Home Business Nancy Neveloff Dubler, mediator for the final moments of life, dies at 82

Nancy Neveloff Dubler, mediator for the final moments of life, dies at 82

by SuperiorInvest

Nancy Neveloff Dubler, a medical ethicist who pioneered the use of hospital bedside mediation to navigate the complex dynamics between stubborn doctors, distraught family members and patients in their final days, died April 14 in his home on Manhattan's Upper West Side. She was 82 years old.

The cause was heart and lung disease, his family said.

Dubler, a Harvard-educated lawyer who won her student presidency by campaigning to dissolve student government, was a revolutionary figure in the health care sector who sought, in her words, to “level the playing field” and “amplify voices.” “nonmedical” in complicated medical situations, especially when deciding next steps for the sickest patients.

In 1978, Ms. Dubler founded the Bioethics Consultation Service at Montefiore Medical Center in the Bronx. Among the first such teams in the country, the service employed lawyers, bioethicists and even philosophers who, as on-call doctors, wore pagers alerting them to emergency ethical issues.

Bioethics consultants emerged as a medical subspecialty following innovative advances in technology, pharmaceuticals, and surgical techniques.

“Our technology now allows us to confer several decades of healthy, productive life through procedures such as cardiac catheterization or triple bypass surgery,” Ms. Dubler wrote in her book. “However, it also allows us to take a body with a massive brain hemorrhage, hook it up to a machine, and keep it nominally 'alive,' with functioning organs in a bed, with no hope of recovery.”

These advances can create friction between doctors, who have been trained for generations to keep patients alive with all the tools available; family members, who might fight over their often incapacitated loved ones; and hospital administrators, who may fear lawsuits.

The questions Ms. Dubler and her team faced were complex and heartbreaking.

Should a premature baby who has little chance of survival be intubated? Should an unconscious patient whose religious beliefs prohibit blood transfusions receive one because a member of her family demands it? Should a teenager be allowed to forego excruciating treatment for terminal cancer?

“Nancy brought a human face to bioethics that focused on empathy and inclusion and really gave a voice to the voiceless,” Tia Powell, who succeeded Ms. Dubler at Montefiore, said in an interview.

Ms. Dubler's first tactic in engaging in these discussions was to sit down with the families.

“They've been in the hospital for who knows how long,” he said during a presentation at Columbia University in 2018, “and no one has sat down to talk to them,” especially the doctors. “They run in and out, and they all look pretty much the same in their white coats.”

Ms. Dubler often encountered family members who did not want their loved ones to know that they, the patients, were terminally ill.

In an essay for the Hastings Center, a bioethics research institute in Garrison, New York, Ms. Dubler recalled a case involving an elderly man who was seriously ill but breathing independently after being removed from a ventilator.

It was clear that the man was dying, but his children did not want to include him in conversations with hospital staff about other measures to prolong his life.

“I met with the children and explained that the team felt obligated to talk to their patient about what kind of care they would want in the future,” Ms. Dubler wrote. “The children exploded saying this was unacceptable.”

Mrs. Dubler, dispassionate but firm, carried on the conversation.

“After much discussion about the patient and what a great person and father he had been,” she wrote, “I asked him what it would be like if I started a conversation with him with three questions: 'Do you want to talk about your future care with me?' Would you like me to talk to your children about future care? And you want to have this discussion without your children being present?'”

The children worried that this conversation would alert their father to the fact that he was dying. What he needed, they thought, was hope.

“I described studies indicating that when family members try to protect the patient from bad news, the patient usually knows the worst and silence often results in feelings of abandonment,” Ms. Dubler wrote.

That influenced the children. She approached the man's bed.

“The patient was clearly very weak and tired,” Dubler wrote. “I asked the patient if, as he had recently been extubated, he would agree to be intubated again if the doctors thought it was necessary. He said, “I would think about it.” The children said they would think about it too.”

The process worked.

“The full-blown conflict over whether to 'tell dad' subsided,” he wrote. “In this case, mediation worked with the children to design an approach to their father that they could tolerate, if not accept.”

Nancy Ann Neveloff was born on November 28, 1941 in Bayport, New York, on the south shore of Long Island. Her parents, Aaron and Bess (Molinoff) Neveloff, owned a pharmacy below her house.

As a student at Barnard College, he studied religion with a concentration in Sanskrit. While she was there, she ran for campus president as a single-issue candidate.

“He won by a landslide and really dissolved the student government,” his classmate, Nancy Piore, said in an interview. (It was eventually restored.)

Piore recalled once seeing Dubler reading a James Bond novel dressed in her academic robes. “She was a character,” she said, “she and she was a real force.”

After graduating in 1964, he studied law at Harvard, where he met Walter Dubler, a recent Ph.D. Graduated in English, at a New Year's Eve party. They married in 1967, the year she graduated, and moved to New York City, where she worked as an attorney for prisoners, child delinquents and alcoholics.

“If Nancy and I were going to do something after work, we would meet her at the men's shelter,” Dubler said in an interview. “But after a meeting there, I told her that she was too squeamish and that I would meet her somewhere else. But she really liked that kind of stuff.”

He joined Montefiore in 1975 to work on legal and ethical issues and three years later formed the Bioethics Consultation Service.

Outside of her hospital work, Ms. Dubler advocated for equal access to health care for prisoners. She also served on committees that design ethical procedures for stem cell research and the allocation of ventilators in case of shortages.

In addition to her husband, she is survived by a daughter, Ariela Dubler; one son, Josh Dubler; and five grandchildren.

Ms. Dubler's colleagues suggested that her greatest legacy was the creation of a certification program at Montefiore to train doctors, nurses and hospital staff in bioethics.

One of the program's graduates, a doctor, was at Ms. Dubler's hospital bed when, in her final months, she gathered her medical team and family around her to declare that she was going home and not I would return.

“He was clearly in awe of her,” Dubler's son-in-law, Jesse Furman, a federal judge in the Southern District of New York, said of the doctor. “He saw how, even in her weakened state, she could control her own treatment and her death.”

The doctor told her it was an honor to be there to help her.

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