Full Description
Bioethics Mediation offers stories about patients, families, and health care providers enmeshed in conflict as they wrestle with decisions about life and death. It provides guidance for those charged with supporting the patient's traditional and religious commitments and personal wishes. Today's medical system, without intervention, privileges those within shared cultures of communication and disadvantages those lacking power and position, such as immigrants, the poor, and nonprofessionals. This book gives clinical ethics consultants, palliative care providers, and physicians, nurses, and other medical staff the tools they need to understand and manage conflict while respecting the values of patients and family members.
Conflicts come in different guises, and the key to successful resolution is early identification and intervention. Every bioethics mediator needs to be prepared with skills to listen, ""level the playing field,"" identify individual interests, explore options, and help craft a ""principled resolution"" -- a consensus that identifies a plan aligned with accepted ethical principles, legal stipulations, and moral rules and that charts a clear course of future intervention.
The organisation of the book makes it ideal for teaching or as a handbook for the practitioner. It includes actual cases, modified to protect the privacy of patients, providers, and institutions; detailed case analyses; tools for step-by-step mediation; techniques for the mediator; sample chart notes; and a set of actual role plays with expert mediator and bioethics commentaries.
Contents
Foreword by James R. Tallon Jr.
Preface
Part I: A Framework for Understanding Bioethics Mediation
Chapter 1: Why Mediation?
• The Angry Family Acting against the Best Interest of the Patient: Clarence Corning's Case
• The Isolated Wife Adjusting to Loss: Edward Davidoff's Case
• Managing Conflict in the Contemporary Medical Context
• What Is Bioethics?
• What Is Clinical Ethics Consultation?
• Mediation
• Mediation in Health Care Settings
• Principled Resolutions
• The Limitations of Mediation
• Mediation and Consultation Distinguished
• The Case for Mediation
• A Dying Patient and the Issue of Scarce Resources: Alex Barlow's Case
Chapter 2: What Makes Bioethics Mediation Unique?
• The Bioethics Mediator Is Generally Employed by the Hospital
• The Bioethics Mediator and Members of the Treatment Team Are Repeat Players
• The Bioethics Mediator Provides Information, Enforces Norms, and Ensures That Resolutions Fall within Medical Best-Practice Guidelines
• Deciding Not to Reach a Resolution Is Not an Option
• The Playing Field Is Usually Uneven for Patients and Their Families
• Confidentiality Is Limited to Information Not Relevant to Patient Care
• Time Is of the Essence
• Bioethics Mediations Involve Life-and-Death Issues
• Facts Play a Different Role
• The Person with the Greatest Stake in the Dispute, the Patient, Is Often Not at the Table
• There May Be a Sequence of Separate, Prior Meetings in Addition to the Group Mediation
• Bioethics Mediations Are Almost Always Multiparty Events
• The Parties Usually Do Not Sign an Agreement to Mediate
• The Physical Setting May Not Be in the Mediator's Control
• Bioethics Mediators Are Often Involved in Following Up on Implementation of the Agreement
• The Clinical Ethics Consultant Enters a Detailed Account of the Mediation in the Patient's Chart
• All Participants in a Bioethics Mediation Have a Common Interest in the Well-Being of the Patient
Part II: A Practical Guide to Bioethics Mediation
Chapter 3: Before You Begin a Bioethics Mediation Program
• What Bioethics Mediators Should Know
• Who Should Conduct Bioethics Mediations
• Who Can Request a Bioethics Mediation and Who Must Participate
Chapter 4: The Stages of Bioethics Mediation
• Overview of the Stages of Bioethics Mediation
• How the Process Works: Jennifer's Case
• Stage 1: Assessment and Preparation
• Stage 2: Beginning the Mediation
• Stage 3: Introducing the Patient
• Stage 4: Presenting and Refining the Medical Facts
• Stage 5: Gathering Information
• Stage 6: Problem Solving
• Stage 7: Resolution
• Stage 8: Follow-up
Chapter 5: Techniques for Mediating Bioethics Disputes
• STADA
• Summarizing
• Reframing
• Questioning
• Looking beyond Labels
• Dealing with Power and Power Imbalances
• An "Old Lady" and Her Twelve Cats
• Generating Movement
Part III: Chart Notes
Chapter 6: How to Write a Bioethics Mediation Chart Note
• Introduction
• The Chart Note
• Typical Ethical Issues and Analysis
Part IV: Case Analyses
Chapter 7: Mediation with a Competent Patient: Mr. Samuels's Case
Chapter 8: Mediation with a Dysfunctional Family: Mrs. Bates's Case
Chapter 9: A Complex Mediation with a Large and Involved Family: Mrs. Leonari's Case
Part V: Role-Plays: Practicing Mediation Skills
Chapter 10: Discharge Planning for a Dying Patient: A Role-Play
Chapter 11: An At-Risk Pregnancy: A Role-Play
Chapter 12: HIV and Postsurgical Complications in the ICU: A Role-Play
Chapter 13: Treating the Dying Adolescent: A Role-Play
Chapter 14: She Didn't Mean It: A Role-Play
Chapter 15: Don't Tell Mama: A Role-Play
Part VI: Annotated Transcripts of Bioethics Mediation Role-Plays
Chapter 16: An At-Risk Pregnancy: A Role-Play Transcript
Chapter 17: HIV and Postsurgical Complications in the ICU: A Role-Play Transcript
Chapter 18: She Didn't Mean It: A Role-Play Transcript
Chapter 19: Don't Tell Mama: A Role-Play Transcript
Afterword
Appendix: Charting the Future: Credentialing, Privileging, Quality, and Evaluation in Clinical Ethics Consultation
References
Suggested Reading on Mediation
Index
