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Guilt, forgiveness and medical error

02 March 2019
Volume 27 · Issue 3


Is the greater emphasis on no-blame working cultures at odds with health professionals' responsibility to recognise and learn from errors? George Winter debates the issues at stake

The writer Ambrose Bierce said that guilt is felt by one who has committed an indiscretion but failed to cover his tracks, while forgiveness aims to throw an offender off his guard and catch him red-handed in his next offence (Bierce, 1967). Leaving aside Bierce's cynicism, to err is human, and sometimes the outcome is trivial; other times, disastrous. So perhaps it is worth considering philosophical perspectives on guilt and forgiveness.

Schrøder et al (2017) found that, in the aftermath of a difficult childbirth, obstetricians and midwives struggled with blame and guilt, and noted how these feelings contrasted with a blame-free patient safety culture that approaches errors as systemic failings, not individual ones. Furthermore, Skinner and Maude (2016: 35) detected a shift in midwifery in recent decades, with skilful practice and conscious alertness apparently ‘replaced by the concept of risk with its connotations of control, surveillance and blame.’

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