Bioethics Mediation: A Guide to Shaping Shared
By Nancy N. Dubler and Carol B. Liebman
United Hospital Fund of New York, 2004
236 pp., $39.95
REVIEWED BY FR. TIMOTHY L. DOHERTY, STL, PhD
This book works. The authors appreciate that whole lives intersect in hospital
clinical decision making: patients, family members, administrators, physicians,
and other care givers. Life histories, long in the making, bump into one another
amid stress. When interests are mutually shared, treatment decisions proceed
calmly. It is sometimes a different story in the compressed decisional time
frames common to life and death choices. Apparent ethical dilemmas often disguise
conflicts that might be ameliorated through professional mediation. Timely interventions,
on the other hand, promote productive consensus about the correctness of treatment
among involved parties.
Bioethics Mediation limits its scope to in-house mediators who are also
hospital employees, explaining the time-saving advantages and the ethical disclosures
that support their effectiveness. Chapter 2 briefly describes the unique nature
of this kind of mediation, and how it differs from formally enlisted third-party
Nancy N. Dubler is a bioethics director at Montefiore Medical Center and a
professor at Albert Einstein College of Medicine, Bronx, NY. Carol B. Liebman
is a clinical professor at Columbia Law School, New York City, where she is
director of the Columbia Law School Mediation Clinic. Their collaboration updates
a 1993 work by Dubler and Leonard Marcus. Informed by a sociological perspective
on the hospital environment, they help their reader-students to observe the
human element. Good writing and editing make this a fine introduction. Basic
tools of ethics consultation are reviewed, but the authors are mainly interested
in teaching mediation skills. There are tactful reminders about physicians'
responsibilities overall, and the consideration owed them in the mediation process.
Bioethics Mediation is made up of five sections, beginning with a basic
explanation of mediation in a hospital setting. This section is followed, first,
by a practical guide to bioethics mediation, then by case analyses, role plays,
and annotated transcripts of bioethics mediation role plays. A certain amount
of repetition makes for a book longer than was perhaps necessary, but it also
allows some chapters to stand on their own.
The authors do not pretend that formal mediation is appropriate for every difficulty.
"A successful mediation may occur when the mediator acknowledges that the situation
is not appropriate for mediation and that there are well-accepted legal rules
and ethical principles that must be applied" (p.77). Just getting people to
admit that a conflict exists among them requires skill. "Conflict tends to be
expressed by the parties through positions, insults, generalities and threats.
. . . The mediator's job is to help the parties refocus so they can discuss
their interests, communicate productively, focus on the issues that should be
resolved, generate options, and evaluate proposals" (p.39).
Dubler and Liebman's intended audience includes hospital ethics committees,
care consultants, and clinical professionals. They present a commonsense outlook
for aspiring mediators, and for those seeking to participate effectively in
mediation. Future studies will tell us whether imposed solutions or mediations
"produce patient care plans that are comfortable for all" (p. 218).
The index notes only half of the textual references to religious beliefs. Various
narratives mention beliefs so that decision makers will account for convictions
affecting communications or compliance regarding a particular patient or family.
Legal and moral issues specifically related to hospitals with church-based missions
are beyond the purview of this particular book.
Fr. Timothy L. Doherty, STL, PhD
Diocese of Rockford
Copyright © 2005 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.