title: Medical Error and Moral Luck.
abstract: This paper addresses the concept of moral luck. Moral luck is discussed in the context of medical error, especially an error of omission that occurs frequently, but only rarely has adverse consequences. As an example, a failure to compare the label on a syringe with the drug chart results in the wrong medication being administered and the patient dies. However, this error may have previously occurred many times with no tragic consequences. Discussions on moral luck can highlight conflicting intuitions. Should perpetrators receive a harsher punishment because of an adverse outcome, or should they be dealt with in the same way as colleagues who have acted similarly, but with no adverse effects? An additional element to the discussion, specifically with medical errors, is that according to the evidence currently available, punishing individual practitioners does not seem to be effective in preventing future errors. The following discussion, using relevant philosophical and empirical evidence, posits a possible solution for the moral luck conundrum in the context of medical error: namely, making a distinction between the duty to make amends and assigning blame. Blame should be assigned on the basis of actual behavior, while the duty to make amends is dependent on the outcome.
authors.affiliation: Wandsworth Crisis and Home Treatment Team, Springfield Academic Hospital, South West London and St. George's Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ, UK. dieneke@doctors.org.uk.
authors.forename: Dieneke
authors.initials: D
authors.lastname: Hubbeling
mesh_terms: D006801:Humans; D019300:Medical Errors / Q000009:adverse effects* / Q000941:ethics*; D009014:Morals; D010686:Philosophy, Medical; D011678:Punishment / Q000523:psychology*; D012941:Social Responsibility
keywords: Adverse event; Control; Medical error; Moral luck; Side-effect effect