Patient Safety and Policy Reform

Virginia A. Sharpe, Editor

"Explore[s] human and cultural elements in depth, offering thought-provoking commentaries on the rapidly burgeoning patient-safety movement."
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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 Jésica Santillán, 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.

Table of Contents


Introduction: Accountability and Justice in Patient Safety Reform
Virginia A. Sharpe

1. Writing/Righting Wrong
Sandra M. Gilbert

2. Life but No Limb: The Aftermath of Medical Error
Carol Levine

3. In Memory of My Brother, Mike
Roxanne Goeltz

4. Error Disclosure for Quality Improvement: Authenticating a Team of Patients and Providers to Promote Patient Safety
Bryan A. Liang

5. Prevention of Medical Error: Where Professional and Organizational Ethics Meet
Edmund D. Pellegrino

6. Medical Mistakes and Institutional Culture
Carol Bayley

7. "Missing the Mark": Medical Error, Forgiveness, and Justice
Nancy Berlinger

8. Is There an Obligation to Disclose Near-Misses in Medical Care?
Albert W. Wu

9. God, Science, and History: The Cultural Origins of Medical Error
Kenneth De Ville

10. Reputation, Malpractice Liability, and Medical Error
William M. Sage

11. Ethical Misfits: Mediation and Medical Malpractice Litigation
Edward A. Dauer

12. On Selling "No-Fault"
David M. Studdert

13. Medical Errors: Pinning the Blame versus Blaming the System
E. Haavi Morreim

Cases Cited


"Explore[s] human and cultural elements in depth, offering thought-provoking commentaries on the rapidly burgeoning patient-safety movement."—New England Journal of Medicine

"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


Carol Bayley Nancy Berlinger Edward A. Dauer Kenneth De Ville Sandra M. Gilbert Roxanne Goeltz Carol Levine Bryan A. Liang E. Haavi Morreim Edmund D. Pellegrino William M. Sage Virginia A. Sharpe David M. Studdert Albert W. Wu

Supplemental Materials


About the Author

Virginia A. Sharpe is a visiting scholar at Georgetown University and medical ethicist at the National Center for Ethics of the Veterans Health Administration. She is the former deputy director of the Hastings Center. Her books include Medical Harm: Historical, Conceptual and Ethical Dimensions of Iatrogenic Illness and Wolves and Human Communities.

288 pp., 6 x 9

ISBN: 978-1-58901-023-9
Sep 2004

288 pp., 6 x 9

Sep 2004

288 pp.

ISBN: 978-1-58901-230-1
Sep 2004

Hastings Center Studies in Ethics series
Gregory E. Kaebnick and Daniel Callahan, Series Editors

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