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Medical Error and Moral Luck

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Abstract

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.

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Notes

  1. See http://www.smd.qmul.ac.uk/risk/yearfive/casestudies/wayne-jowett.html for a discussion of an actual case. The actual case will also be mentioned later in this essay.

  2. The idea of luck is sometimes equated with something happening against the odds, such as winning the lottery. In the moral luck discussion, luck has a broader interpretation (Enoch and Marmor 2007).

  3. Nagel (1976) mentioned in footnote 10 that the Nobel prize is not awarded to people who turn out to be wrong, no matter how brilliant their reasoning.

  4. Williams’ (1976) key example in his original article is the artist Gauguin who leaves his family and becomes a successful painter but could not know when he decided to leave his family that he was going to become successful. This is not a typical moral luck example, more an example of decision making under uncertainty and it is not clear what it is supposed to show (Enoch 2010).

  5. Nagel (1976) identified four kinds of moral luck, namely resultant or consequential luck (focusing on outcome), constitutive luck (focusing on an individual’s characteristics), causal luck (focusing on circumstances which influence actions, relating to the compatibilism/incompatibilism debate), and circumstantial luck (the types of situations that one faces). With medical errors, consequential luck is most important, and only this form of moral luck will be discussed in the paper.

  6. Wolf uses the words ‘truck driver’. Williams and Nagel use the words ‘lorry driver’.

  7. Wolf does not address the issue of limits to the duty to amend. According to her, one should offer to pay if one’s child accidentally broke an expensive vase, but if one is on benefits and this action will leave no money for food, one can wonder whether the offer is appropriate. In the context of medical errors, it will be an insurance company paying, so this issue will not arise under normal circumstances.

  8. See for example http://news.bbc.co.uk/1/hi/health/3133198.stm or http://www.theguardian.com/uk/2003/sep/25/ukcrime.comment.

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Authors and Affiliations

  1. Wandsworth Crisis and Home Treatment Team, Springfield Academic Hospital, South West London and St. George’s Mental Health NHS Trust, 61 Glenburnie Road, London, SW17 7DJ, UK

    Dieneke Hubbeling

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  1. Dieneke Hubbeling
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Hubbeling, D. Medical Error and Moral Luck. HEC Forum 28, 229–243 (2016). https://doi.org/10.1007/s10730-015-9295-3

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