The standard account of informed consent has recently met serious criticism, focused on the mismatch between its implications and widespread intuitions about the permissibility of conducting research and providing treatment under conditions of partial knowledge. Unlike other critics of the standard account, we suggest an account of the relations between autonomy, ignorance, and valid consent that avoids these implausible implications while maintaining the standard core idea, namely, that the primary purpose of the disclosure requirement of informed consent is to prevent (...) autonomy-undermining ignorance. The problem with the standard account, we argue, is that it fails to distinguish between different forms of ignorance–in particular, error and suspending ignorance–that have very different effects on individuals’ ability to provide valid consent. While error often undermines our ability to provide valid consent, suspending ignorance, we argue, does not. Once the moral weight of this distinction is appreciated, it becomes apparent that valid informed consent requires far less knowledge than suggested by the standard account. (shrink)

La extensa obra de Galeno de Pérgamo, médico del estoico Marco Aurelio, incluye diversos tratados de corte filosófico, especialmente éstos en que analiza las causas de las pasiones y de los errores del alma, cuyo objetivo general es comprender de un modo amplio la naturaleza humana y plantear pautas apropiadas para su mejoramiento moral. Galeno divide la exposición de las cuestiones referentes al diagnóstico y tratamiento de las pasiones y los errores del alma de cada uno, porque su tesis principal, (...) que la estructura del alma es tripartita (racionalidad, emociones vehementes o pasiones y deseos), así se lo exige. En su opinión, el tratamiento de las pasiones difiere del tratamiento de las fallas cognitivas a que se refieren los errores del alma; cuya causa pueden ser pasiones y deseos inmoderados y falsas opiniones sobre bienes y males; que median, finalmente, en la elección de una vida mesurada o, por el contrario, inmoderada. El hilo que une el tratado sobre las pasiones y el tratado sobre los errores del alma son precisamente las falsas opiniones, que incrementan la violencia ejercida por nuestras pasiones cuando no hemos revisado las causas (creencias y deseos) de nuestra conducta excesiva, ni los juicios de valores con que estamos acostumbrados a juzgar las circunstancias cotidianas de la propia vida. El poder de las opiniones consiste en incrementar, precisamente, el cuantum de fuerza de las emociones, haciéndolas inmoderadas e indómitas, o moderables. (shrink)

Medical error is a leading problem of health care in the United States. Each year, more patients die as a result of medical mistakes than are killed by motor vehicle accidents, breast cancer, or AIDS. While most government and regulatory efforts are directed toward reducing and preventing errors, the actions that should follow the injury or death of a patient are still hotly debated. According to Nancy Berlinger, conversations on patient safety are missing several important components: religious voices, traditions, (...) and models. In After Harm, Berlinger draws on sources in theology, ethics, religion, and culture to create a practical and comprehensive approach to addressing the needs of patients, families, and clinicians affected by medical error. She emphasizes the importance of acknowledging fallibility, telling the truth, confronting feelings of guilt and shame, and providing just compensation. After Harm adds important human dimensions to an issue that has profound consequences for patients and health care providers. (shrink)

We present a taxonomy of errors in the scientific literature and an account of how the errors are distributed over the categories. We have developed the taxonomy by studying substantial errors in the scientific literature as described in retraction notices published in the journal Science over the past 35 years. We then examine how the sorts of errors that lead to retracted papers can be prevented and detected, considering the perspective of collaborating scientists, journal editors and referees, and readers of (...) the published articles. (shrink)

Applying and extending principles that can help prevent consumer error, worker fault, managerial mistakes, and organizational blunders, Human Error: Causes and Control provides useful information on theories, methods, and specific techniques for controlling human error. It forms a how-to manual of good practice, focusing on identifying human error, its causes, and how to control or prevent it. It presents constructs that assist in optimizing human performance and to achieve higher safety goals. Human Error: Causes and (...) Control bridges the gap and illustrates the means for achieving a comprehensive, fully integrated, process compatible, user effective, methodologically sound model. (shrink)

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. (shrink)

Is there not any place in the history of ideas for the imperfect character of human doings (i.e. capability of error) that is repeated for so long until we lately start to think that it had long been wrong? The answer is: In the conventional histories of ideas there is almost none. The importance of the phenomenon,however, is immense. Intellectual history is full of errors. Scholarly errors are among the factors that generate intellectual pathways in which consequences of historical (...) small events feed back up on each other positively and give rise to historical pathologies in the end. Pathways hold the intellectuals dependent on the consequences of errors which interact upon each other and prevent resulting pathologies to disappear fully. As a result, ideas do not converge to a level of perfection. Evolutionary account of errors suggests that errors in the history of ideas matter even though they are often corrected. (shrink)

This essay reviews and defines avoidable medical error, malpractice and complication. The relevant ethical principles pertaining to unanticipated medical outcomes are identified. In light of these principles I critically review the moral culpability of the agents in each circumstance and the resulting obligations to patients, their families, and the health care system in general. While I touch on some legal implications, a full discussion of legal obligations and liability issues is beyond the scope of this paper.

In his discussion of the tragic act in Poet. 14. 1453b15 ff. Aristotle separates the pity which we feel at mere suffering from pity roused by the way in which this suffering is or will be brought about. The revenge of an enemy is not in itself pitiable. We pity, if victim and agent are closely related to one another as members of the same family, but only if the action is of a certain kind. Four possible ways of presenting (...) the tragic act are therefore distinguished: attempted but not performed, with knowledge of the relevant facts ; performed with knowledge ; performed but in ignorance, recognition following later ; attempted in ignorance but not performed, since recognition occurs in time to prevent it. Of these four variations the first is censured on the ground that it is morally shocking without being tragic, since it lacks πάθος. The second is mentioned in b27 as the favourite of the older poets, but is here passed over without comment. The third is explicitly approved on the ground that it avoids moral shock and has the emotional κπληξις of the recognition. But for some reason which he does not state, Aristotle prefers the last, where recognition is in time to prevent the tragic suffering from actually taking place. (shrink)

This paper focuses on Paul of Venice’s realist theory of direct knowledge. In the second half of the 13th century human knowledge was standardly viewed as a process of abstraction enabling the human intellect to grasp the essences of corporeal things, regardless of the matter in which they are embodied. This process was achieved thanks to the mediation of mental entities (species intelligibiles) representing the dematerialised objects in the intellect. By the late 13th and early 14th centuries, however, some authors (...) began to regard this account as unsatisfactory. These authors held that assuming the existence of mediating species (considered themselves as objects of knowledge) amounts to thinking that between ourselves and the world there is a barrier preventing us from acquiring knowledge of reality in itself. Paul of Venice is aware of the sceptical accusations made against the theory of species in the 13th and 14th centuries. Nevertheless, he is a firm advocate of the existence of species. He claims that knowledge, despite coming about through species, is not indirect. Quite the contrary: we have immediate access to reality, and the individual objects that constitute it, precisely because our senses (which are purely passive) receive impressions direct from outside, thanks to species. He points out that species are not object of knowledge. They are not known at all during the cognitive process, as they are a mere means (a mechanical means, so to say), not an image nor a representation of anything, and therefore they are no obstacle between ourselves and the world. Thus, we are able to know reality exactly as it is in itself and, under ordinary conditions, our perceptions are practically infallible and cannot produce false knowledge. (shrink)

Compared to other health care professions such as medicine, nursing and pharmacy, few studies have been conducted to examine the nature of practice errors in occupational and physical therapy. In an ongoing study to determine root causes, typographies and impact of occupational and physical therapy error on patients, focus group interviews have been conducted across the United States. A substantial number of harmful practice errors and/or other patient safety events (deviations or accidents) have been identified. Often these events have (...) had moral dimensions that troubled the therapist involved. In this article, six of these transcribed cases are analyzed, using predominant bioethical theories, ethical principles and professional codes of ethics. The cases and their analyses are intended to be exemplary, improving the readers’ ability to discern and critically address similar such events. Several patient safety strategies are suggested that might have prevented the events described in these cases. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP (...) violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

This book is a collection of original, interdisciplinary essays on the topic of medical error. Given the complexities of understanding, preventing, and responding to medical error in ethically responsible ways, the scope of the book is fairly broad. The contributors include top scholars and practitioners working in bioethics, communication, law, medicine and philosophy. Their contributions examine preventable causes of medical error, disproportionate impacts of errors on vulnerable populations, disclosure and apology after discovering medical errors, and ethical (...) issues arising in specific medical contexts, such as radiation oncology, psychopathy, and palliative care. They also offer practical recommendations for respecting autonomy, distributing burdens and benefits justly, and minimizing injury to patients and other stakeholders. Ethics and Error in Medicine will be of interest to a wide range of researchers, students, and practitioners in bioethics, philosophy, communication studies, law, and medicine who are interested in the ethics of medical error. (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)

Shaun Gallagher has actively looked into the possibility that psychopathologies involving “thought insertion” might supply a counterexample to the Cartesian principle according to which one can always recognize one’s own thoughts as one’s own. Animated by a general distrust of a priori demonstrations, Gallagher is convinced that pitting clinical cases against philosophical arguments is a worthwhile endeavor. There is no doubt that, if true, a falsification of the immunity to error through misidentification would entail drastic revisions in how we (...) conceive the boundary between self and other. However, I argue that (1) the idea of unearthing an exception to the Cartesian thesis is, on further reflection, not a realistic prospect and that (2) this casts doubt on the attempt to conjoin first-person phenomenology and third-person cognitive science in the service of philosophical debates. (shrink)

Understanding the nature of errors in a simple, rule‐based task—programming a VCR—required analyzing the interactions among human cognition, the artifact, and the task. This analysis was guided by least‐effort principles and yielded a control structure that combined a rule hierarchy task‐to‐device with display‐based difference‐reduction. A model based on this analysis was used to trace action protocols collected from participants as they programmed a simulated VCR. Trials that ended without success (the show was not correctly programmed) were interrogated to yield insights (...) regarding problems in acquiring the control structure. For successful trials (the show was correctly programmed), steps that the model would make were categorized as matches to the model; steps that the model would not make were violations of the model. The model was able to trace the vast majority of correct keystrokes and yielded a business‐as‐usual account of the detection and correction of errors. Violations of the model fell into one of two fundamental categories. The model provided insights into certain subcategories of errors; whereas, regularities within other subcategories of error suggested limitations to the model. Although errors were rare when compared to the total number of correct actions, they were important. Errors were made on 4% of the keypresses that, if not detected, would have prevented two‐thirds of the shows from being successfully recorded. A misprogrammed show is a minor annoyance to the user. However, devices with the approximate complexity of a VCR are ubiquitous and have found their way into emergency rooms, airplane cockpits, power plants, and so on. Errors of ignorance may be reduced by training; however, errors in the routine performance of skilled users can only be reduced by design. (shrink)

Kant’s concept of conscience has been largely neglected by scholars and contemporary moral philosophers alike, as has his concept of “indirect” duty. Admittedly, neither of them is foundational within his ethical theory, but a correct account of both in their own right and in combination can shed some new light on Kant’s moral philosophy as a whole. In this paper, I first examine a key passage in which Kant systematically discusses the role of conscience, then give a systematic account of (...) “indirect” duties and the function of hypothetical imperatives in the course of their generation. I then turn to the possibility of moral error and the part “indirect” duty can play in its prevention. In conclusion, I try to show how clarifying the concept of “indirect” duty can help us to shed light on the nature of Kantian ethics as a whole. (shrink)

Barbieri introduced and developed the concept of organic codes. The most basic of them is the genetic code, a set of correspondence rules between otherwise unrelated sequences: strings of nucleotides on the one hand, polypeptidic chains on the other hand. Barbieri noticed that it implies ‘coding by convention’ as arbitrary as the semantic relations a language establishes between words and outer objects. Moreover, the major transitions in life evolution originated in new organic codes similarly involving conventional rules. Independently, dealing with (...) heredity as communication over time and relying on information theory, we asserted that the conservation of genomes over the ages demands that error-correcting codes make them resilient to casual errors. Moreover, the better conservation of very old parts of the genome demands that they result from combining successively established nested codes such that the older an information, the more numerous component codes protect it. Barbieri’s concept of organic code and that of genomic error-correcting code may seem unrelated. We show however that organic codes actually entail error-correcting properties. Error-correcting, in general, results from constraints being imposed on a set of sequences. Mathematical equalities are conveniently used in communication engineering for expressing constraints but error correction only needs that constraints exist. Biological sequences are similarly endowed with error-correcting ability by physical-chemical or linguistic constraints, thus defining ‘soft codes’. These constraints are moreover presumably efficient for correcting errors. Insofar as biological sequences are subjected to constraints, organic codes necessarily involve soft codes, and their successive onset results in the nested structure we hypothesized. Organic codes are generated and maintained by means of molecular ‘semantic feedback loops’. Each of these loops involves genes which code for proteins, the enzymatic action of which controls a function needed for the protein assembly. Taken together, thus, they control the assembly of their own structure as instructed by the genome and, once closed, these loops ensure their own conservation. However, the semantic feedback loops do not prevent the genome lengthening. It increases both the redundancy of the genome and the information quantity it bears, thus improving the genome reliability and the specificity of the enzymes, which enables further evolution. (shrink)

Economists tend to view ignorance as ?rational,? neglecting the possibility that ignorance is unintentional. This oversight is reflected in economists? model of ?information search,? which can be fruitfully contrasted with ?information browsing.? Information searches are designed to discover unknown knowns, whose value is calculable ex ante, such that this value justifies the cost of the search. In this model of human information acquisition, there is no primal or ?radical? ignorance that might prevent people from knowing which information to look for, (...) lacking omniscience. Unlike ignorance that is rationally chosen on the basis of an accurate cost/benefit calculation, radical ignorance can explain human error. An account of error as grounded in radical ignorance bypasses the need to appeal to irrationality in order to explain economic (and other) mistakes. (shrink)

Economists tend to view ignorance as “rational,” neglecting the possibility that ignorance is unintentional. This oversight is reflected in economists’ model of “information search,” which can be fruitfully contrasted with “information browsing.” Information searches are designed to discover unknown knowns, whose value is calculable ex ante, such that this value justifies the cost of the search. In this model of human information acquisition, there is no primal or “radical” ignorance that might prevent people from knowing which information to look for, (...) lacking omniscience. Unlike ignorance that is rationally chosen on the basis of an accurate cost/benefit calculation, radical ignorance can explain human error. An account of error as grounded in radical ignorance bypasses the need to appeal to irrationality in order to explain economic (and other) mistakes. (shrink)

ABSTRACTComparative effectiveness studies, referred to here as “usual-care” trials, seek to compare current medical practices for the same medical condition. Such studies are presumed to be safe and involve only minimal risks. However, that presumption may be flawed if the trial design contains “unusual” care, resulting in potential risks to subjects and inaccurately informed consent. Three case studies described here did not rely on clinical evidence to ascertain contemporaneous practice. As a result, the investigators drew inaccurate conclusions, misinformed research participants, (...) and subjects’ safety was compromised. Before approving usual-care protocols, IRBs and scientific review committees should evaluate the quality and completeness of information documenting usual-care practices. Guidance from governmental oversight agencies regarding evidence-based documentation of current clinical practice could prevent similar occurrences in future usual-care trials. Accurate information is necessary to ensure that trials comply with government regulations that require minimizing research risks to subjects and accurate informed consent documents. (shrink)

A general consensus has been reached in health care organizations that the disclosure of medical errors can be a very powerful way to improve patients and physicians well-being and serves as a core component to high quality health care. This practice strongly encourages transparent communication with patients after medical errors or unanticipated outcomes. However, many countries, such as Brazil, do not have a culture of disclosing harmful errors to patients or standards emphasizing the importance of disclosing, taking responsibility, apologizing, and (...) discussing the prevention of recurrences. Medical error is not discussed or approached during medical school. The stigma of error has a strong connection with value judgments, and emotional support for physicians does not exist. This paper suggests that open communication with the patient is essential. Guidance about error disclosure from health care organizations would be helpful for quality and patient safety and for health care professionals in countries like Brazil. (shrink)

A general consensus has been reached in health care organizations that the disclosure of medical errors can be a very powerful way to improve patients and physicians well-being and serves as a core component to high quality health care. This practice strongly encourages transparent communication with patients after medical errors or unanticipated outcomes. However, many countries, such as Brazil, do not have a culture of disclosing harmful errors to patients or standards emphasizing the importance of disclosing, taking responsibility, apologizing, and (...) discussing the prevention of recurrences. Medical error is not discussed or approached during medical school. The stigma of error has a strong connection with value judgments, and emotional support for physicians does not exist. This paper suggests that open communication with the patient is essential. Guidance about error disclosure from health care organizations would be helpful for quality and patient safety and for health care professionals in countries like Brazil. (shrink)

Background Adherence to ethical guidelines and regulations and protecting and respecting the dignity and autonomy of participants by obtaining a valid informed consent form (ICF) prior to participation in research are crucial; The subjects did not add signatures next to the corrections made to signatures or dates on the ICF, Multiple signatures in other fields, ICF missing/missing signature, Incorrect ICF version Signed after modification, Correction tape used to correct signature, Impersonated signature, Non-research-member signature, however, ICFs are often not properly completed, (...) which must be addressed. This study analyzed ICF signing errors and implemented measures to reduce or prevent these errors. Methods We used the plan–do–check–act (PDCA) cycle to help improve the correctness and validity of ICF signing. Results Interim and final reports from January 2016 to February 2020 including 363 ICFs were studied. The total proportion of correct ICF signatures (200, 83.3%) following the PDCA intervention was significantly higher than that before the intervention (P < 0.05). Analysis of the types of signing error demonstrated that signature errors were significantly reduced after the intervention, particularly for subjects did not add signatures next to the corrections made to signatures or dates on the ICF (16, 6.7%) and impersonated signature (0; P < 0.05). Conclusions The proportions of other error types—multiple signatures in other fields, missing or unsigned ICF, incorrect signature order, incorrect ICF version, use of correction tape to correct signature, and non-medical profession members signing the ICF—did not differ significantly. (shrink)

In order to explain why cultural traits remain stable despite the error-proneness of social learning, Dan Sperber has proposed that human psychology and ecology lead to cultural traits being transformed in the direction of attractors. This means that simple-minded Darwinian models of cultural evolution are not appropriate. Some scientists and philosophers have been concerned that Sperber’s notion of attractors might show more than this, that attractors destroy subtle cultural variation and prevent adaptive cultural evolutionary processes from occurring. I show (...) that Sperber’s view does not have this consequence—that even if there are attractors, cumulative cultural evolution can still occur. (shrink)

A general consensus has been reached in health care organizations that the disclosure of medical errors can be a very powerful way to improve patients and physicians well-being and serves as a core component to high quality health care. This practice strongly encourages transparent communication with patients after medical errors or unanticipated outcomes. However, many countries, such as Brazil, do not have a culture of disclosing harmful errors to patients or standards emphasizing the importance of disclosing, taking responsibility, apologizing, and (...) discussing the prevention of recurrences. Medical error is not discussed or approached during medical school. The stigma of error has a strong connection with value judgments, and emotional support for physicians does not exist. This paper suggests that open communication with the patient is essential. Guidance about error disclosure from health care organizations would be helpful for quality and patient safety and for health care professionals in countries like Brazil. (shrink)

Anyone wearing rose-tinted glasses might be forgiven if s/he comes to the conclusion that the world out there is rosier than it actually is. With his Fish Story, Sir Arthur Eddington warned us how analogous illusions might have happened in our models of the physical world. His allegory describes how observer characteristics can be inadvertently assigned to the systems being observed. If Eddington's conjecture is applicable, the most fundamental properties of nature will turn out to be the construction rules of (...) the observer who measures nature. Since no one exactly knows how the brain works and because it is the final measuring instrument that collapses the wave function at the end of von Neumann's measurement chain, it is likely that observer characteristics have been falsely attributed to physical reality and our theories of it. These errors may prevent us from understanding consciousness because they mask the actual operations of the psyche. Starting with Velmans' model of consciousness I analyse the role of cognitive models in the development of science. I then model how both the set-up of experiments and the interpretation of resulting data could be influenced to arrive at erroneous theories. Using examples I show how potential errors, due to our incomplete understanding of the conscious process, have crept into physics. These need to be corrected if we are to evolve a concept of physical reality that includes conscious experiences. (shrink)

Quantum computers are hypothetical quantum information processing (QIP) devices that allow one to store, manipulate, and extract information while harnessing quantum physics to solve various computational problems and do so putatively more efficiently than any known classical counterpart. Despite many ‘proofs of concept’ (Aharonov and Ben–Or 1996; Knill and Laflamme 1996; Knill et al. 1996; Knill et al. 1998) the key obstacle in realizing these powerful machines remains their scalability and susceptibility to noise: almost three decades after their conceptions, experimentalists (...) still struggle to maintain useful quantum coherence in QIP devices with more than a pair of qubits (e.g., Blatt and Wineland 2008). This slow progress has prompted debates on the feasibility of quantum computers, yet the quantum information community has dismissed the skepticism as “ideology” (Aaronson 2004), claiming that the obstacles are merely technological (Kaye et al. 2007, 240). In a recent paper (Hagar 2009) I’ve argued that such a skepticism with respect to the feasibility of quantum computers need not be deemed ideological at all, and that the aforementioned ‘proofs of concept’ are physically suspect. Using analogies from the foundations of classical statistical mechanics (SM), I’ve also argued that instead of active error correction, the appropriate framework for debating the feasibility of large–scale, fault–tolerant and computationally superior quantum computers should be the project of error avoidance: rather than trying to constantly ‘cool down’ the QIP device and prevent its thermalization, one should try to locate those regions in the device’s state space which are thermodynamically ‘abnormal’, i.e., those regions in the device’s state space which resist thermalization regardless of external noise. This paper is intended as a further contribution to the debate on the feasibility of large–scale, fault–tolerant and computationally superior quantum computers. Relying again on analogies from the foundations of classical SM, it suggests a skeptical conjecture and frames it in the ‘passive’, error avoidance, context.. (shrink)

Integrating regulatory focus theory and personality literature, we develop and test a moderated mediation model to specify the underlying mechanisms and boundary conditions of the linkage between employee conscientiousness and job crafting. Two-wave data collected from 389 employees and 95 supervisors showed that: Employee conscientiousness had a positive effect on work promotion focus and work prevention focus. Employee conscientiousness was positively related to job crafting via work promotion focus, negatively related to job crafting via work prevention focus. Error management (...) climate positively moderated the relationship between employee conscientiousness and work promotion focus, negatively moderated the relationship between employee conscientiousness and work prevention focus. The indirect relationship between employee conscientiousness and job crafting through work promotion focus and work prevention focus were more pronounced respectively when the error management climate is higher rather than lower. (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)

Efforts to decrease errors in health care are directed at prevention rather than at managing a situation when a mistake has occurred. Consequently, nurses and other health care providers may not know how to respond properly and may lack sufficient support to make a healthy recovery from the mental anguish and emotional suffering that often accompany making mistakes. This article explores the conceptualization of mistakes and the ethical response to making a mistake. There are three parts to an ethical response (...) to error: disclosure, apology and amends. Honesty and humility are discussed as important virtues that facilitate coping and personal growth for the health care provider who is involved in mistakes. In conclusion, a healthy view of nursing practice and mistake making is one that prevents error but, when prevention is not possible, accepts fallibility as part of the human condition and achieves the best possible outcome for all. (shrink)

The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain (...) circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death. In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation. (shrink)

While the medical ethics literature has well explored the harm to patients, families, and the integrity of the profession in failing to disclose medical errors once they occur, less often addressed are the moral and professional obligations to take all available steps to prevent errors and harm in the first instance. As an expanding body of scholarship further elucidates the causes of medical error, including the considerable extent to which medical errors, particularly in diagnostics, may be attributable to cognitive (...) sources, insufficient progress in systematically evaluating and implementing suggested strategies for improving critical thinking skills and medical judgment is of mounting concern. Continued failure to address pervasive thinking errors in medical decisionmaking imperils patient safety and professionalism, as well as beneficence and nonmaleficence, fairness and justice. We maintain that self-reflective and metacognitive refinement of critical thinking should not be construed as optional but rather should be considered an integral part of medical education, a codified tenet of professionalism, and by extension, a moral and professional duty. (shrink)

The article reveals the problems of listening comprehension in a foreign-language audience, in particular, by students who are non-native speakers. The theoretical part is a brief characteristic of listening as a type of speech activity: the content of the term, its internal components – the psychophysiological mechanisms involved, the difficulties associated with them. In the practical part the authors of the article demonstrate exercises from the purposefully developed lesson on the removal of difficulties in the perception of sounding speech in (...) non-native speakers children of middle school age, consisting in the systematic development of mechanisms of listening comprehension. Based on the analysis of the experimental lesson, solutions for systematic and consistent work in the classes within the additional remedial course in the Russian language in order to prevent errors and difficulties, as well as to facilitate the process of listening comprehension are proposed. (shrink)

Para hacer justicia hay que saber la verdad. Existen al menos dos justicias, una humana, otra divina. Eventualmente la segunda precave los errores de la primera y enmienda lo obrado por la desmesura de los mortales, imponiendo su dominio, mandato y castigo. Este ensayo reflexiona respecto del tema de la verdad como aletheia, esto es, como desocultación y rememoración, en la obra Edipo rey de Sófocles. En este drama la justicia la impondrá Apolo y devendrá violenta, a causa de lamentables (...) “hechos de sangre” ocultados y olvidados. Desde el oráculo de Delfos, salpicando y chorreando sangre de los ojos del rey de Tebas, la verdad divina emergerá exigiendo venganza, sin compasión alguna para sus protagonistas. La verdad como aletheia no es solo poder, justicia y castigo por medio del logos -y aquí lo relevante-, también es grito, sangre y muerte, es tragedia. To do justice we must know the truth. There are at least two types of justice: human and divine. Eventually the second one prevents errors of the first and amends uncontrollable human actions, imposing its power, order and punishment. This essay reflects on the theme of truth as aletheia, that is, as disclosure and remembrance in Sophocles' King Oedipus. In this drama, Apollo’s justice prevails and turns violent, because of unfortunate “bloodshed” hidden and forgotten incidents. From the Delphi Oracle, the divine truth will emerge spilling blood from Thebas King’s eyes, demanding vengeance, without mercy for its players. The truth as aletheia is not only power, justice and punishment through the logos -this being what is relevant- but cry, blood and death, and tragedy. (shrink)

The question, what makes a clinician a healer? may evoke the image of a devoted physician paying a critically important home visit at the end of a long day or the image of an astute nurse—steadfast, empathic, anticipating the patient's needs before they become apparent to others. But health care is no longer provided by lone doctors or nurses. In the modern health care system, multiple professionals must work together to provide safe and effective care. The moral nature of healing (...) has not changed. But what is required of clinicians to facilitate healing has. To be a healer today, a clinician must be a good team player. Medical students have opened our eyes to this new reality. Building on their observations, we articulate a view that, over and above the role of teamwork in providing technically appropriate care and preventing errors, health care requires teamwork to promote healing. Being a good team player is now a moral imperative because it makes an essential contribution to healing. (shrink)