After Harm

Contents

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pp. vii-

Preface

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pp. ix-xv

In the years since the release of To Err Is Human—the Institute of Medicine’s report on the problem of medical error in the United States—made front-page news across the nation in November 1999, it has become almost de rigueur for scholars, health care professionals, and journalists to begin their books and articles by invoking the report with its startling...

Acknowledgments

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pp. xvii-xviii

This book was inspired by the extraordinary intellectual community that is The Hastings Center, a community of which I am honored to be part, and where I learned to apply my longstanding interest in the religious and cultural dimensions of error and forgiveness to the problem of medical harm. In 2000, the Center launched an interdisciplinary research project entitled...

1. Narrative Ethics

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pp. 1-10

Like others who have had traumatic experiences, persons affected by medical mistakes may write and publish their own accounts of these experiences. These stories are rich resources for physicians and other health care professionals, for ethicists and patient-safety advocates seeking to improve the way institutions...

2. Physicians’ Narratives

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pp. 11-27

Physicians’ stories about their own mistakes may take the form of the clinical tale or may be embedded in other familiar genres, such as the memoir or the how- I-became-a-doctor Bildungsroman of medical school or residency. In the wake of the Harvard Medical Practice Study,¹ the Institute of Medicine report To Err Is Human, and other...

3. Patients’ and Families’ Narratives

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pp. 28-39

Personal narratives about medical error that describe the experience of injured patients and their families may be published as essays in peer-reviewed health policy journals or in newsletters for patient-safety advocates. They may take the form of memorial Web sites. They may be shaped into advertisements by activists. They may be read during legislative...

4. Disclosure

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pp. 40-50

Yet the nature of the practice of disclosure—what is meant by the phrase ‘‘telling the truth’’ in cases of medical error—continues to be among the most highly contested and emotionally fraught issues within conversations on patient safety in the United States and other developed nations. According to researchers who have closely examined physicians’ attitudes toward...

5. Apology

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pp. 51-62

At the outset of any discussion involving those troublesome words ‘‘I’m sorry,’’ one ought always to make a commonsense distinction: To say ‘‘I’m sorry your father died’’ is not at all the same thing as saying, ‘‘I’m sorry I killed your father.’’ When these two statements are juxtaposed in this way, we immediately recognize that the former is an expression of sympathy...

6. Repentance

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pp. 63-80

Apology and compensation are intimately linked as ethical responses to harm, despite efforts, sometimes well intentioned, sometimes calculated, to separate them. Legal scholar Jonathan Cohen, writing about the status of apology under the law, concludes that ‘‘decoupling’’ apology from liability—that is, finding ways to allow responsible parties to apologize...

7. Forgiveness

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pp. 81-91

The title of the landmark Institute of Medicine report on medical error, To Err Is Human, is derived from Alexander Pope’s ‘‘Essay on Criticism’’ (1711): ‘‘To err is human; to forgive, divine’’ (l. 525).¹ Given how familiar this proverb is in its entirety, it is striking that the IOM report itself contains no reference to forgiveness, divine or otherwise, in its treatment of medical...

8. Ethical Action

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pp. 92-113

There are ways to improve how individuals working within systems care for injured patients and their families and for clinicians whose mistakes harm patients. In the proposals that follow, I draw on the religious and cultural traditions that have helped to shape secular Western norms and expectations surrounding error and forgiveness, while looking critically...

Appendix

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pp. 115-119

Notes

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pp. 121-137

References

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pp. 139-150

Index

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pp. 151-156