Draft:Nancy Neveloff Dubler

Nancy Neveloff Dubler (November 28, 1941 - April 14, 2024) was an American bioethicist and attorney, and a pioneer in the field of clinical bioethics. She worked at Montefiore Medical Center in the Bronx from 1975 to 2008, where she founded and served as Director of the Bioethics Consultation Service, among the first of its kind in the country. Nancy's trademark phrase, "level the playing field," captures her life-long focus on addressing inequity in health care and health ethics.

Early Background

Nancy Dubler was born in Bayport, NY on November 28, 1941, where her family lived above the pharmacy they owned. She graduated from Barnard College, where she was elected president of student government on a platform calling for its dissolution. (She won, and in fact dissolved the student government.) She went on to Harvard Law School in 1964, where she was one of 5 women in a class of roughly 500 students. In 1967 she married Walter Dubler, who served as a beloved English professor at Lehman College for many decades.

Dubler's first jobs after law school included stints at South Brooklyn Legal Services, the Vera Institute of Justice, and Bank Street College of Education.

Contributions to Bioethics Consulting, Education and Mediation

In 1975, she joined Montefiore Medical Center and Albert Einstein College of Medicine as director of the division of legal and ethical issues in health care, where she remained until 2008. Dubler founded Montefiore's Ethics Consult Service in 1978, bringing a multi-disciplinary approach to assist patients, families and providers with difficult health care decisions and dispute resolution. The goal of the Service was to create solutions that were just, feasible, and acceptable to all involved. Nancy described the ethics consult service in her 1992 book, Ethics on Call: Taking Charge of Life-and-Death Choices in Today's Health Care System, co-authored with David Nimmons: "We sit with doctors and nurses, discuss and ask questions to clarify the issues, propose different ways to think about the situation, highlight the patients' rights, and work to give the tools they need to deal with patients and families."

Among Dubler's most significant contributions to bioethics was her approach to bioethics education. In 1995 she co-created, with the late historian David Rothman, the Certificate Program in Bioethics and the Medical Humanities, now the longest running bioethics educational program in the tri-state area, and among the earliest in the country. This year-long interdisciplinary program continues to thrive, and has trained roughly 1,000 health and legal professionals, and numerous others. The course draws on texts from fiction, history, law, medicine and other fields to broaden the perspective and challenge the assumptions of participants. Lively class discussions and student-to-student learning are a hallmark of the program.

Over time Dubler increasingly argued that the techniques of mediation were the best way to balance the differing views of those faced with challenging medical decisions. She incorporated the teaching of bioethics mediation into the Certificate Program and mediation is now also taught in the Bioethics MS program at Einstein. With her colleague Carol Liebman of Columbia Law School, she co-authored Bioethics Mediation: A Guide to Shaping Shared Solutions in 2004; it is now the landmark text in the field and used nationally in teaching bioethics mediation. Building on the work in this book, Dubler published, "A Principled Resolution: The Fulcrum for Bioethics Mediation" in Duke Law Review in 2011. Here Dubler lays out in detail the ethical foundation for mediating bioethics resolutions in challenging cases. She notes the challenge of balancing among three competing factors: limits imposed by law on medical professionals and institutions, the decision-making authority of patients and families, and power imbalances in modern hospitals.

After stepping down from her leadership role at Montefiore and Einstein in 2008, Dubler took up what she intended as part-time work at New York City Health + Hospitals Corporation, New York City's public hospital group. However, this assignment evolved into a complex and years-long project of training health ethics consultants at each of the HHC medical facilities, and consulting on hospital ethics policies, including during the pandemic.

Contributions to Medical Ethics Public Policies

Dubler greatly influenced public policies on medical ethics through her participation in governmental and professional advisory bodies. During the Clinton presidency, she co-chaired the Bioethics Committee of the White House Task Force on Health Care Reform. She also served for many years as a member of the New York State Task Force on Life and the Law, and contributed significantly to, among other work, its reports on genetic testing and screening and genomic medicine; the allocation of ventilators in a pandemic; research with human subjects who lack capacity; extending New York's Family Health Care Decisions Act to other settings and populations; and legalizing gestational surrogacy. Dubler also was a Member of the Empire State Stem Cell Board. In all those bodies, she was known for directing attention to the impact of policies on people with less power, including the poor, minorities, prisoners, people with disabilities, and those patients she called the "unbefriended elderly."

Dubler also authored or co-authored about 100 articles and book chapters. Much of her written work calls for improvements in public policies on such matters as end of life decisions for unbefriended patients and nursing home residents, end of life care in prisons and jails, the donation of organs after out-of-hospital cardiac death and the core competencies necessary for ethics consultation.

During her "retirement", Dubler also played a crucial role in the formation of the Empire State Bioethics Consortium, a state-wide group of bioethics professionals committed to sharing their expertise.