A Great Gift … with Great Caveats: Bioethics Mediation versus Bona Fide Mediation

AbstractWithout question, Professors Nancy Dubler and Carol Liebman provided a service of immeasurable value to clinical bioethics, by bringing mediation to the clinical setting. As clinical ethics consultants learned long ago, the great majority of consults stem not from genuine moral puzzlement, in which everyone is truly uncertain about what decision(s) may be best, but from conflict. Sometimes that conflict can be resolved by clearing up miscommunications or securing missing information. But sometimes conflict is real and entrenched. It is here that mediation offers great worth, and in this tribute issue of the Journal of Clinical Ethics we acknowledge an enormous debt of gratitude to Dubler and Liebman for bringing this shining light into healthcare's clinical setting. That said, by attempting to merge mediation with traditional ethics consultation, Dubler/Liebman's adapted version of mediation revises all three cornerstone tenets of ethics and process in mediation: neutrality, self-determination, and privacy. The result is often not bona fide mediation but a process quite different from it.