Kennedy Institute of Ethics Journal

Kennedy Institute of Ethics Journal 11.2, June 2001

Contents

Feature Articles

    Pinkus, Rosa Lynn B.
  • Mistakes as a Social Construct: An Historical Approach
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    Subject Headings:
    • Cushing, Harvey, 1869-1939.
    • Nervous system -- Surgery -- United States -- History.
    • Medical errors.
    Abstract:
      The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years. This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during the years 1890–1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this time frame, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone “underground" and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOM’s suggestions for change and comments on what they mean for the culture of medicine.
    May, Thomas, 1964-
    Aulisio, Mark P.
  • Medical Malpractice, Mistake Prevention, and Compensation
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    Subject Headings:
    • Physicians -- Malpractice -- United States.
    • Physicians -- United States -- Psychology.
    • Medical errors.
    Abstract:
      Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address clinicians' fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.
    Thurman, Andy.
  • Institutional Responses to Medical Mistakes: Ethical and Legal Perspectives
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    Subject Headings:
    • Medical errors.
    • Medical ethics.
    • Medical personnel -- Malpractice.
    Abstract:
      Health care institutions must decide whether to inform the patient of a medical error. The barriers to disclosure are an aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liability. However, admission of medical errors is the ethical thing to do and may be required by law. When examined, the barriers to such disclosures have little merit, and, in fact, lawsuits and liability may actually be reduced by informing the patient of medical errors. Therefore, a health care institution should implement a written policy providing for disclosure of medical errors, using a process such as that outlined in the article.
    DeVita, Michael A.
  • Honestly, Do We Need a Policy on Truth?
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    Subject Headings:
    • Physician and patient.
    • Medical errors.
    • Truth.
    Abstract:
      Physicians are taught that the foundation of the physician-patient relationship is trust, and trust is based in part on truthfulness. While drawing important "lines in the sand" regarding whether and why to tell the truth, ethics codes promulgating honesty fail to provide clinicians with guidance regarding what is the truth, as well as when and how to disclose it. These issues may be at the core of why an adverse event is left undisclosed. Consistently being truthful in the setting of an error is particularly difficult and requires overcoming a number of institutional and personal barriers. The article concludes that if delivering "the truth" is important, then articulation of criteria for determining what should be told, by whom, and when is essential. A policy that considers the practical issues and provides guidance may be useful.
    UPMC Presbyterian.
  • Guidelines for Disclosure and Discussion of Conditions and Events with Patients, Families and Guardians
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    Subject Headings:
    • Informed consent (Medical law)
    • Physician and patient.
    Pellegrino, Edmund D., 1920-
  • Philosophy of Medicine: Should It Be Teleologically or Socially Constructed?
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    Subject Headings:
    • Wildes, Kevin Wm. (Kevin William), 1954- Crisis of medicine: philosophy and the social construction of medicine.
    • Medicine -- Philosophy.
    Abstract:
      This response to Kevin Wildes's article in the previous issue of the Kennedy Institute of Ethics Journal addresses several major points of disagreement between Pellegrino and Wildes regarding the nature and scope of a philosophy of medicine, in particular how it is derived and by what method of philosophical enquiry it is best pursued.
    Resnik, David B.
  • Setting Biomedical Research Priorities: Justice, Science, and Public Participation
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    Subject Headings:
    • Medicine -- Research -- United States -- Public opinion.
    • Government spending policy -- United States -- Public opinion.
    • Public opinion -- United States.
    Abstract:
      This paper addresses the appropriate role for public input into priority setting for federal funding of biomedical research and development. The public should be involved in priority setting because researchers should be publicly accountable, because the public has a right to oversee government activities, and because public input is needed to assess normative questions related to the burden of disease and health care needs. On the other hand, political factors arising from public input can also hamper the government's ability to allocate funds according to the burden of disease or to promote the progress of biomedical science. When it comes to public input into R & D priority setting, more is not necessarily better. What is needed is the right balance of public and expert decision making with respect to the setting of biomedical R & D priorities.

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