Accountability : Patient Safety and Policy Reform

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.

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.