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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
16c* Errors
[C16:1] A patient with multiple medical problems has been admitted to the hospital four times in the last month. The patient’s overall condition continues to deteriorate. Hospice has been recommended, but the patient’s offspring wants aggressive management. During the current admission, the patient is accidentally given a dose of medication that is too high, and the patient has a cardiac arrest and dies. The attending practitioner is reluctant to divulge this to the patient’s offspring because the practitioner is afraid of being sued and believes that such a lawsuit would not be warranted given the patient’s condition and imminent death prognosis. What should be done?
[C16:2]
- A. Do not report the error. The patient had less than six months to live, and no harm was really done.
- B. Do not report the error. The medical liability consequence is so much worse than the consequence to the patient.
- C. Report the error to the patient’s family and the hospital administration. The family has a legal and moral right to know, and the hospital administration needs to know so that they can perform a root cause analysis.
- D. Report the error to hospital administration so they can prevent future errors. It is not necessary to inform the family.
- E. Report to the family if they are willing to keep the disclosure secret from the hospital administration.
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TAC: Think - Assess - Conclude
I. Think: What is the question?
[C16:3] Do medical errors need to be divulged?
II. Assess: Specify & Balance the four principles of bioethics
Patient: 1) Autonomy - Informed Consent
[C16:4] The patient had not provided the practitioner autonomous informed consent authorizing the administration of the wrong dose of medication. Therefore, the medical error was a violation of patient autonomy. However, since the patient has died due to the overdose error, it is impossible to disclose this error to the patient.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[C16:5] Professional beneficence (do good) and professional nonmaleficence (do no harm) have both been violated even though the overdose was not intentional. Professionally it is essential to disclose this error to both the patient’s family and the hospital administration. Institutionally this is important so that a root cause analysis can be conducted to determine what, how, and why the accidental overdose error occurred and how to prevent this error from ever happening again, i.e., nonmaleficence. Examples of error mitigation procedures are implementing checklists, double-checking doses, and armband patient identification. The practitioner has a professional obligation of beneficence to report this overdose error to the patient’s offspring so they can decide how to proceed. The practitioner has a professional obligation of nonmaleficence to report this overdose error to the institution so that procedures can be put in place to eliminate similar errors from happening again.
Public Policy: 4) Justice
[C16:6] The state has an obligation towards the protection of its citizens. Malpractice suits happen when an avoidable error or negligence occurs in addition to harm to the patient. Both negligence and harm to the patient did occur in this situation. The practitioner is legally and morally obligated to disclose all medical errors.
[C16:7]
III. Conclude: Nationally or Professionally True Answer
[C16:8] Practitioners are legally and morally bound to divulge all medical errors, regardless of how minor and regardless of whether or not the error resulted in harm to the patient.
Answer Options: [C16:9]
(Choice A) Do not report the error. The patient had less than six months to live, and no harm was really done.
(Choice B) Do not report the error. The medical liability consequence is so much worse than the consequence to the patient.
(Choice D) Report the error to hospital administration so they can prevent future errors. It is not necessary to inform the family.
(Choice E) Report to the family if they are willing to keep the disclosure secret from the hospital administration.
A,B,D, and E are wrong because the medical professional has a legal and moral obligation to disclose the medical error to the family and the hospital administration so that the hospital can perform a root cause analysis in order to prevent such an occurrence from happening again in the future.
(Choice C) Report the error to the patient’s family and the hospital administration. The family has a legal and moral right to know, and the hospital administration needs to know so that they can perform a root cause analysis.
C is the correct answer. Both the family and the hospital institution must be informed of the error. The patient’s family has the legal and moral right to know how and why their mother died. Qualifying for hospice, meaning having a prognosis of less than six months, does not diminish a patient’s rights and liberties and the moral and legal obligation to keep the family substantially informed. Hospital administration must also be informed so that they can perform a root cause analysis for determining how and why this error occurred so that they can then implement effective policies and procedures for mitigating such occurrences.
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Assessment
Medical Errors
Principles
Divulge
Keep Secret
NA
NA
Autonomy
Beneficence
X
X
X
Nonmaleficence
Justice
