Medical Ethics Cut

Disclosure of errors is an express ethical obligation in the medical profession. “Non-disclosure of medical errors to patients and/or their families is a violation of ethical principles and cannot ever be justified,” (Edwin, 2009, p. 34). The American Medical Association underscores the importance of honesty in the physician-client relationship, and that relationship is tacitly extended to include the healthcare institution’s relationship with the surviving family. In “One Small Cut That Killed,” Dr. Contadina is doing what has actually become normative, common practice in healthcare. As Tabler (2013) points out, “in a subsequent civil suit by the patient, the apology could be admitted into evidence against the physician, and it wouldn’t be excluded on the grounds of hearsay,” (p. 1). Therefore, Dr. Contadina is acting logically, out of self-interest. If the healthcare institution’s ethical standards are patient-centric, ascribing to the basic principles of honesty and integrity, then the hospital administrator needs to disclose what happened, requiring Dr. Contadina to directly communicate with and apologize to the family.
Indeed, many institutions in the United States have begun to develop cohesive protocols for error admission. Encouraging honesty and a climate of respect for all patients and families, the policies include formal processes of disclosure, apology, and even compensation (Detsky, Baerlocher & Wu, 2013). Some states have even ensconced apology protocols into law. According to Tabler (2013), there are two categories of apology laws. One type completely protects the physician from legal liability, essentially making it so that the apology cannot be used as an admission of guilt or wrongdoing. The other type of apology law protects the physician only if there is an apology but not if doctor admits to actual error (Tabler, 2013). Clearly, the main reason why physicians and even their presiding institutions may disclose information is to preserve their self-interest in avoiding costly lawsuits. These laws recognize the financial incentive to withhold information, while also encouraging the higher ethical standard of honesty, integrity, and respect for others. Edwin (2009) also states that disclosure protects patient autonomy by empowering the person and the family with information; avoids maleficence by refraining from lying, and of course provides for the principles of justice and fidelity.
Disclosing and apologizing, as well as making amends, serves several ethical purposes; withholding information or refusing to apologize actually serves no real ethical function with the exception of ethical egoism. One ethical function of disclosure is to promote the principle of respect, which is closely linked with beneficence. Another function is to promote trust between the community and the healthcare institution, which creates a climate of beneficence that can benefit all stakeholders. Research actually shows that apologies promote patient forgiveness, reduce the physician’s feelings of guilt or shame, and lead to empathy (Detsky, Baerlocher & Wu, 2013). Detsky, Baerlocher & Wu (2013) also point out research indicates that apologies do not lead to increased likelihood of the patient filing a malpractice suit. The patients or their families may sue to gain back power in the situation, if they believe that the hospital or physician is actually withholding information. Desiring to know what happened, the family in this case simply approached the institution for information and did not threaten to sue.
In fact, apology laws and hospital policies that mandate disclosure have been proven effective not just in engendering trust among the clientele, but also for pragmatic reasons. The formal apology programs “reduce the cost of medical liability suits,” and also “improve patients’ safety and satisfaction while providing institutional assistance to physicians in cases where error and adverse events occur,” (Detsky, Baerlocher & Wu, 2013, p. 448). Therefore, requiring doctors like Contadina to apologize is both ethical and practical.








References

Bohonik, L. (n.d.). One small cut that killed. Center for Practical Bioethics. http://practicalbioethics.org/case-studies-one-small-cut-that-killed
Detsky, A.S., Baerlocher, M.O. & Wu, A.W. (2013). Admitting mistakes: ethics says yes, instincts say no. Canadian Medical Association Journal 185(5): 448.
Edwin, A.K. (2009). Non-disclosure of medical errors an egregious violation of ethical principles. Ghana Medical Journal 43(1): 34-39.
Tabler, N.G. (2013). Dealing with a medical mistake: should physicians apologize to patients? Medical Economics. http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/apology-laws/dealing-medical-mistake-should-physicians-apologize-pati