Nancy Neveroff Dubler, a medical ethicist who pioneered the use of mediation at the hospital bedside to navigate the complex dynamics between stubborn doctors, distressed families, and dying patients, has published 4 He died on April 14th at his home on Manhattan's Upper West Side. She was 82 years old.
According to his family, the cause was heart and lung disease.
Dubler, a Harvard-educated lawyer who won the position of student body president by campaigning to disband the student government, has, in her words, “leveled the playing field” and “emphasized non-medical voices.” He was a revolutionary figure in the medical world who aimed to spread the word. When she decides on next steps for tricky medical situations, especially the most critical patients.
In 1978, Ms. Dubler established the Bioethics Consultation Service at Montefiore Medical Center in the Bronx. Some of the first such teams in the country employ lawyers, bioethicists and even philosophers, who, like doctors on duty, carry pagers to alert them to urgent ethical issues. Was.
Bioethics consultants emerged as a medical subspecialty following breakthrough advances in technology, pharmaceuticals, and surgical techniques.
“Our technology allows us to gain decades of healthy, productive lives through procedures such as cardiac catheterization and triple bypass surgery,” Dubler writes in her book. “However, this technology also allows us to remove a corpse that has suffered a massive brain hemorrhage, connect it to a machine, and keep nominally 'living' organs functioning in bed even if there is no hope of recovery. is.”
Such advances could cause friction among doctors, who have been trained for generations to keep patients alive by any means available. Families may often argue over their helpless loved one. Some hospital administrators fear lawsuits.
The problems Dubler and her team faced were complex and heart-wrenching.
Should a premature baby with a low chance of survival be intubated? Should an unconscious patient whose religious beliefs forbid blood transfusions receive a blood transfusion at the request of the family? Should I be allowed to withhold excruciating treatment?
“Nancy brings a human dimension to bioethics with an emphasis on empathy and inclusivity, and really empowers people who don't have that,” Tia Powell, Dubler's successor at Montefiore University, said in an interview. It gave me a voice.”
Ms. Dubler's first strategy when participating in these discussions was to sit down with her family.
“No one knows how long they've been in the hospital, but no one has ever sat down to talk to them,” she said in a presentation at Columbia University in 2018. , especially for doctors. “They come running out and they all look pretty much the same in their white coats.”
Dabler often encountered families who did not want their loved ones to know that they were terminally ill.
In an essay for the Hastings Center, a bioethics institute in Garrison, New York, Ms. Dubler recalled an incident involving an elderly man who was seriously ill but was breathing on his own after being taken off a ventilator.
Although the man was clearly dying, his sons did not want to include him in discussions with hospital staff about further life-sustaining measures.
“I met with my sons and explained that the team felt obligated to discuss the type of care the patient wanted in the future,” Dubler wrote. “My sons exploded that this was unacceptable.”
Mr. Dubler continued the conversation with a calm but steely demeanor.
“After we talked a lot about the patient and what a great man and father he was, I asked him what would happen if we started a discussion with him by asking these three questions: 'We can discuss future care. Would you like to discuss future care with your sons? Would you like to have this discussion without your sons present?
The sons feared that such a conversation would alert their father to the fact that he was dying. What he needed, they thought, was hope.
“I described research that showed that when families try to protect patients from bad news, patients usually know the worst, and that silence often translates into feelings of abandonment.” wrote Dubler.
That upset my sons. She approached the man's bedside.
“The patient was clearly very weak and tired,” Dubler wrote. “I asked the patient, who had recently been extubated, if he would agree to be intubated again if the doctor decided it was necessary. He said, 'I'll think about it.' My sons said they would think about it too. ”
The process went well.
“The full-blown conflict over whether or not to 'tell dad' has receded,” she wrote. “The mediator in this case worked with her sons to craft an approach to their father that they could tolerate, if not accept.”
Nancy Ann Neveroff was born on November 28, 1941 in Bayport on the South Shore of Long Island, New York. Her parents, Aaron and Beth (Molinoff) Neveroff, operated a pharmacy below their home.
As a student at Barnard College, she studied religion with a focus on Sanskrit. While there, she ran for campus president as a one-issue candidate.
“She won in a landslide. She really dissolved the student government,” classmate Nancy Piore said in an interview. (It eventually returned to normal.)
Piore recalled seeing Dubler wearing an academic robe and reading a James Bond novel. “She was a unique person and she was a really strong person,” she said.
After graduating in 1964, she studied law at Harvard University, where she met Walter Dubler, who had just completed his Ph.D. She graduated in English at a New Year's Eve party. The two married in 1967, the year she graduated, and moved to New York City, where she worked as a lawyer for prisoners, child delinquents, and alcoholics.
“If Nancy and I were going to do something after work, I'd meet her at a men's shelter,” Dabler said in an interview. “But after we met there once, I told her she was too picky and we should meet her somewhere else. But she was really interested in that kind of thing.”
She joined Montefiore in 1975 to work on legal and ethical issues and three years later founded the Bioethics Consultation Service.
Dubler advocated for inmates to have equal access to medical care outside of their hospital work. She also served on a committee that developed ethical procedures for stem cell research and allocation of ventilators in case of shortages.
In addition to her husband, she is survived by a daughter, Ariella Dubler. her son Josh Dubler; and five grandchildren.
Dubler's colleagues suggested that her greatest accomplishment was creating a certification program at Montefiore to train doctors, nurses and hospital staff in bioethics.
One of the program's graduates, a doctor, was at Mr. Dubler's hospital bedside during his final months, gathered his medical team and family, and announced that he was going home and not coming back.
“He was obviously kind of in awe of her,” Dubler's son-in-law, Jesse Fuhrman, a federal judge in the Southern District of New York, said of the doctor. “He saw how, even in her weakened state, he could control her own treatment and her death.”
The doctor told her it was an honor to be there for her.