Shared Blame for Medical Errors: the Preservation & Repair of Trust

Abstract: In this paper I show that blame can help restore trust when it is shared between clinicians and institutions in the context of medication errors. I utilize the case of RaDonda Vaught, a nurse criminally charged after accidentally administering a lethal dose of the wrong medication, to illustrate how blame can be shared such that it fulfills what I call it’s trust-reparative function: the restoration of trust across all participants in the clinician-patient-institution relationship. Shared blame demonstrates what the existing debate on clinician versus institutional responsibility and blame fails to adequately capture, that trust and blame in healthcare are features of networked relationships that both clinicians and institutions are responsible for facilitating between themselves and with the patient. Shared blame, as I characterize it, further makes salient three relational goods that result when both clinicians and institutions respond to errors by sharing blame: 1) acknowledgement that the error, and its consequences for the patient, occurred; 2) appropriate emotional regard for the harm of the error; and 3) more sincere apology. Using Vaught’s case , I examine different social dynamics between clinicians and institutions that occur when blame is either unilaterally or disproportionately discharged between parties rather than appropriately shared. When clinicians and institutions engage in the ideal of sharing blame, it prevents the escalation of further conflict and further enables them to appropriately prioritize repair with the patient and family. Shared blame is necessary for all parties to maintain healthy trusting relationships in the face of imperfect healthcare administration.

Keywords: Blame, Medical Errors, Trust