First things first: "medical error" is not "medicine" it is "error." The discipline appropriate to its study and diagnosis is not medicine but theory of error - errorology! What is involved is a part of the study of human behavior. That errors happen to occur in a medical setting is the reason for my speaking here. If the identical error happened to occur in a nuclear power plant I would be saying very similar things to a meeting of nuclear power specialists (with some variation in nomenclature of course). It has been repeatedly said, over thousands of years, that to err is part of being human. For example:
1. ERRARE HUMANUM EST; to err is human. (Probably a variation on Plutarch, Morals, c 100 AD)
2. "I presume you're mortal, and may err." (Shirley, The Lady of Pleasure, 1635)
3. "To err is human; to forgive divine." (Pope, Essay on Criticism 1711)
4. "To err is human; to forgive is against company policy." (Senders, various, 1978)
All of these state that errors will be made by people despite their determination to avoid them. Yet people are consistently held accountable for their errors when they lead to accidents: adverse outcomes.Is this proper? I argue that it is not, in the same way that in law no-one is held accountable for acts of God.
The Distinction Between Errors And Accidents
What is an error? From the external viewpoint, an error is a failure to perform an intended action which was correct given the circumstances. In my view an error can occur only if there was or should have been an appropriate intention to act on the basis of a perceived or a remembered state of events; and if the action finally taken was not that which was or should have been intended. An error is not defined by an adverse or serious outcome. An adverse outcome may occur with no error if the intention was the proper one, the action was properly executed, and the outcome was probabilistic in nature (as in playing a game, in deciding whether to carry an umbrella, or in...