Selected Issues > Medical Error & Malpractice Reform
Medical Error & Malpractice Reform

malpractice imageA landmark report by the Institute of Medicine (IOM) in 1999 estimated that medical errors caused as many as 98,000 deaths in the United States each year—more than breast cancer or motor vehicle accidents. According to more recent estimates, millions are harmed each year by errors such as giving the wrong medication or dose, performing the wrong surgical procedure, or using contaminated medical equipment.

Traditionally, medical error has been dealt with in the courts, but the legal system is a poor solution to the problem. For one thing, the fear of lawsuits discourages doctors and medical institutions from speaking openly and giving patients and their families the truthful and complete information they deserve after a known or suspected mistake. In addition, because award formulas are based on lost income and earning potential and plaintiffs’ attorneys are paid out of awards, those attorneys are not inclined to represent people with little or no income, no matter how great the harm they may have suffered.

From the Hastings Center

Special Report

The Ethics of Using QI Methods to Improve Health Care Quality & Safety

This report from The Hastings Center explores the ethical dimensions of efforts to make health care safer and better through continuous improvements in patient care, with special attention to the relationship between everyday QI activities and the ethical rules and


The Ethics of Improving Health Care Quality & Safety

Lead Investigators Mary Ann Baily, Bruce Jennings (Center for Humans and Nature) Project Consultants Joanne Lynn (The RAND Corporation), Melissa Bottrell (National Center for Ethics in

Bioethics Briefing Book

Medical Error

By Nancy Berlinger

Special Report

What Could Have Saved John Worthy?

A working group assembled by The Hastings Center explores the structure of health care delivery in managed care, ponders its potential effect on patient care, and queries the market orientation of managed care. It notes problems with the current structure

2011 January-February

Legal Commentary Society

By Gregory Kaebnick

For many years, we have had a wonderful rotating line-up for our At Law column. But Carl Schneider, of the University of Michigan, has signed off. It feels like the end of an era.

Hastings Center Report

A Day Too Long: Rethinking Physician Work Hours

By Mark R. Mercurio
The long hours worked by resident physicians, and the mandated reduction of those hours in recent years, are widely known. A related issue—perhaps an even more important issue—has so far received less attention. This was brought home to me one day, many years after my residency was over, during the care of an infant with a rare and frequently fatal birth defect in the newborn intensive care unit of the teaching hospital where I am an attending neonatalogist.

Hastings Center Report


By Guang-Shing Cheng
A physician’s greatest fear is to miss a serious diagnosis that can result in a devasting outcome—an acute anterior myocardial infarction, a ruptured appendix, an early breast tumor. Nothing reminds us of our fallibility more than when a patient dies of a disease that we had dismissed or even failed to consider. Whether we miss the diagnosis for reasons of incompetence, fatigue, or lack of time, these are the patients who teach us medicine the hard way and mold our habits. Think of sepsis in a patient with a low white count and hypothermia. Double-check the post-procedure chest x-ray with a radiologist. Never ignore a new complaint of chest pain, even in a young person. 

Hastings Center Report

The Curious Case of Off-Label Use

By Rebecca Dresser
In the United States, new drugs and devices cannot be marketed until the Food and Drug Administration finds that they are safe and effective for their intended use. But the FDA oversees only product manufacturers and commercial activities. After it approves a drug or device for its intended use, physicians and others may prescribe the product for uses not covered by the approved label. Off-label prescribing merits more rigorous oversight.

Bioethics Forum

14,000 Women

Nancy Berlinger

Bioethics Forum

Safety First – Or Safety Preempted?

Wendy Parmet


Institute for Healthcare Improvement

Patient Safety Network of the Agency for Health Care Research and Quality

Nancy Berlinger, After Harm: Medical Error and the Ethics of Forgiveness, Johns Hopkins University Press, 2007.

Nancy Berlinger, AW Wu, “Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error,” Journal of Medical Ethics 31, no. 2 (2005): 106-108.

Nancy Berlinger, “Fair compensation without litigation: addressing patients’ financial need in disclosure,” Journal of Healthcare Risk Management 24, no. 1 (2004): 7-11.

Nancy Berlinger, “Promoting patient safety: implications for pastoral care,” Journal of Pastoral Care Counseling 58, no. 1-2 (2004): 55-61.

Nancy Berlinger, “What is meant by telling the truth: Bonhoeffer on the ethics of disclosure,” Studies in Christian Ethics 16, no. 2 (2003): 80-92.

Nancy Berlinger, “Broken stories: patients, families, and clinicians after medical error,” Literature and Medicine 22, no. 2 (2003): 230-240.

Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, To Err is Human: Building a Safer Health System, National Academy Press, 2000.