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02/10/2017

Apologies and Outcomes

What if a study shows that the course of action we know to be right doesn’t “work”? Or that it may even place us at a disadvantage?

When bad things happen to patients in the course of medical treatment, doctors traditionally have avoided apologizing or even expressing sympathy to patients, for fear that such expressions would be used against them in malpractice court as an admission of guilt. So multiple states have passed “apology laws” excluding such expressions from trials, in order to encourage doctors to make apologies. The underlying idea is that the act of apologizing helps to enhance communication between patients and physicians and to assuage some of the anger that leads people to sue their doctor, thereby reducing the likelihood of a malpractice suit.

However, a recent extensive study found that in states where apology laws are on the books, doctors’ risk of malpractice suits actually increased, as did the average payment to settle a claim.

Assuming for the sake of argument that the results of the study are valid, what conclusions are we to draw from them? It seems like a right, normal, ethical, human thing to do to apologize when we have harmed someone. Should doctors avoid apologizing to patients if it will increase their risk of a malpractice suit? More generally, how much do we allow outcomes (a major buzzword in medicine these days) to influence our moral reasoning and acting? Take, for instance, the opposite scenario: What if a wrong action is shown to have a beneficial result? For example, what if a study showed that a stem-cell therapy that relied on destroying embryos would effectively cure diabetes, or Alzheimer’s? Should such a compelling good outcome sway our moral reasoning and acting?

Outcomes need to be taken into account, but they must not be the only or the overriding factor in making ethical decisions. Just as a potentially good outcome does not make it more right to destroy an embryonic human, a potentially bad outcome does not make it less right to apologize to a fellow person when we have done them harm.

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