Accountability

The moral dimension of wrestling with the problem of error in medicine has not received the attention it deserves. Virginia Sharpe and the other contributors to Accountability have gone a long way toward remedying this omission. In tracing the burden that error creates for patients and their caregivers through the moral consequences of various forms of liability and responsibility that could be used to decrease the rate of error that now plagues our health care system, Accountability stands as an important reminder that our moral choices, rather than simply legal, professional or economic, should guide our public policies in this crucial area. Error will not yield easily to attempts at reform but it will not yield at all unless the insights captured in this book become a core part of that effort. -- Arthur L. Caplan, director of the Center for Bioethics, University of Pennsylvania Accountability offers a well-rounded view of the complex and multifaceted problem of medical mistakes and various attempts to deal with and prevent them. From compelling firsthand accounts of tragedy wrought by medical error to efforts to grapple with professional, institutional, systemic, cultural, and societal factors in mistake causation and prevention, this volume richly repays a careful read. -- Mark P. Aulisio, director of Clinical Ethics Program at MetroHealth Medical Center and director of the Master's Program in Bioethics at Case Western Reserve University

According to a Institute of Medicine report, as many as 98,000 Americans die each year as a result of medical error - a figure higher than deaths from automobile accidents, or breast cancer. This book examines how conventional structures of accountability in law and medical structure should be replaced by ethically informed institutional policies.According to a recent Institute of Medicine report, as many as 98,000 Americans die each year as a result of medical error - a figure higher than deaths from automobile accidents, breast cancer, or AIDS. That astounding number of fatalities does not include the number of those serious mistakes that are grievous and damaging but not fatal. Who can forget the tragic case of 17-year-old Jesica Santillan, who died after receiving a heart-lung transplant with an incompatible blood type? What can be done about this? What should be done? How can patients and their families regain a sense of trust in the hospitals and clinicians that care for them? Where do we even begin the discussion? "Accountability" brings the issue to the table in response to the demand for patient safety and increased accountability regarding medical errors. In an interdisciplinary approach, Virginia Sharpe draws together the insights of patients and families who have suffered harm, institutional leaders galvanized to reform by tragic events in their own hospitals, philosophers, historians, and legal theorists. Many errors can be traced to flaws in complex systems of health care delivery, not flaws in individual performance. How then should we structure responsibility for medical mistakes so that justice for the injured can be achieved alongside the collection of information that can improve systems and prevent future error? Bringing together authoritative voices of family members, health care providers, and scholars - from such disciplines as medical history, economics, health policy, law, philosophy, and theology - this book examines how conventional structures of accountability in law and medical structure (structures paradoxically at odds with justice and safety) should be replaced by more ethically informed federal, state, and institutional policies. Accountability calls for public policy that creates not only systems capable of openness concerning safety and error - but policy that also delivers just compensation and honest and humane treatment to those patients and families who have suffered from harmful medical error.