Illustrative image for Remembering Nancy Neveloff Dubler 1941 2024

Hastings Center News

Remembering Nancy Neveloff Dubler (1941-2024)

Nancy Neveloff Dubler, a Hastings Center fellow whose pathbreaking work shaped the field of medical ethics, died on April 14. Dubler worked on a wide range of bioethics topics, but her outstanding contribution was in clinical bioethics consultation and mediation.

She was the director of the Division of Bioethics at Montefiore Medical Center and the Albert Einstein College of Medicine in Bronx, N.Y. and a professor of epidemiology and population health at Einstein. In 1978, she created one of the country’s first bioethics consultation services at Montefiore. In 1995, in response to a need for rigorous training, Dubler developed the Certificate Program in Bioethics and Medical Humanities.

She was a consultant for bioethics at the New York City Health and Hospitals Corporation, the nation’s largest public hospital system. In that capacity, she helped develop guidelines to assist care providers in making life-sustaining treatment decisions for patients lacking a surrogate, and she created training and educational opportunities to support public hospital clinicians in practice.

“Nancy Dubler was my mentor for nearly 20 years,” said Nancy Berlinger, a senior research scholar at The Hastings Center. “She always kept her eye on the reality of the experiences of being a patient, being a family caregiver, being the clinician in the room, and being responsible for the care of this patient and for discussions with this family. She would remind clinicians of their basic ethical duty—to be faithful to that person in the bed—and would remind bioethicists that when we were discussing ethical challenges, identifying principles, and crafting guidance, the same duty applied to us.”

At The Hastings Center, Dubler was integral to a decades-long and continuing line of research on treatment decision-making, end-of-life care, care for vulnerable populations, and health care quality improvement. She was a working group member for the project that produced the revised and expanded second edition of The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (Oxford University Press, 2013). She participated in meetings that informed the original Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying, a landmark report of The Hastings Center published in 1987.

Dubler also contributed to Improving End of Life Care: Why Has It Been So Difficult?, a 2005 Hastings Center special report funded by the Robert Wood Johnson Foundation. Her essay, “Conflict and Consensus at the End of Life,” focused on the benefits of discussion-oriented interventions to help clinicians manage disagreements about care. With Columbia law professor Carol Liebman, she helped create the process of bioethics mediation. Their book, Bioethics Mediation: A Guide to Shaping Shared Solutions (Vanderbilt University Press, 2011 and 2013), has been widely integrated into bioethics training and practice.

“Dubler and Liebman’s book, Bioethics Mediation, is the seminal work in the field and has had an indelible impact on the teaching of bioethics consultation nationally,” said Tia Powell, Dubler’s successor as the leader of bioethics activities at Montefiore and Einstein and a Hastings Center fellow.

Dubler was part of The Hastings Center’s 2006 project on the ethics of pandemic planning, which was informed by her participation in a workgroup of the New York State Department of Health and the New York State Task Force on Life and the Law to develop ethical and clinical guidelines for ventilator allocation during a public health emergency. This work anticipated the challenges that clinicians and hospitals would face in the early days of the Covid-19 pandemic.

Dubler’s work during the Covid pandemic included serving on the Long-Term Care Work Group of the Empire State Bioethics Consortium, which studied and responded to the problem of isolation of long-term care residents to manage outbreaks. The work group’s products included “Vaccinated and Still Isolated: The Ethics of Overprotecting Nursing Home Residents,” published in Hastings Bioethics Forum, which proposed  an approach to managing communicable disease in residential care that balanced the protection of individual health with the social needs of people living in community. This approach gained attention in the media, including in The Week.

Dubler’s deep knowledge of health care institutions and the challenges of real-time quality improvement informed a Hastings Center project on the ethics of health care quality improvement. She contributed to Health Care and Quality Improvement: Ethical and Regulatory Issues(2007), a book produced by a Hastings Center project funded by the Agency for Healthcare Research and Quality. She co-authored (with Jeffrey Blustein, Rohit Bhalla, and David Bernard) “Informed Participation: An Alternative Ethical Process for Including Patients in Quality Improvement Projects,” a chapter in the book that discussed the importance of distinguishing quality improvement—a “morally mandatory element of medical care”—from medical research.

Her other articles and reports covered a wide range of topics, including psychiatric decision-making, ethics in long-term care and in home care, prison health care, HIV/AIDS research, and pandemic planning and decision-making. Her writing contributed to thinking, practice, and policy development in bioethics and beyond.