Accountability: Patient Safety and Policy Reform, Hastings Center Studies in Ethics Series

Edited by Virginia A. Sharpe
Georgetown University Press, September 2004
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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 – more than from automobile accidents, breast cancer, or AIDS. And that astounding number does not include those serious mistakes that are grievous and damaging but not fatal. What can be done about medical mistakes, and 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: Patient Safety and Policy Reform brings the issue to the table in response to the demand for patient safety and increased accountability regarding medical errors. 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?

Accountability examines how the conventional structures of accountability in law and medicine (structures paradoxically at odds with justice and safety) should be replaced by more ethically informed federal, state, and institutional policies. It calls for public policy that not only creates systems capable of openness concerning safety and error, but also delivers just compensation and honest and humane treatment to those patients and families who have suffered from harmful medical error.


“Explore[s] human and cultural elements in depth, offering thought-provoking commentaries on the rapidly burgeoning patient-safety movement.” –The 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 toAccountability 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

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 IllnessandWolves and Human Communities.