title: Guilt without fault: A qualitative study into the ethics of forgiveness after traumatic childbirth.
abstract: When a life is lost or severely impaired during childbirth, the midwife and obstetrician involved may experience feelings of guilt in the aftermath. Through three empirical cases, the paper examines the sense of guilt in the context of the current patient safety culture in healthcare where a blame-free approach is promoted in the aftermath of adverse events. The purpose is to illustrate how healthcare professionals may experience guilt without being at fault after adverse events, and Gamlund's theory on forgiveness without blame is used as the theoretical framework for this analysis. Philosophical insight has proven to be a useful resource in dealing with psychological issues of guilt and Gamlund's view on error and forgiveness elucidates an interesting dilemma in the field of traumatic events and medical harm in healthcare, where healthcare professionals experience that well-intended actions may cause injury, harm or even death to their patients. Failing to recognise and acknowledge guilt or guilty feelings may preclude self-forgiveness, which could have a negative impact on the recovery of midwives and obstetricians after adverse events. Developing and improving support systems for healthcare professionals is a multi-factorial task, and the authors suggest that the narrow focus on medico-legal and patient safety perspectives is complemented with moral philosophical perspectives to promote non-judgemental recognition and acknowledgement of guilt and of the fallible nature of medicine.
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark; Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark. Electronic address: kschroeder@health.sdu.dk.
authors.forename: Katja
authors.initials: K
authors.lastname: Schrøder
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: la Cour
authors.affiliation: Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark.
authors.forename: Jan Stener
authors.initials: JS
authors.lastname: Jørgensen
authors.affiliation: Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark; Division of Surgery, University College London, Northwick Park Institute for Medical Research Campus, London, UK.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Lamont
authors.affiliation: Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark.
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Hvidt
mesh_terms: D000328:Adult; D003718:Denmark; D005260:Female; D061347:Forgiveness / Q000941:ethics*; D006167:Guilt; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology; D009774:Obstetrics; D036801:Parturition / Q000523:psychology*; D061214:Patient Safety / Q000592:standards; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D011247:Pregnancy; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D000078329:Workforce; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology*
keywords: Blame; Denmark; Forgiveness; Guilt; Midwifery; Obstetrics; Second victim; Traumatic childbirth