The ethical obligation for disclosure of medical error in the intensive care unit

摘要

The very facts that humans are fallible and that they are integrally involved in the delivery of healthcare and medical treatment guarantee that medical errors will occur despite the best of training, skills and vigilance, precautions, or preventive procedures. While medical errors occur across the spectrum of care and treatment, the propensity for their occurrence and the severity of the damage they are likely to inflict are undeniably greatest in the hospital intensive care unit (ICU).;The fundamentals of biomedical ethics require nothing less than a thorough systematic analysis of the sources of error in the ICU, along with a comprehensive, coordinated approach to preventing error to the extent humanly possible and to handling and mitigating the effects of error whenever they do occur. Through the chapters of this dissertation, the research and analysis has provided the following: 1) a detailed account, to the extent that it has been documented, of the high frequency of errors occurring in the U.S. in general and specifically in hospital intensive care units, as well as the range and extent of the harm done to patients and family members, both physically and financially; 2) a classification and analysis of the proximate, intermediate and ultimate causes of and contributing factors to medical errors, which in addition to identifying causation has formed the basis for this dissertation's recommendations aimed at developing procedures and protocols to effectively reduce errors to the greatest degree possible while minimizing their harmful impact; 3) an in-depth analysis of expectations, grounded in biomedical ethics, for dealing with the consequences of medical errors including disclosure and communication, the expectations of patients and family members, the attitudes and concerns of medical professionals, the disconnect between these two groups, and recommendations for procedures and protocols to ensure prompt, complete, and just handling of all consequences of the error; 4) an in-depth framework, based on Western religious and cultural foundations, for both those responsible for and those injured by medical errors to interact in handling the consequences of the error, as well as all of the communication which it engenders; and 5) proposals for numerous procedures and protocols, both for lessening the vulnerability of hospital ICU patients to suffering the effects of an error and for addressing and counteracting the variety of systemic problems which create or heighten the propensity for the occurrence of medical errors.