Tuesday, June 14, 2005

Saving Face, Losing Community

If nature is the product of chance, it has no intrinsic order, so order can only be imposed from outside. On the human level, we've abandoned belief that the individual can exercise self-control. The demands of public order remain, so we can only pass laws and file suits to enforce our ideas of justice.1

During my recent internship, I ran across a couple interesting examples of how our extrinsic notion of justice hurts health care.

First it discourages the frank recognition and discussion of errors that require correction.

Two thirds of the Harris Poll respondents, including nurses and doctors, reported that frank discussion of adverse events or errors sometimes help them avoid making a similar error, yet only only one fourth reported that their colleagues are comfortable discussing uncertainty, and only 5% think their colleagues are very comfortable discussing errors among themselves.

Fear of liability is cited by physicians and hospital administrators as the leading factor that discourages medical professionals from openly discussing and thinking of ways to reduce medical errors.

Second, the reflex to avoid potential litigation actually exacerbates litigation. It discourages apologizing and feeds into further conflict:

In over 25 years of representing both physicians and patients, it became apparent that a large percentage of patient dissatisfaction was generated by physician attitude and denial, rather than the negligence itself. In fact, my experience has been that close to half of malpractice cases could have been avoided through disclosure or apology but instead were relegated to litigation. What the majority of patients really wanted was simply an honest explanation of what happened, and if appropriate, an apology. Unfortunately, then there were only offered neither but were rejeted as well, they felt doubly wronged and then sought legal counsel.

The litigious mindset is not limited to health care. The reflex to control appearances and limit liability, instead of taking responsibility and remedying the problem is how the U.S. Catholic hierarchy got itself into the sex-abuse pickle in the first place. But occasionally, someone has the courage to risk honesty:

One parish priest says he will never forget the day he realized his former boss, an East Coast bishop (now retired), was a true man of God. "We had to meet with a family whose child had been abused by one of our priests. When we sat down face to face with them and the lawyers, we told them that the bishop had said his first priority was to do the right thing. We told them our investigation had found that the priest was guilty, but that he had never been in this kind of situation before. We had removed him from any further parish involvement. We told them that we didn't believe we had been neglectful, but we wanted to help the family in any way we could, because we recognized lives had been damaged, and we were profoundly sorry. And that was the bishop's position.

"I looked across the table, and the family was crying," the priest recalled. "The father said, 'Thank you. We never wanted to persecute anybody. That was all we wanted to hear.'"

When a society becomes so concerned with appearance that it neglects truth, its health is an illusion that rapidly rots from inside. But if we can rediscover nature's intrinsic ordering, we can recover an integral justice in which each person assumes responsibility and admits his faults to the community. Then human society can fully flourish.

Without the right view of nature, human society will only deepen in its brutality and loneliness.


1. With these assumptions our ideas of justice can only be completely arbitrary or animalistic. If nature in itself is disordered, we can draw no notion of justice from nature: justice has no objective reference, so we must arbitrarily choose a reference. We suffer from the illusion that when we decide with no particular goal in mind that we decide "freely," but without acknowledging our base desires we leave them a free hand to control us.

Harris Interactive, Fear of Litigation Study, The Impact of Medicine, (prepared for Common Good), April 11, 2002, p. 9.

Albert W. Wu, "Handling Hospital Errors: Is Disclosure the Best Defense?" Annals of Internal Medicine 131:12 (December 21, 1999), 970.

Rod Dreher, "Sins of the Fathers: Pedophile priests and the challenge to the American Church," National Review (February 11, 2002).

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