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Discontinuity and disaster: Gaps and the negotiation of culpability in medication delivery

Dekker, Sidney LU (2007) In Journal of Law, Medicine & Ethics 35(3). p.463-470
Abstract
This paper shows how discontinuities in the process of drug delivery enable but also underdetermine the isolation of a culprit in adverse medication events. A case example illustrates how we are forced to abandon conceptualizations of blame that assume a dichotomy (either culpable or not), and shift instead to a more nuanced version that estimates the degree to which an actor desired, generated, or could have foreseen the harmful outcome, and the extent to which constraints external to the actor altered the event. The paper concludes that meaningful safety interventions in a system as diverse, socially embedded and complex as health care delivery cannot just build on "good science" (e.g., good methods) to generate "root" causes. Rather,... (More)
This paper shows how discontinuities in the process of drug delivery enable but also underdetermine the isolation of a culprit in adverse medication events. A case example illustrates how we are forced to abandon conceptualizations of blame that assume a dichotomy (either culpable or not), and shift instead to a more nuanced version that estimates the degree to which an actor desired, generated, or could have foreseen the harmful outcome, and the extent to which constraints external to the actor altered the event. The paper concludes that meaningful safety interventions in a system as diverse, socially embedded and complex as health care delivery cannot just build on "good science" (e.g., good methods) to generate "root" causes. Rather, they need to somehow be sensitive to how and which narratives of success and failure are created, as these constrain which countermeasures are likely to be encouraged, funded, and accepted. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Law, Medicine & Ethics
volume
35
issue
3
pages
463 - 470
publisher
Wiley-Blackwell
external identifiers
  • wos:000249126600013
  • scopus:34547956825
ISSN
1073-1105
DOI
10.1111/j.1748-720X.2007.00168.x
language
English
LU publication?
yes
id
780c7e34-b177-42a9-9584-c20a89e3089c (old id 657186)
date added to LUP
2007-12-07 09:45:41
date last changed
2017-01-01 04:35:36
@article{780c7e34-b177-42a9-9584-c20a89e3089c,
  abstract     = {This paper shows how discontinuities in the process of drug delivery enable but also underdetermine the isolation of a culprit in adverse medication events. A case example illustrates how we are forced to abandon conceptualizations of blame that assume a dichotomy (either culpable or not), and shift instead to a more nuanced version that estimates the degree to which an actor desired, generated, or could have foreseen the harmful outcome, and the extent to which constraints external to the actor altered the event. The paper concludes that meaningful safety interventions in a system as diverse, socially embedded and complex as health care delivery cannot just build on "good science" (e.g., good methods) to generate "root" causes. Rather, they need to somehow be sensitive to how and which narratives of success and failure are created, as these constrain which countermeasures are likely to be encouraged, funded, and accepted.},
  author       = {Dekker, Sidney},
  issn         = {1073-1105},
  language     = {eng},
  number       = {3},
  pages        = {463--470},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Law, Medicine & Ethics},
  title        = {Discontinuity and disaster: Gaps and the negotiation of culpability in medication delivery},
  url          = {http://dx.doi.org/10.1111/j.1748-720X.2007.00168.x},
  volume       = {35},
  year         = {2007},
}