Sometimes medical errors should not be disclosed. We report a case of semen samples exchange, during a homologous artificial insemination procedure, where a bioethics consultation was required. The bioethics consultation addressed ethical and legal elements in play, supporting non-disclosure to some of the subjects involved. Through a proper methodology, gathering factual and juridical elements, a consultant can show when a moral dilemma between values and rights—privacy versus fatherhood, in our case—is unsubstantial, in a given context, because of the groundlessness of (...) the value or the right itself. However, being the error elicited by organizational factors, a broader ethical pronouncement was needed. Under such circumstances, ethical evaluation should engage in a sort of ‘ethical-based root-cause analysis’, linking ethical principles to quality aims and showing the opportunity to integrate ethical methodology in healthcare management. From this perspective, errors may become an incentive to promote high-quality organizations, attending to the central value of person even through the organizational process. (shrink)

LIU W, MANIAS E and GERDTZ M. Nursing Inquiry 2011; 18: 290–302 Understanding medication safety in healthcare settings: a critical review of conceptual modelsCommunication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations (...) of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision‐Making Model, the Medication Decision‐Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed. (shrink)

The belated but formal acknowledgment of medical errors and their impact has been well documented. Curiously, the topic of management or executive mistakes in healthcare is not raised in professional meetings nor, until recently, addressed by an article in health administration journals.

Objective Cluster randomised trial (CRT) investigators face challenges in seeking informed consent from individual patients (cluster members). This study examined associations between reporting of patient consent in healthcare CRTs and characteristics of these trials. Study design Consent practices and study characteristics were abstracted from a random sample of 160 CRTs performed in primary or hospital care settings that were published from 2000 to 2008. Multivariable logistic regression was used to examine associations between reporting of patient consent and methodological characteristics, (...) as well as publication features such as date and journal of publication. Results 82 (53.8%) of 160 studies reported obtaining informed consent from individual patients. Reporting of patient consent was independently and positively associated with: smaller cluster size, the evaluation of experimental interventions targeted at patients, data collection from individual patients, publication later than 2004 and publication in higher-impact journals. Conclusions Reporting of consent practices in published CRTs should be improved. Consent practices in published CRTs appear to be related to the type of interventions under study, as well as journal impact and trends in research ethics practices. These findings will inform best practices in trial conduct and ethics review, remediation of errors in consent practices and ethics review and the development of regulatory guidance for CRTs. (shrink)

The United Kingdom case R v Lee EWCA Crim 1404 resulted in a pharmacist being convicted for an inadvertent dispensing error and paved way for the decriminalisation of such errors by way of a due diligence defence enacted in 2018. In relation to Hong Kong, what is its legal position for dispensing errors, and can it follow the decriminalising steps of UK? The primary objective of this paper is to explore whether and how HK can reach the normative position (...) for a dispensing error legal regime: I posit that the normative position for healthcare professional liability for dispensing errors should prioritise the public interest of minimisation of future dispensing errors over the retribution of past wrongs; I illustrate HK’s current position for the liabilities of HCPs on dispensing errors, focusing analysis on the relatively controversial aspects of HK’s criminal liability, referencing the landmark cases Hin Lin Yee v HKSAR 13 HKCFAR 142 and Kulemesin v HKSAR 16 HKCFAR 195 to assist my analysis of the requisite mental element for relevant statutory offences; through comparison with UK’s development post-R v Lee and application of Rule of Law principles, HK’s current position is critiqued, coming to the conclusion that while there are compelling reasons for the decriminalisation of dispensing errors in HK, the prerequisite for this to happen is an overhaul of regulatory frameworks by significantly increasing levels of accountability. (shrink)

In this chapter I explicate and evaluate the concept of medical error. Unlike standard philosophical approaches to analyzing medical phenom- ena in the abstract, I instead address medical error specifi cally within the context of an embodied social world. I illustrate how, as a deeply contex- tual concept, medical error is inextricably tied to the social conditions— and concrete, powerful interests—of the particulars in which it is found. -/- I begin with an analysis that demonstrates the relational (...) quality of medi- cal error, as a functional, outcome-oriented concept, evaluating the origin and context of the term’s emergence, and connecting it to a similarly contextual concept, “standard of care.” I move on to note the concern- ing implications of medical error identifi cation and measurement when viewed through an intersectional standpoint. To do so, I discuss what intersectional approaches can help reveal about our contemporary social world of medicine and public health. Intersectional approaches, as I will explain, focus on how intersections of social identity can unmask social structures that negatively impact groups and individuals. It appears, as -/- I will suggest, that disparities in social goods (e.g., social standing, edu- cation, wealth) complicate our identification of medical error, itself, and compound concerns of equity and access to medical goods for those who have diminished expectations for health. (shrink)

While the past decade has witnessed a proliferation of work in the intersection between phenomenology and empirical studies of cognition, the multitude of possible methodological connections between the two remains largely uncharted. In line with recent developments in enactivist ethnography, this article contributes to the methodological multitude by proposing an integration between phenomenological interviews and cognitive video ethnography. Starting from Schütz’s notion of the _taken-for-granted_ (_das Fraglos-gegeben_), the article investigates a complex work environment through phenomenological interviews and Cognitive Event Analysis, (...) drawing on distributed cognition and embodied cognitive science. The methodological integration is illustrated through the study of an adverse event in a highly specialised medical ward. Starting from a nurse’s task of administering medicine to a patient, the analysis tracks how a distributed cognitive system in the ward handles an adverse event where a pill becomes contaminated. The analysis demonstrates how complex decision-making processes depend on agents’ micro-scale embodied coordination, on their engagement with the material environment, and their anticipation of other agents’ intentions. It is concluded that ethnography can accommodate both cognitive and phenomenological research aims, while also contributing to the important mission of understanding successful responses to adverse events in healthcare. The article further contributes to patient safety studies by demonstrating how safe medicine administration itself can lead to increased risk, hereby pointing to a problem of incompatible safety logics as a source of medication errors in healthcare. (shrink)

Conflict resolution is a core component of healthcare ethics consultation (HEC) and proficiency in this skill set is recognized by the national bioethics organization and its HEC certification process. Difficult interpersonal interactions between the clinical team and patients or their families are often inexorably connected to the normative disputes that are the catalyst for the consult. Ethics consultants are often required to navigate challenging dynamics that have become entrenched and work with patient-provider or family-provider relationships that have already broken (...) down. The first step in conflict resolution is diagnosing the source of the conflict. Because so many interpersonal and normative conflicts rest on misunderstanding and mischaracterization, the diagnosis of the problem requires untangling the actual positions and perspectives of the conflicting parties from the fallacious assumptions made about the parties’ respective positions and views. Developed in management science, the Ladder of Inference (LOI) is a diagnostic tool for assisting stakeholders in re-examining the process they used to form beliefs about others involved in the conflict. The LOI is a device that detects errors in reasoning, including implicit racial bias, that lead to false judgments and counterproductive responses to those judgments. The LOI is an instrument that can be used by ethics consultants to help resolve contentious bedside conflicts, but the LOI can also be employed as a teaching tool used by healthcare ethics consultants in training the clinical staff in how to avoid such conflicts in the first place. (shrink)

This paper discusses the current initiatives on error and adverse events within healthcare, with a particular focus on the NHS, within the context of health policy. One of the key features of the paper is the proposal for an emergent taxonomy of the medical error literature, developed from the ideologies and rationales that underpin their approaches. This taxonomy provides details of three categories—empiricists, organisational rationalists and reformers of professional culture—and these act as an organising framework for the (...) exploration of the potential consequences of current policy on errors and adverse events. This discussion highlights the tension between optimising health outcomes for patients and managing the health system as effectively as possible. In particular, the inherent tension between explicit managerial formulations of risk and implicit risk management strategies associated with medical professionalism are considered. (shrink)

The rapid expansion of computational tools and of data science methods in healthcare has, undoubtedly, raised a whole new set of bioethical challenges. As Laacke and colleagues rightly note,...

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of ‘shocking’ systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse (...) face the prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare. (shrink)

BackgroundBetween the need for transparency in healthcare, widely promoted by patient’s safety campaigns, and the fear of negative consequences and malpractice threats, physicians face challenging decisions on whether or not disclosing medical errors to patients and families is a valid option.We aim to assess the knowledge, attitudes and practices (KAP) of physicians in our center regarding medical error disclosure.MethodsThis is a cross-sectional self-administered questionnaire study. The questionnaire was piloted and no major modifications were made.A day-long training workshop consisting (...) of didactic lectures, short and long case scenarios with role playing and feedback from the instructors, were conducted. Physicians who attended these training workshops were invited to complete the questionnaire at the end of the training, and physicians who did not attend any training were sent a copy of the questionnaire to their offices to complete. To assure anonymity and transparency of responses, we did not query names or departments.Descriptive statistics were used to present demographics and KAP. The differences between response\s of physicians who received the training and those who did not were analyzed with t-test and descriptive statistics. The 0.05 level of significance was used as a cutoff measure for statistical significance.ResultsEighty-eight physicians completed the questionnaire (55 attended training (62.50%), and 33 did not (37.50%)). Sixty Five percent of physicians were males and the mean number of years of experience was 16.5 years. Eighty-Seven percent (n = 73) of physicians were more likely to report major harm, compared to minor harm or no harm. Physicians who attended the workshop were more knowledgeable of articles of Jordan’s Law on Medical and Health Liability (66.7% vs 45.5%,p-value = 0.017) and the Law was more likely to affect their decision on error disclosure (61.8% vs 36.4%,p-value = 0.024).ConclusionFormal training workshops on disclosing medical errors have the power to positively influence physicians’ KAP toward disclosing medical errors to patients and possibly promoting a culture of transparency in the health care system. (shrink)

Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective (...) was to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

Introduction Errors are inevitable in medical practice and this issue has attracted the attention of healthcare systems worldwide. Therefore, it is of utmost importance to pay attention in educational systems. The present study aimed to investigate the frequency and cause of nursing students’ errors. Methods This descriptive study conducted based on a cross-sectional design. The researcher provided nursing students with a questionnaire. The participants were selected through a purposive sampling method. Eventually, the collected data were analyzed by SPSS17. Results (...) The mean value of errors in students was 32.83 ± 28.5 and the prevalence rate of the errors ranged from 0 to 175. In total, 2922 errors were reported by the students, the most frequent of which were wearing the same pair of gloves for the care of more than one patient, negligence to wash the hands and clean the thermometer before utilization. Moreover, errors in oxygen therapy and medication obtained the lowest frequency. Furthermore, most of the students’ errors were due to not having enough knowledge about medicines, lack of appropriate equipment, and poor clinical skills. Discussion and conclusion: The most frequent nursing students’ errors are related to hand hygiene and personal protection. In addition, the lack of enough skills and appropriate equipment are prevalent causes of nursing students’ errors. Authorities in this field should attend to these errors in nursing education, clinical practice, and nursing studies in order to promote this profession in all of these three dimensions. (shrink)

Healthcare reforms in India have been a much-debated issue in the recent past. While the debate has focused mainly on the right to healthcare, another by-product that has evolved out of the debate was the current problem of medical malpractice and the healthcare law. The last decade has seen an increase in the healthcare facilities in the country. This, however, has come with a bulk of medical error cases which the courts have entertained. According to (...) reports, there has been an increase in medical litigation cases by 400% in the last decade. There are about 5.2 million cases of medical error in the country every year. While there exists a standard legal system in the country which entertains such complaints of medical malpractice, the attempt by regulators and medical practitioners should be to reduce these cases. This paper seeks to analyze the extent to which medical malpractice cases affect consumers. It analyzes the existing medical liability system which has mainly evolved through the jurisprudence laid down by the English courts and critiques it. It also looks into the major reasons for such medical mishaps. Authors argue that a “No-Fault” system may give better outcomes. They analyze this by looking at the no-fault liability model implemented in New Zealand. Narratives of no-fault liability being implemented in India have also been used. These are showcased from instances of Motor Vehicles Act, 1988, and Clinical Trial regulations. It is also argued that a by-product of a no-fault liability system is stringent regulations which are used to reduce the possibility of medical mishaps altogether. Lastly, the possible problems of the no-fault liability system are discussed in the paper. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple (...) factors. Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple (...) factors. Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

Position papers on artificial intelligence (AI) ethics are often framed as attempts to work out technical and regulatory strategies for attaining what is commonly called trustworthy AI. In such papers, the technical and regulatory strategies are frequently analyzed in detail, but the concept of trustworthy AI is not. As a result, it remains unclear. This paper lays out a variety of possible interpretations of the concept and concludes that none of them is appropriate. The central problem is that, by framing (...) the ethics of AI in terms of trustworthiness, we reinforce unjustified anthropocentric assumptions that stand in the way of clear analysis. Furthermore, even if we insist on a purely epistemic interpretation of the concept, according to which trustworthiness just means measurable reliability, it turns out that the analysis will, nevertheless, suffer from a subtle form of anthropocentrism. The paper goes on to develop the concept of strange error, which serves both to sharpen the initial diagnosis of the inadequacy of trustworthy AI and to articulate the novel epistemological situation created by the use of AI. The paper concludes with a discussion of how strange error puts pressure on standard practices of assessing moral culpability, particularly in the context of medicine. (shrink)

Background and purpose Changes to deceased organ donation policy in the USA, including opt-out and priority systems, have been proposed to increase registration and donation rates. To study attitudes towards such policies, we surveyed healthcare students to assess support for opt-out and priority systems and reasons for support or opposition. Methods We investigated associations with supporting opt-out, including organ donation knowledge, altruism, trust in the healthcare system, prioritising autonomy and participants’ evaluation of the moral severity of incorrectly assuming (...) consent in opt-in systems or opt-out systems, by conducting an online survey among healthcare students at a large academic institution. Results Of 523 respondents, 86% supported opt-out, including 53% who strongly supported the policy. The most popular reason for supporting opt-out was the potential for increased donation rates, followed by convenience for those not registered but willing to donate. The most popular reason for opposing opt-out was the belief that presuming consent is morally wrong. Those strongly supporting opt-out viewed the opt-in error as more morally unacceptable, and had higher knowledge and altruism scores. Those opposing opt-out viewed the opt-out error as more unacceptable, and had higher autonomy scores. 48% of respondents supported priority within opt-in systems; 31% supported priority in opt-out. Conclusions There is strong support for opt-out organ donation among healthcare students, influenced by both practical and moral considerations. (shrink)

The integration of technology in care is core business in nursing and this role requires that we must understand and use technology informed by evidence that goes much deeper and broader than actions and behaviours. We need to delve more deeply into its complexity because there is nothing minor or insignificant about technology as a major influence in healthcare outcomes and experiences. Evidence is needed that addresses technology and nursing from perspectives that examine the effects of technology, especially related (...) to increasing demands for efficiency, the relationship of technology to nursing and caring, and a range of philosophical questions associated with empowering people in their healthcare choices. Specifically, there is a need to confront in practice the ways technique influences care. Technique is the creation of a kind of thinking that is necessary for contemporary healthcare technology to develop and be applied in an efficient and rational manner. Technique is not an entity or specific thing, but rather a way of thinking that seeks to shape and organize nursing activity, and manage efficiently individual difference(s) in care. It emphasizes predetermined causal relationships, conformity, and sameness of product, process, and thought. In response is needed a radical vision of nursing that attempts in a real sense to ensure we meet the needs of individuals and their community. Activism and advocacy are needed, and a willingness to create a certain detachment from the imperatives that technique demands. It is argued that our responsibility as nurses is to respond in practice to the errors, advantages, difficulties, and temptations of technology for the benefit of those who most need our assistance and care. (shrink)

Untoward injuries are unacceptably common in medical treatment, at times with tragic consequences for patients. The phrases 'an epidemic of error' and 'the medical toll' have been coined to describe this problem of 'iatrogenic harm', which it has been suggested may have contributed to 98,000 deaths per year in the US. Some of these incidents are the result of negligence on the part of doctors, but more usually they are no more than inevitable concomitants of the complexity of modern (...) healthcare. This book is fundamentally about distinguishing the former from the latter. Although medicine is used as the book's primary example, the points made apply equally to aviation, industrial activities, and many other fields of human endeavour. The book advocates a more informed alternative to the blaming culture which has increasingly come to dominate our response to accidents, whether in the medical field or elsewhere. (shrink)

Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would (...) serve the medical community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of (...) moral testimony by colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

We examined nurses’ perceptions of the ethical climate of their workplace and the relationships among the perceptions, medical error experience and intent to leave through a cross-sectional survey of 1826 nurses in 33 Korean public hospitals. Ethical climate was measured using the Hospital Ethical Climate Survey. Although the sampled nurses perceived their workplace ethical climate positively, 19% reported making at least one medical error during the previous year, and 25% intended to leave their jobs in the near future. (...) Controlling for individual and organizational characteristics, we found that nurses with a more positive perception of the ‘patient’ dimension of ethical climate were less likely to have made medical errors. Nurses with a more positive perception of the ‘patient’, ‘manager’, ‘hospital’ and ‘physician’ dimensions of ethical climate were less likely to leave their current job. Enhancing workplace ethical climate could reduce medical errors and improve nurses’ retention in public hospitals. (shrink)

Tigard suggests that the medical community would benefit from continuing to promote notions of individual responsibility and blame in healthcare settings. In particular, he contends that blame will promote systematic improvement, both on the individual and institutional levels, by increasing the likelihood that the blameworthy party will ‘own up’ to his or her mistake and apologise. While we agree that communicating regret and offering a genuine apology are critical steps to take when addressing patient harm, the idea that medical (...) professionals should continue to ‘take the blame’ for medical errors flies in the face of existing science and threatens to do more harm than good. We contrast Dr Tigard’s approach with the current literature on blame to promote an alternative strategy that may help to create lasting change in the face of unfortunate error. (shrink)

Social exclusion, especially social exclusion in old age, represents an area of interest at European level, in the context of demographic transformations. At national level, studies and research on social exclusion in old age are scarce, although the older population is more likely to be at risk of social exclusion. The article presents the results of a quantitative research methodology based on a questionnaire applied to older people of age 65 years and over. The research was conducted during November - (...) December 2021 and the survey was representative at national level with a margin of error of ±3.5%. The aim of this article is to analyse the perceptions of older persons regarding the access and quality of social and healthcare services accessed, and thus, to gain a better understanding on how these types of services could contribute to social inclusion. Data interpretation was made using techniques of descriptive statistical analysis. Results emphasize that access to social and healthcare services are essential in old age. Perceptions of older persons highlight the need for structural changes at national level, so that social and healthcare services could make a real contribution to reducing social exclusion. (shrink)

Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value (...) in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system’s customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery. (shrink)

How does a self-described “simple teacher of religion” at the College of the Holy Cross get involved in bioethics? Nothing in my training or experience had prepared me for involvement in medicine. Much like that of my moral theology professor and then mentor, Richard McCormick, my training was in moral theology and social ethics. I also had an abiding interest in the courts and constitutional law. That interest led to a doctoral dissertation at the University of Southern California's Program in (...) Social Ethics on “The Supreme Court's Understanding of Religion in Conscientious Objector Cases.” Interestingly, doctoral work in the late 1960s on the ethical dimension of war was the starting point for other ethicists such as Leroy Walters and James Childress who subsequently became early voices in bioethics. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not fracturing, of the (...) provider-patient relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty (...) Systems Model is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients. (shrink)

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where (...) healthcare professionals are held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors. (shrink)

As sophisticated artificial intelligence software becomes more ubiquitously and more intimately integrated within domains of traditionally human endeavor, many are raising questions over how responsibility (be it moral, legal, or causal) can be understood for an AI’s actions or influence on an outcome. So called “responsibility gaps” occur whenever there exists an apparent chasm in the ordinary attribution of moral blame or responsibility when an AI automates physical or cognitive labor otherwise performed by human beings and commits an error. (...) Healthcare administration is an industry ripe for responsibility gaps produced by these kinds of AI. The moral stakes of healthcare are often life and death, and the demand for reducing clinical uncertainty while standardizing care incentivizes the development and integration of AI diagnosticians and prognosticators. In this paper, we argue that (1) responsibility gaps are generated by “black box” healthcare AI, (2) the presence of responsibility gaps (if unaddressed) creates serious moral problems, (3) a suitable solution is for relevant stakeholders to voluntarily responsibilize the gaps, taking on some moral responsibility for things they are not, strictly speaking, blameworthy for, and (4) should this solution be taken, black box healthcare AI will be permissible in the provision of healthcare. (shrink)

IntroductionThe COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals and the general public.ObjectivesThe aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioral, and physical wellbeing of HCPs in the early and mid-term periods of the pandemic in comparison to non-HCPs. Thus, facilitating and guiding optimum planning and delivery of support to HCPs.Methods and AnalysisAn observational cross-sectional survey and cohort study aiming (...) to enroll over 1050 participants. Study questionnaires will be completed at baseline and after 6-weeks and 4-months. Recruitment initiated July 2020. The study was designed in London, United Kingdom, but open to participants worldwide. Baseline: Questionnaires comprising of validated self-administered screening tools for depression, anxiety, sleep-related issues, wellbeing, and burnout. The questionnaires also explore changes in behavior and physical wellbeing of the participants. In addition, associations of these mental health and behavioral factors with work-related factors and support will be explored. Six-weeks and 4-months follow-up: Follow-up questionnaires will assess change in symptoms of anxiety and depression, sleep disorders, use of alcohol and other substances, behavioral or interpersonal relationship changes. Physical wellbeing will be assessed through the presence of suspected or confirmed COVID-19 infection and absence from work. We will also evaluate the impact of variable provision of personal protection equipment, extended working hours, and concern for the wellbeing of family members, anxiety levels, and evidence of burnout.Statistical ConsiderationsThe study has 80% power to detect a 10% difference of combined depression and/or anxiety symptoms between the groups using two-sided type 1 error at 0.05 at baseline. Assuming that only 50% of these HCPs agree to be a part of a cohort survey, we will have 80% power to detect around 12% difference in the two groups in reported physical symptoms, or prevalence of depression and/or anxiety at the end of the study.EthicsThe study was approved by the Cambridge East, Research Ethics Committee.Trial Registration NumberClinicalTrials.gov, NCT04433260. (shrink)

In classifications of vocabulary knowledge, vocabulary size and depth have often been separately conceptualized (Schmitt, 2014). Although size and depth are known to be substantially correlated, it is not clear whether they are a single construct or two separate components of vocabulary knowledge (Yanagisawa & Webb, 2020). This issue has not been addressed extensively in the literature and can be better examined using structural equation modeling (SEM), with measurement error modeled separately from the construct of interest. The current study (...) reports on conventional and Bayesian SEM approaches (e.g., Muthén & Asparouhov, 2012) to examine the factor structure of the size and depth of second language vocabulary knowledge of Japanese adult learners of English. A total of 255 participants took five vocabulary tests. One test was designed to measure vocabulary size in terms of the number of words known, while the remaining four were designed to measure vocabulary depth in terms of word association, polysemy, and collocation. All tests used a multiple-choice format. The size test was divided into three subtests according to word frequency. Results from conventional and Bayesian SEM show that a correlated two-factor model of size and depth with three and four indicators, respectively, fit better than a single-factor model of size and depth. In the two-factor model, vocabulary size and depth were strongly correlated (r =.945 for conventional SEM and.943 for Bayesian SEM with cross loadings), but they were distinct. The implications of these findings are discussed. (shrink)

Learn how to think beyond the theoretical in any environment. "Ethics & Issues in Contemporary Nursing, 1st Edition" examines the latest trends, principles, theories, and models in patient care to help you learn how to make ethically sound decisions in complex and often controversial situations. Written from a global perspective, examples throughout the text reflect current national and international issues inviting you to explore cases considering socio-cultural influences, personal values, and professional ethics. Historical examples demonstrate how to think critically while (...) upholding moral and professional standards, as well as the law. Key topics throughout explore advocacy and rights, diversity, nurse burnout, mass casualty events, social media, violence in the workplace, medication error prevention, opioid and other substance use, HIPAA, and healthcare reform. In addition, this new title contains supplemental case studies and review questions to further challenge and prepare you to make morally sound decisions in any healthcare setting. -- From product description. (shrink)

Clinicians, operating within complex systems, make mistakes, as people do in every human endeavor, and when they do, patients are sometimes harmed. One important question is how we as clinicians can find resolution in the wake of an error. The published literature has divided errors into those caused by “systems” and by “individuals.” But whereas both “systems” and “individual” approaches are important in understanding the cause of an error, neither alone can fully lead to resolution once an (...) class='Hi'>error has occurred. Instead, both are necessary to understand, resolve, and prevent errors. (shrink)

Religious considerations in medical decision-making have enjoyed newfound attention in recent years, challenging the assumption that the domains of biological and spiritual flourishing can be cleanly separated in clinical practice. A surprising majority of patients desire their physicians to engage their religious and spiritual concerns, yet most never receive such attention, particularly in cases near the end of life where such attention seems most warranted.1–3 As physicians Aparna Sajja and Christina Puchalski recently wrote in the AMA Journal of Ethics theme (...) issue on ‘Religion and Spirituality in Healthcare Practice’, modern medical training is ‘falling short of preparing physicians to help patients with the metaphysical needs of their illness’.4 It would seem then that both patients and physicians might challenge the conclusions proffered by philosophers Jake Greenblum and Ryan Hubbard in ‘Responding to Religious Patients: Why Physicians Have No Business Doing Theology’, in which they claim that physicians ought not to engage religious reasoning for medical decisions. Their conclusion relies on two core arguments: a ‘public reason’ argument and a ‘fiduciary argument’, both of which contend that theology and religious considerations have no place in medical reasoning. We find that two central errors undergird these arguments. First is the fraught notion of an epistemically and ethically normative public reason, and second is a fundamental mischaracterisation of the fiduciary nature of the patient–physician relationship and the nature of medicine itself. In response, we argue that all physicians essentially ‘do theology’ and that, rather than divorcing theology from medical practice, clinicians should make it their business to do theology well. To support the exclusion of religious reasoning from medical decision-making, the authors open with a ‘public reason argument’, suggesting that physicians serve in roles closely resembling those of public officials. As such, the physician as public official ought to limit himself …. (shrink)

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. (...) Search terms included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

What is the correct concept behind measures of inflation? Does money cause business activity or is it the other way around? Shall we stimulate growth by raising aggregate demand or rather by lowering taxes and thereby providing incentives to produce? Policy-relevant questions such as these are of immediate and obvious importance to the welfare of societies. The standard approach in dealing with them is to build a model, based on economic theory, answer the question for the model world and then (...) apply the results to economic phenomena outside. Data come in, if at all, only in testing a limited number of the model's consequences. Despite some critical voices, economic methodology too has by and large subscribed to a "theory first" approach to applied economics. Error in Economics systematically develops an alternative to the theory-based orthodoxy. It places the methodical study of evidence at the centre of the scientific enterprise and thus provides a foundation for a methodology of evidence-based economics. But the book does not stop at the truism that claims should be based on the best available evidence. Rather, detailed studies in the areas of measurement, causal inference and policy analysis show what it means for a claim to be evidence-based in the context of a concrete case. The examples discussed concern topics as diverse as consumer price indices, radio spectrum auctions, the transmission mechanism, natural experiments on minimum wages and the evaluation of counterfactuals for policy. Error in Economics is essential reading for economic methodologists, philosophers of science and anyone interested in how claims about socio-economic matters are validated. (shrink)

Background The twenty first- century marked the exponential growth in the use of intelligent robots and artificial intelligent in nursing compared to the previous decades. To the best of our knowledge, this article is first in responding to question, “Can nurses in clinical practice ascribe responsibility to intelligent robots and artificial intelligence when they commit errors?”. Purpose The objective of this article is to present two worldviews (anthropocentrism and biocentrism) in responding to the question at hand chosen based on the (...) roles of the entities involved in the use of intelligent robots and artificial intelligence in nursing. Methods The development of this article was motivated by the immense discoveries, the current landscape, and nurses’ role in relation to advanced technologies in healthcare. The paper begins the discussion by situating the use of intelligent robots and artificial intelligence in nursing and healthcare and presenting its ethical and moral implications. Then, we presented the two worldviews: anthropocentrism and biocentrism which are used to respond to the task at hand. Results Anthropocentrism puts humans in the center in terms of moral standing and thus responsibility rests on them alone. Biocentrism declares that all creations deserve moral consideration and thus responsibility is equally allocated to all entities. Within these two worldviews, consensus development was offered to resolve these issues. Consensus provides clarity and democracy between and among the societies. Conclusions The findings of this article can be basis in (1) instituting mechanisms of robust peer review and a rigorous series of simulation before adopting or implementing intelligent robots and artificial intelligence in clinical practice; (2) education and training of highly specialized nurse practitioners who can be focal persons in responding to ethical and moral issues with regard to these advanced technologies; and (3) harmonization of robotics research, manufacturing, and clinical practice. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we (...) indicate here what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

Today, monitoring of patient complaints in healthcare services is being used as a tool for quality assurance systems and in the future development of services. This nationwide register study describes the number of all complaints processed, number of complaints between different state provinces, healthcare services and healthcare professionals, and outcomes of complaints in Finland during the period 2000–2004. All complaints processed at the State Provincial Offices and the National Authority for Medicolegal Affairs were analysed by statistical methods. (...) Complaints about mental healthcare were explored in greater detail. The analysis showed that the number of patient complaints increased considerably during the study period. There were changes in the number of complaints between study years in different provinces. Out of different healthcare services, an especially marked increase was seen in private healthcare. Nearly all complaints were lodged against physicians, and over half of the complaints were made because of medical error. In mental health care, patients more often complained about unsatisfactory certificates and statements and the use of compulsory hospital care. An analysis of the outcomes revealed that in mental health care complaints more seldom led to consequences. The results need to be utilised when planning interventions for advanced supervision, prevention of adverse events and patient safety in healthcare, and especially in mental health care. From the patients’ perspective, it is important to create a culture where most problem situations are handled where the treatment was provided, thus avoiding a complex complaints process. (shrink)

Background:The concept of patient advocacy is still poorly understood and not clearly conceptualized. Therefore, there is a gap between the ideal of patient advocacy and the reality of practice. In order to increase nursing actions as a patient advocate, a comprehensive and clear definition of this concept is necessary.Research objective:This study aimed to offer a comprehensive and clear definition of patient advocacy.Research design:A total of 46 articles and 2 books published between 1850 and 2016 and related to the concept of (...) patient advocacy were selected from six databases and considered for concept analysis based on Rodgers’ evolutionary approach.Ethical considerations:This study was approved by the Research Ethics Committee of Tarbiat Modares University.Findings:The attributes of patient advocacy are safeguarding (track medical errors, and protecting patients from incompetency or misconduct of co-workers and other members of healthcare team), apprising (providing information about the patient’s diagnosis, treatment, and prognosis, suggesting alternatives of healthcare, and providing information about discharge program), valuing (maintaining self-control, enabling patients to make decisions freely, maintaining individualization and humanity, maintaining patient privacy, and acting in the patients’ values, culture, beliefs, and preferences), mediating (liaison between patients, families, and healthcare professionals, being patients’ voice, and communicate patient preferences and cultural values to members of the healthcare team), and championing social justice in the provision of healthcare (confronting inappropriate policies or rules in the healthcare system, identifying and correcting inequalities in delivery of health services, and facilitating access to community health services and health resources).Discussion and conclusion:The analysis of this concept can help to develop educational or managerial theories, design instruments for evaluating the performance of nurses in patient advocacy, develop strategies for enhancing patient advocacy, and improve the safety and quality of nursing care in the community and healthcare system. (shrink)

Chat Generative Pre-Trained Transformer (ChatGPT) has been a growing point of interest in medical education yet has not been assessed in the field of bioethics. This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character (...) count were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient–physician relationships and performed poorly on questions pertaining to informed consent. Of all the specialties, it performed best in paediatrics. Yet, certain specialties and bioethical categories were under-represented. Among the errors made, it tended towards content errors and application errors. There were no significant associations between character count and accuracy. Nevertheless, this investigation contributes to the ongoing dialogue on artificial intelligence’s (AI) role in healthcare and medical education, advocating for further research to fully understand AI systems’ capabilities and constraints in the nuanced field of medical bioethics. (shrink)

In this paper we are going to show that error coping strategies play an essential role in linguistic pragmatics. We study the effect of noisy speaker strategies within a framework of signalling games with feedback loop. We distinguish between cases in which errors occur in message selection and cases in which they occur in signal selection. The first type of errors affects the content of an utterance, and the second type its linguistic expression. The general communication model is inspired (...) by the Shannon–Weaver communication model. We test the model by a number of benchmark examples, including examples of relevance implicatures, quantity implicatures, and presupposition accommodation. (shrink)

The paper examines Kant’s self-criticism to the account of hypothetical imperatives given in the "Groundwork for the Metaphysics of Morals". Following his corrections in the introductions to the third "Critique", the paper traces the consequences of that change in his later writings, specifically with regard to the status of prudence. I argue that the revision of the account of hypothetical imperatives leads to differentiate, and ultimately separate, two functions in prudence: the setting of ends through maxims, and the pragmatic rules (...) establishing means to reach those ends. Accordingly, I furthermore argue, there is ultimately no genuine structural distinction between the rules of prudence and skill. The only difference lies in the domain in which prudence unfolds, that is, the field of human relations, and in the relevant cognitions. (shrink)

Moral error theory of the kind defended by J. L. Mackie and Richard Joyce is premised on two claims: (1) that moral judgements essentially presuppose that moral value has absolute authority, and (2) that this presupposition is false, because nothing has absolute authority. This paper accepts (2) but rejects (1). It is argued first that (1) is not the best explanation of the evidence from moral practice, and second that even if it were, the error theory would still (...) be mistaken, because the assumption does not contaminate the meaning or truth-conditions of moral claims. These are determined by the essential application conditions for moral concepts, which are relational rather than absolute. An analogy is drawn between moral judgements and motion judgements. (shrink)