Bioethics Mediation : A Guide to Shaping

This book provides the theory, practice, and hands-on tools needed to resolve the medical care disputes that regularly entangle patients, family members, physicians, and other health care professionals. While these disputes may indeed raise ethical issues, they are first and foremost conflicts among individuals with complex, strongly held positions. Building on this fresh perspective, the authors make a thoughtful, systematic case for the use of mediation skills and techniques to achieve "principled resolutions" to troubling, often life-and-death questions. Bioethics Mediation: A Guide to Shaping Shared Solutions is a commonsense introduction to mediation for bioethics committees, consultants, and other health care professionals, making cogent arguments for the need for mediation in the medical context. It is also an invaluable guide for mediators wishing to learn more about bioethics and the complex medical conflicts so prevalent in contemporary health care. Book jacket.

Foreword	p. xi
Preface	p. xiii
Acknowledgments	p. xix
A Framework for Understanding Bioethics Mediation	p. 1
Why Mediation?	p. 3
Managing Conflict in the Contemporary Medical Context	p. 5
Mediation	p. 8
Mediation in Health Care Settings	p. 10
The Limitations of Mediation	p. 12
Mediation and Consultation Distinguished	p. 13
The Case for Mediation	p. 14
What Makes Bioethics Mediation Unique?	p. 21
The Bioethics Mediator Is Generally Employed by the Hospital	p. 22
The Bioethics Mediator and Members of the Treatment Team Are Repeat Players	p. 23
The Bioethics Mediator Provides Information, Enforces Norms, and Ensures That Resolutions Fall within Medical "Best Practice" Guidelines	p. 24
Deciding Not to Reach a Resolution Is Not an Option	p. 25
The Playing Field Is Usually Uneven for Patients and Their Families	p. 25
Confidentiality Is Limited to Information Not Relevant to Patient Care	p. 26
Time Is of the Essence	p. 27
Bioethics Mediations Involve Life-and-Death Issues	p. 27
Facts Play a Different Role	p. 27
The Person with the Greatest Stake in the Dispute, the Patient, Is Often Not at the Table	p. 28
There May Be a Sequence of Separate, Prior Meetings in Addition to the Group Mediation	p. 29
Bioethics Mediations Are Almost Always Multiparty Events	p. 29
The Parties Usually Do Not Sign an Agreement to Mediate	p. 30
The Physical Setting May Not Be in the Mediator's Control	p. 30
Bioethics Mediators Are Often Involved in Following Up on Implementation of the Agreement	p. 31
All Participants in a Bioethics Mediation Have a Common Interest in the Well-Being of the Patient	p. 31
A Practical Guide to Bioethics Mediation	p. 33
Before You Begin a Bioethics Mediation Program	p. 35
What Bioethics Mediators Should Know	p. 35
Who Should Conduct Bioethics Mediations	p. 40
Who Can Request a Bioethics Mediation and Who Must Participate	p. 44
The Stages of Bioethics Mediation	p. 45
Overview of the Stages of Bioethics Mediation	p. 45
Assessment and Preparation	p. 49
Beginning the Mediation	p. 58
Eliciting the Medical Facts	p. 62
Gathering Information	p. 66
Problem Solving	p. 72
Resolution	p. 74
Follow-Up	p. 80
Techniques for Mediating Bioethics Disputes	p. 85
Summarizing	p. 87
Questioning	p. 90
Generating Movement	p. 91
Case Analyses	p. 99
Mediation with a Competent Patient: Mr. Samuels's Case	p. 101
Background	p. 101
Analysis	p. 105
Mediation with a Dysfunctional Family: Mrs. Bates's Case	p. 109
Background	p. 109
Analysis	p. 112
A Complex Mediation with a Large and Involved Family: Mrs. Leonari's Case	p. 117
Background	p. 117
Analysis	p. 128
Role Plays: Practicing Mediation Skills	p. 135
Discharge Planning for a Dying Patient: A Role Play	p. 139
General Instructions	p. 139
Confidential Player Instructions	p. 142
An At-Risk Pregnancy: A Role Play	p. 147
General Instructions	p. 147
Confidential Player Instructions	p. 149
HIV and Postsurgical Complications in the ICU: A Role Play	p. 153
General Instructions	p. 153
Confidential Player Instructions	p. 155
Treating the Dying Adolescent: A Role Play	p. 163
General Instructions	p. 163
Confidential Player Instructions	p. 165
Annotated Transcripts of Bioethics Mediation Role Plays	p. 171
An At-Risk Pregnancy: A Role Play Transcript	p. 173
Background	p. 173
Annotated Transcript	p. 174
Further Discussion	p. 184
HIV and Postsurgical Complications in the ICU: A Role Play Transcript	p. 187
Background	p. 187
Annotated Transcript	p. 188
Further Discussion	p. 213
Postscript	p. 214
Afterword	p. 217
Suggested Reading on Mediation	p. 219
References	p. 223
About the Authors	p. 227
Index	p. 229
Table of Contents provided by Rittenhouse. All Rights Reserved.

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Bioethics Mediation : A Guide to Shaping Shared Solutions

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