Julia Kolak

In “Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering,” Jennifer Blumenthal‐Barby and colleagues ask whether there is a duty for family members to be present at the bedside of an unconscious or minimally conscious patient. In responding to the article, I argue that the authors’ presumption against a general duty for this bedside presence follows in part from the level of generality at which the question is posed. As the categories “family,” “unconscious,” and “suffering” are too heterogeneous to generate a single, action‐guiding obligation of bedside presence, I suggest that the question should be reframed as one concerning whether surrogate decision‐makers should be thought of as incurring narrower role‐specific obligations that sometimes require bedside presence. In surfacing the practical circumstances in which questions surrounding perceived family absence are typically raised by clinicians, this reply also suggests an overlooked dimension of such conflicts: they may signal uncertainty about the conditions under which surrogate authority is being exercised. The possibility that this uncertainty underlies clinicians’ occasional frustration can become an important conceptual foothold for clinical ethics facilitation.

This 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.