Bioethics Mediation: A Guide to Shaping Shared Solutions, Revised and Expanded Edition

Table of Contents

Contents Foreword by James R. Tallon Jr. xi Preface xiii Acknowledgments xxiii PART I A Framework for Understanding Bioethics Mediation 1 1 Why Mediation? 3 THE ANGRY FAMILY ACTING AGAINST THE BEST INTEREST OF THE PATIENT: Clarence Corning’s Case 3 THE ISOLATED WIFE ADJUSTING TO LOSS: Edward Davidoff’s Case 5 Managing Conflict in the Contemporary Medical Context 7 What Is Bioethics? 8 What Is Clinical Ethics Consultation? 9 Mediation 11 Mediation in Health Care Settings 12 Principled Resolutions 14 The Limitations of Mediation 15 Mediation and Consultation Distinguished 15 The Case for Mediation 16 A DYING PATIENT AND THE ISSUE OF SCARCE RESOURCES: Alex Barlow’s Case 17 2 What Makes Bioethics Mediation Unique? 21 The Bioethics Mediator Is Generally Employed by the Hospital 22 The Bioethics Mediator and Members of the Treatment Team Are Repeat Players 23 The Bioethics Mediator Provides Information, Enforces Norms, and Ensures That Resolutions Fall within Medical Best-Practice Guidelines 23 Deciding Not to Reach a Resolution Is Not an Option 24 The Playing Field Is Usually Uneven for Patients and Their Families 24 Confidentiality Is Limited to Information Not Relevant to Patient Care 25 Time Is of the Essence 26 Bioethics Mediations Involve Life-and-Death Issues 26 viii Bioethics Mediation: A Guide to Shaping Shared Solutions Facts Play a Different Role 26 The Person with the Greatest Stake in the Dispute, the Patient, Is Often Not at the Table 27 There May Be a Sequence of Separate, Prior Meetings in Addition to the Group Mediation 28 Bioethics Mediations Are Almost Always Multiparty Events 28 The Parties Usually Do Not Sign an Agreement to Mediate 28 The Physical Setting May Not Be in the Mediator’s Control 29 Bioethics Mediators Are Often Involved in Following Up on Implementation of the Agreement 29 The Clinical Ethics Consultant Enters a Detailed Account of the Mediation in the Patient’s Chart 29 All Participants in a Bioethics Mediation Have a Common Interest in the Well-Being of the Patient 30 PART II A Practical Guide to Bioethics Mediation 31 3 Before You Begin a Bioethics Mediation Program 33 What Bioethics Mediators Should Know 33 Who Should Conduct Bioethics Mediations 37 Who Can Request a Bioethics Mediation and Who Must Participate 40 4 The Stages of Bioethics Mediation 43 Overview of the Stages of Bioethics Mediation 43 HOW THE PROCESS WORKS: Jennifer’s Case 44 Stage 1: Assessment and Preparation 47 Stage 2: Beginning the Mediation 54 Stage 3: Introducing the Patient 57 Stage 4: Presenting and Refining the Medical Facts 58 Stage 5: Gathering Information 61 Stage 6: Problem Solving 66 Stage 7: Resolution 68 Stage 8: Follow-up 71 5 Techniques for Mediating Bioethics Disputes 73 STADA 74 Summarizing 75 Reframing 78 Questioning 79 Looking beyond Labels 81 Dealing with Power and Power Imbalances 81 AN “OLD LADY” AND HER TWELVE CATS 83 Generating Movement 85 Contents ix PART III Chart Notes 93 6 How to Write a Bioethics Mediation Chart Note 95 Introduction 95 The Chart Note 98 Typical Ethical Issues and Analysis 111 PART IV Case Analyses 131 7 Mediation with a Competent Patient: Mr. Samuels’s Case 133 8 Mediation with a Dysfunctional Family: Mrs. Bates’s Case 141 9 A Complex Mediation with a Large and Involved Family: Mrs. Leonari’s Case 147 PART V Role-Plays: Practicing Mediation Skills 161 10 Discharge Planning for a Dying Patient: A Role-Play 165 11 An At-Risk Pregnancy: A Role-Play 173 12 HIV and Postsurgical Complications in the ICU: A Role-Play 179 13 Treating the Dying Adolescent: A Role-Play 189 14 She Didn’t Mean It: A Role-Play 197 15 Don’t Tell Mama: A Role-Play 203 PART VI Annotated Transcripts of Bioethics Mediation Role-Plays 213 16 An At-Risk Pregnancy: A Role-Play Transcript 215 17 HIV and Postsurgical Complications in the ICU: A Role-Play Transcript 227 18 She Didn’t Mean It: A Role-Play Transcript 253 19 Don’t Tell Mama: A Role-Play Transcript 273 x Bioethics Mediation: A Guide to Shaping Shared Solutions Afterword 291 Appendix 293 Charting the Future: Credentialing, Privileging, Quality, and Evaluation in Clinical Ethics Consultation References 311 Suggested Reading on Mediation 315 Index 317 ...