2021 Theses Master's

Realizing Shared Medical Decision-Making Through Bioethics Mediation: The Need For Independence, Education, Endorsement and Research

Purvis Lively, Cathy

Patients, families, providers, healthcare institutions, and society benefit from early and effective conflict engagement. Mediation increases the likelihood of closure and lessens the likelihood of moral residue. Adhering to the fundamentals of a principled resolution creates unique differences between bioethics and conventional mediation. The most profound difference is that the bioethics mediator is typically employed by the hospital and often a member of the ethics committee. This goes against the role of the conventional mediator, who must be independent. Although the in-house mediator is familiar with the providers and the institutional policies, procedures, and protocols, it is simply not possible to overcome the cloud of bias. I maintain that the bioethics mediator should be independent and suggest possible ways to overcome barriers to the independent mediator. In the long term care setting, it is standard practice that when the resident or family sign admission documents they also sign an arbitration clause. Mediation should be an initial step in conflict resolution before arbitration. I strongly urge further exploration to expand mediation into the long term care setting. The COVID-19 pandemic forced mediation from conference rooms to zoom rooms. I suggest that using video conferencing for mediation has benefits. For example, it is more efficient and economical than requiring in-person meetings, and the family may feel less intimidated in their home environment. There is a compelling need for more significant publications and future research to move bioethics mediation to the forefront of conflict engagement in healthcare.