Bioethics Mediation: A Guide to Shaping Shared Solutions

Reviewed by Sharon Baker, MS, RN, CNS, CNRN

By N. N. Dubler and C. B. Liebman. New York: United Hospital Fund of New York, 2004. $39.95. ISBN 1-881277-70-4.

The book is an overview in using the bioethics mediation framework in assisting bioethics committees, consultants, and other healthcare professionals in dealing with conflicts in the healthcare setting. The book is structured to identify the framework for understanding bioethics mediation with a practical guide to the mediation in the first few chapters. The book defines bioethics as "a body of scholarship produced by philosophers, lawyers, medical care providers, and theologians, who[horizontal ellipsis], have identified shared values that provide the basis for normative principles and rules" (p. 6). Ethical and legal principles are applied in the bioethics component to provide the healthcare profession with a foundation to engage in medical decisions with patients/families. While ethics committees have been developed because of regulatory and institutional requirements, they primarily engage in staff education and review of cases. The component of mediation takes this one step farther. The book states that mediation is based on 3 core principles: "party autonomy, informed decision making, and confidentiality" (p. 9). The outcome for the mediation is to find a balance in the conflict where all options are considered and resolutions are based on the individual's needs.

The last part of the book consists of case analyses, role-playing, and transcripts to assist in role-playing. The book provides stages of the bioethics mediation, which are the following: assessment and preparation, beginning of the mediation, presenting and refining the medical facts, gathering information, problem solving, resolution, and follow-up. This gives the reader a step-by-step process to initiate the mediation. It follows up in subsequent chapters with ways to role-play and with written transcripts or actual cases to show the outcome of case mediation. By giving the reader the techniques for mediating, the reader can then use the information to apply to practice.

I would recommend this book for clinical nurse specialists/nurse practitioners who are first interested in this area but also for all registered nurses and physicians in helping to mediate with clients who are in conflict. The book provides a foundation to begin to understand the components, skills, and techniques needed to be successful in dealing with all types of medical conflicts. The book could provide knowledge and a foundation for students in both nursing and medicine to understand the ethic principles, legal requirements, and regulatory standards.