Dialogic Engagement and the Epistemic Norms of Bioethics Mediation

AbstractThis article examines Nancy Dubler's pioneering work in bioethics mediation and its enduring impact on the Bioethics Consultation Service for Montefiore Medical Center. In its early formulations, Dubler's application of the techniques and skills of alternate dispute resolution arose directly from her attempt to procedurally grapple with the emotional, psychological, and interpersonal realities uncovered through direct encounters with patients, families, and medical providers in situ. In this article, we argue that the resulting emphasis on dialogic engagement and the firsthand identification of values within the methodology of bioethics mediation fundamentally alters the substance and process of ethics facilitation by changing how we communicate with stakeholders and the way in which we subsequently reason about and derive normative claims. In contrast to committee-based and non-bedside models of case consultation, we maintain that this shift toward an inclusive and deliberative approach to ethics consultation introduces important insights into what it means to be an epistemically responsible interlocuter at the bedside. After examining this question in relation to an adapted case study, we offer the claim that the discursive norms of bioethics mediation-grounded in the concept of speaking with rather than for others-underscore the transformative potential of dialogue, which remains Nancy Dubler's most enduring legacy.