Mediation at the End of Life: Getting Beyond the Limits of the Talking Cure

Mediation has been touted as the magic band-aid to solve end-of-life conflicts. When families and health care providers clash at the end of life, bioethicists and conflict theorists alike have seized upon mediation as the perfect procedural balm. Dissonant values, tragic choices, and roiling grief and loss would be confronted, managed, and soothed during the emotional alchemy of the mediation process. But what is happening in a significant subset of end-of-life disputes is not mediation as we traditionally understand it. Mediation\u27s allure stems from its promise to excavate underlying needs and interests, identify common ground, and push disputants toward more moderate, creative, and mutually satisfying outcomes. But in the growing number of intractable medical futility cases, there is no movement to middle ground. Rather, we have a conversation that leads to a predictable outcome. The provider backs down, and the surrogate gets the treatment that she wants. Mediation\u27s failure was inevitable. It cannot succeed in the shadow of current health care decisions law that gives surrogates so much power. To make mediation work for these cases, we must equalize bargaining power by giving providers a clearly-defined statutory safe harbor to unilaterally refuse requests for inappropriate treatment