Medication Error Disclosure: Ethics, Law, and Patient Safety

Introduction

An estimated 1.5 million "preventable adverse drug events" occur each year in the United States alone; the number of medication errors that did not lead to adverse effects but remained undisclosed is unknown (Jenkins & Vaida, 2007, p. 41). Consider the following scenario: you are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

Disclosure is an ethical and legal prerogative, showing respect for the patient and a willingness to accept professional responsibility. Consequentialist ethics do not fully apply to situations like these, because the broader issue is about changing advanced nursing practice and ensuring a culture of safety for all patients. Likewise, disclosure empowers the patient to make informed choices about how to respond to the medical error, while encouraging the healthcare team to do whatever is necessary to reduce errors in the future. The best strategies for reducing medical errors include ongoing professional training of all staff, correcting organizational culture barriers, and the implementation of specific protocols for medication administration.

Ethical Issues in Medication Error Disclosure

Whether or not the patient experienced adverse effects has nothing to do with the ethics of disclosure. Even consequentialist frameworks like utilitarianism can be used to show why disclosure should be normative among advanced practice nurses. A utilitarian ethic promotes the greatest good for the greatest number. A culture of safety, by definition, promotes the greatest good for the greatest number. Therefore, nurses need to practice disclosure as a matter of course in order to participate in, uphold, and be accountable for the culture of safety that promotes ideal patient outcomes.

Deontological ethical frameworks categorically uphold the duty of nurses to provide consistent care under the rubric of guiding ethical principles such as patient autonomy, the right to knowledge, and nonmaleficence. Non-disclosure is a form of lying or deceit in that it involves a deliberate withholding of information from a patient about that patient's own body. Likewise, non-disclosure inhibits the ability of the patient "to make appropriate decisions about the treatment that she needed as a result of the error" (Sorrell, 2017, p. 1). Advanced practice nurses also operate under the ethical duty to care and to do no harm. Disclosure prevents further harm from occurring — such as the harm that arises from eroded trust, the harm that arises from the perpetuation of a culture of deceit in the organization, and the harm that could arise if such errors did actually lead to adverse outcomes. As many as 250,000 deaths per year in the United States are directly due to medication errors — the highest rate among almost all developed nations (Sorrell, 2017).

Ironically, many nurses report that the "negative emotions" patients express when a medication error is disclosed is one of the reasons for choosing not to disclose (Leone, Lamiani, Vegni, et al., 2015, p. 446). Nurses who choose not to disclose because of patient "negative emotions" may be confusing nonmaleficence with egoism. Causing anger, fear, or other negative emotions in the patient does not qualify as maleficence; however, refusing to offer pertinent information about a patient's healthcare does.

Legal Framework for Medication Errors

Two types of laws address medication errors: apology laws and disclosure laws. Apology laws generally insulate the nurse and/or the organization from litigation, whereas disclosure laws are typically invoked when there has been a critical incident. Both types of laws vary by state. Most states in the United States have disclosure laws that apply to "specific circumstances" only, but not to cases in which no adverse reaction occurred (Guillod, 2013, p. e31). One of the barriers to enacting both apology laws and disclosure laws is the fear of litigation and related financial or reputational repercussions.

Apology laws may in fact be linked to fewer risks of litigation. Ghazal, Saleem, and Amlani (2014) claim that "disclosure of errors has reduced the chances of lawsuits against hospitals or physicians" (p. 1). Even when apology or disclosure laws do not pertain to a specific situation, healthcare organizations should hold themselves to higher standards of patient care — standards that include mandatory medication error disclosure for the purposes of maintaining a culture of safety.

Conclusion

Disclosure is an ethical and legal prerogative that shows respect for the patient and a willingness to accept professional responsibility. Consequentialist ethics do not fully capture the broader issue, which is about transforming advanced nursing practice and ensuring a culture of safety for all patients. Both utilitarian and deontological frameworks support disclosure as a moral duty, and the legal landscape — though variable — increasingly recognizes its value in reducing litigation and improving outcomes. By investing in training, standardized protocols, and institutional disclosure support, healthcare organizations can move beyond minimum legal compliance toward genuine accountability and patient-centered care.