellate Division; and the Association of the Bar of the City of New York. Professor Liebman is currently working on a project funded by the Pew Charitable Trusts to explore ways mediation and conflict resolution techniques can be used in discussions of adverse medical events.
Originally from Dispute Resolution Journal
Every day physicians, nurses, other hospital staff, patients and family members struggle to reconcile differing visions, conflicting values and changing expectations as they make difficult and complex choices about whether and how aggressively to treat seriously ill patients. Often disputes arise. Traditionally hospitals have turned to bioethics committees and consultants to resolve these disputes. Below is an excerpt from a new book, Bioethics Mediation: A Guide to Shaping Shared Solutions (New York: United Hospital Fund, 2004), in which authors Nancy Neveloff Dubler and Carol B. Liebman argue that mediation should be the process of choice for solving these dilemmas. (For more information or to order a copy of the book, visit www.uhfnyc.org)
The Isolated Wife Adjusting to Loss: Edward Davidoff’s Case
Edward Davidoff, an 82-year-old man, was admitted to the cardiac service with chest pain. Diagnostic tests revealed the need for quadruple bypass surgery to open four occluded vessels. He was a poor candidate for surgery, however, because he had chronic, uncontrolled diabetes with moderate-to-severe compromise of his peripheral vascular system. Unfortunately, there were no other choices if he wanted to live, which he did, and surgery was performed.
After the surgery, Mr. Davidoff did not recover and he developed various infections, necessitating his return to surgery for the removal of infected muscle and bone. A bioethics consultation was requested after the second surgery, at which time he was ventilator-dependent with an open chest wound that would not heal. Mr. Davidoff’s wife was desperate about her husband’s condition and determined that he should recover. She was unable to assimilate the nuanced, and not very clear, discussion by the care team, which used euphemisms to indicate that Mr. Davidoff was dying. No one in the cardiac team had been blunt about the prognosis and Mrs. Davidoff used this oblique discourse to reinforce her own unrealistic expectations about her husband’s possible recovery. Completely alone and desperately lonely, she had moved her chair out into the hall and sat there waiting to waylay any staff member who came along who had any connection to the care of her husband. She responded to any specific discussion about care options by choosing the most invasive option (why that option had been presented was the first question the bioethics mediator asked the cardiac team), which she equated with the best chance of insuring her husband’s survival. She was never told directly that his survival would be unprecedented, and so it is not surprising that she continued to demand that “everything be done.” This demand led to the request for a bioethics consultation by the nursing supervisor, who had spent increasing amounts of time with Mrs. Davidoff.