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Failsafe Systems and Practical Reasoning

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Abstract

This chapter identifies a main tension between a systemic and often simplistic ‘scientific’ stance of knowledge represented by mainstream patient safety thinking and a practical, pragmatic and case-based understanding of medical reasoning. Pedersen describes the patient safety programme’s failsafe and positivist ambitions promoted through enthusiastic advocacy, popular idioms and organizational tools, such as the Institute of Medicine’s report To Err Is Human, The Swiss Cheese Model and the Root Cause Analysis. Juxtaposing the knowledge conceptions of the safety programme, Pedersen introduces the practical philosophies of Aristotle, John Dewey and Stephen Toulmin in order to depict clinical knowledge as inseparable from acting in actual clinical situations where rules such as ‘evidence’ and guidelines are to be related to the situated and developing knowledge of concrete cases.

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Notes

  1. 1.

    Directly translated, the Danish utilsigtede hændelser is ‘unintended incidents’. While the English ‘adverse events’ most often refers to harmful outcomes of medical treatment not related to the patients’ illness (e.g., Kohn et al. 2000), the Danish translation utilsigtet hændelse is used to equally determine those unsafe situations which can potentially lead to injury and those that actually do. In this way, the Danish notion is more equivalent to the internationally used term ‘critical incident’, which is the background for my preferred use of this term throughout the book.

  2. 2.

    Dewey’s discussion of the case of two sick children is a comment to John Stuart Mill (1806–1873), who uses this particular example to account for his principle of induction.

  3. 3.

    Casuistry as a method for solving moral disputes was tarnished especially after Blaise Pascal’s highly influential Lettres provinciales (Provincial letters), dated 1656–1657, where he attacks casuistry and accuses the Jesuit casuists of moral sloppiness and laxity.

  4. 4.

    A rebuttable presumption (praesumptio iuris tantum) is a term used in law. It can be defined as ‘a presumption that the law allows to be contradicted by evidence’ (Oxford English Dictionary), and, as such, it is a presumption taken as true unless contested or proven otherwise. The term has obvious affinities to pragmatic thought, not least to Dewey’s ‘warranted assertability’ as a preferred term for truth.

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Pedersen, K.Z. (2018). Failsafe Systems and Practical Reasoning. In: Organizing Patient Safety. Health, Technology and Society. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-53786-7_3

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  • DOI: https://doi.org/10.1057/978-1-137-53786-7_3

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  • Publisher Name: Palgrave Macmillan, London

  • Print ISBN: 978-1-137-53785-0

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