Abstract

The performance records of cardiac surgeons have been disclosed publicly in several states in the USA, for example New York and Pennsylvania, since the early 1990s. In response to the growing interest in the quality of healthcare, such records have also begun to be disclosed in the UK, starting in 2004. Various studies seem to show that disclosure has, indeed, contributed to the improvement of the quality of healthcare.1 However, at the same time, disclosure does have its critics.2 In this paper, I discuss what I call the ‘defensive medicine objection’ to the disclosure of performance data; that disclosure is not justified because it could cause surgeons to experience high levels of anxiety3, which might eventually lead to the practice of defensive medicine. Although this objection is often mentioned by ethicists and medical professionals4 it has never been carefully analysed or evaluated. The aim of this paper is to consider it in detail. I argue in favour of the objection; disclosure could, indeed, lead to the practice of defensive medicine if it is not conducted properly.5 This paper has the following structure. In Section 2 I discuss the anxiety that surgeons may experience regarding the disclosure of performance data. In Section 3 I introduce a traditional definition of defensive medicine. In Section 4 I argue that disclosure could encourage surgeons to perform a new form of defensive medicine, one that is not captured by the traditional definition. In Section 5 I undermine the claim that surgeons have no good reason to be anxious about disclosure. In Section 6 I consider a possible way of avoiding..