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)

A number of philosophers have recently argued that we should interpret the debate over moral responsibility as a debate over the conditions under which it would be “fair” to blame a person for her attitudes or conduct. What is distinctive about these accounts is that they begin with the stance of the moral judge, rather than that of the agent who is judged, and make attributions of responsibility dependent upon whether it would be fair or appropriate for a moral judge (...) to react to the agent in various (negative) ways. This is problematic, I argue, because our intuitions about whether and when it would be fair to react negatively to another are sensitive to a host of considerations that appear to have little or nothing to do with an agent’s responsibility or culpability for her attitudes or behavior. If this is correct, then theories which make attributions of responsibility dependent upon the appropriateness of our reactions as moral judges will turn out to be fundamentally misguided. (shrink)

According to how we treat others, we acquire merit or guilt, deserve praise or blame, and receive reward or punishment, looking in the end for atonement. In this study distinguished theological philosopher Richard Swinburne examines how these moral concepts apply to humans in their dealings with each other, and analyzes these findings, determining which versions of traditional Christian doctrines--sin and original sin, redemption, sanctification, and heaven and hell--are considered morally acceptable.

Responsibility and the Moral Sentiments offers an account of moral responsibility. It addresses the question: what are the forms of capacity or ability that render us morally accountable for the things we do? A traditional answer has it that the conditions of moral responsibility include freedom of the will, where this in turn involves the availability of robust alternative possibilities. I reject this answer, arguing that the conditions of moral responsibility do not include any condition of alternative possibilities. In the (...) terms that have become familiar, the book thus defends a compatibilist account of moral responsibility. (shrink)

We have all been victims of wrongdoing. Forgiving that wrongdoing is one of the staples of current pop psychology dogma; it is seen as a universal prescription for moral and mental health in the self-help and recovery section of bookstores. At the same time, personal vindictiveness as a rule is seen as irrational and immoral. In many ways, our thinking on these issues is deeply inconsistent; we value forgiveness yet at the same time now use victim-impact statements to argue for (...) harsher penalties for criminals. Do we have a right to hate others for what they have done to us? Providing a nuanced approach to a proper understanding of the place of our strongest emotions in moral, political, and personal life, and using lucid, easily understood prose, this volume is a classic example of philosophical thinking applied to a thorny, everyday problem. (shrink)

Next SectionThis article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients’ distress when physicians fail to disclose, apologise for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians’ professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians (...) may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologise to injured patients, ensure that these patients’ needs are met, and confront the emotional dimensions of one’s own mistakes should be part of medical education and reinforced by the conduct of senior physicians. (shrink)

© The Author 2017. Published by Oxford University Press on behalf of The Analysis Trust. All rights reserved. For Permissions, please email: [email protected] Shoemaker’s new book, Responsibility from the Margins, is an excellent and insightful explication of Shoemaker’s tripartite theory of moral responsibility. After setting out the main elements of his account, Shoemaker uses underexplored marginal cases of responsible agency to illustrate, support and shape his main theses concerning responsibility. The book as a whole thus presents us with a thoroughly (...) defended, subtle, and plausible theory of the extent and the nature of moral responsibility.Shoemaker takes as his starting point Peter Strawson’s claim that an agent’s responsibility for an action stems from the ‘quality of will’ expressed by that action. In particular, the appropriateness of our reactive attitudes towards an... (shrink)

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. Human misstep is (...) certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery. (shrink)

Patient safety has assumed a prominent role on the policy agenda since the Institute of Medicine report To Err Is Human was released in November 1999. The report maintained that medical error is the predominant mechanism by which patients in the United States and around the world are injured. This finding, along with the report’s recommendation for a “systems” approach to reducing medical error, provided an extremely important insight into the operation of our medical delivery system. Clearly, while advances in (...) medical technology, diagnostic techniques, and knowledge provide the foundation for saving lives, medical error has resulted in their loss. However, recognition that medical error is a primary cause of these avoidable patient injuries and deaths is a key one and may result in improvements within our system of health-care delivery as well as minimization of the emotional and financial toll that iatrogenic injury causes. (shrink)

In this article, tragedy and utopia are juxtaposed, and it is proposed that the problem of “medicalisation” is better understood in a framework of tragedy than in a utopian one. In utopia, it is presupposed that there is an error behind every setback and every side effect, whereas tragedy brings to light how side effects can be the result of irreconcilable conflicts. Medicalisation is to some extent the result of such a tragic conflict. We are given power by medical progress, (...) but are also confronted with our fallibility, thus provoking insecurity. This situation is illustrated by the sudden infant death syndrome . Recent epidemiological investigations have shown that infants sleeping in a prone position have a 15–20 times higher risk of dying from SIDS than infants sleeping in a supine position. A simple means of preventing infant death is suggested by this discovery, but insecurity is also created. What else has been overlooked? Perhaps a draught, or wet diapers, or clothes of wool are just as dangerous as sleeping prone? Further investigations and precautions will be needed, but medicalisation prevails. (shrink)