Although medical errors must be avoided due to their unfavorable outcomes for the patients, they sometimes happen. In that case, a medical professional who has made an error has to understand the ethical and legal implications of their actions. The nondisclosure of a mistake may lead to unfavorable health outcomes for the patient, although many medical professionals may be afraid to disclose an error due to fear of being sued. Nurses and hospitals are affected by the decision not to disclose a medical error.
When examining the ethical approach to disclosure and nondisclosure, one has to consider the different ethical theories. For example, from a utilitarian viewpoint, a decision should be based on the number of people and the benefit that a decision will bring. Zwitter (2019) describes the utilitarian approach in the following manner: “with the available resources, do as much good as you can” (p. 15). Disclosure would put the hospital and the nurse in an unfavorable position because the patient may choose to file a lawsuit against the organization. If the patient never finds out about this error, the hospital and the nurse, in general, would benefit. However, Zwitter (2019) notes that the utilitarian approach is practical when working with large-scale disasters and not individual patient cases. This is because this ethical approach allows disregarding the effect of a decision on the individual. For example, this patient may have side effects from the medication that will harm their health in the long term, which they will not know about due to the decision to not disclose.
The virtue ethics approach implies that the nurse has to possess the moral qualities that will require them to disclose the error they made when prescribing the medication. Virtue ethics is based on the appraisal of the character qualities that benefit others and the community (Zwitter, 2019). With this approach, honesty and care for others’ well-being would be the best qualities regarded as good for an individual, and therefore, nondisclosure would be a violation of the ethical norms. Hence, virtue ethics requires the advanced practice nurse to contact the patient and share the details of their medical error as well as the potential consequences and outcomes of this action.
The nurse has to disclose the error due to the respect for the autonomy of the patient and the need to provide them with all the information about the decisions related to their health, following deontological ethics. Deontological ethics is based on the idea that each person is a sacred and autonomous individual (Zwitter, 2019). Moreover, if there is some rule of ethics that is commonly acknowledged and accepted by the other members of society, everyone should follow it and apply it without consideration (Zwitter, 2019). It is widely accepted that lying is unethical, and therefore, the nurse has to disclose the truth to the patient. Thus, deontological ethics also requires a nurse to disclose a prescription error.
Although ethically, it is correct to tell this patient the truth about an error to ensure that they have full information about their health and well-being, the legal aspect of a prescription error may differ. The state of California has a medical error prevention system that differs from that in the other states because the policymakers are allowed to fine hospitals for all preventable errors that their employees have committed (Melnyk et al., 2019). Moreover, according to Melnyk et al. (2019), the state has issued over 300 penalty reports to the hospitals operating in its area. Therefore, the state’s approach to addressing medical errors has affected several hospitals and has shown that serious preventable medical errors are an issue.
On a state level, Medicare requires the healthcare facility to pay for the treatment of the consequences that are a result of the medical error. According to Food and Drug Administration (2019), other states practice fining hospitals for each day that the facility does not report the error to the patient. Therefore, from a legal perspective, the hospital may suffer severely by not reporting the medical error to the patient and not addressing the consequences of it because the authorities have the right to fine this facility for such actions.
Individual states have implemented legislation addressing the issue of medical errors that are common, in many cases preventable, and can have detrimental effects on the patient’s health. However, federal law does not require hospitals to report the errors that have happened within their facilities (Melnyk et al., 2021). As a result, 27 states have legislation dedicated specifically to the requirement regarding the need to report medical errors to patients and authorities (Melnyk t al., 2021). Interestingly, the types of errors that have to be reported and the nature of the reports vary from state to state.
For me as a nurse, legally, nondisclosure does not have a direct effect on my medical license or work, but the insurance company or the hospital can be financially penalized for this issue. However, the hospital or the legislators can issue an investigation to determine the reasons for the non-reporting of the causes. If I am found guilty, my career as a nurse will be affected. For the hospital, nondisclosure could mean a risk of a lawsuit and a fine if the patient discovers this issue.
Since medical errors are common, there are protocols and systems in place that aim to reduce the number of them. de Araujo et al. (2019) offer the following prevention approach: “promoting educational actions on prudent prescribing directed to prescribers; incorporating computerized alert systems into clinical practice; implementing the use of tools for guiding medication prescribing; and, encouraging patient care by a multidisciplinary team, with the participation of a pharmacist” (p. 439). For example, when prescribing medication, the nurse has to follow a systemic approach developed by the WHO. The steps involve specifying the patient’s concern, defining the therapeutic objective, selecting the appropriate medication, providing the details and initiating the therapy, giving information to the patient, and monitoring the outcomes of the process (de Araújo et al., 2019). This approach implies ongoing monitoring of the patient case and the therapy process, which should in part help a nurse identify a prescription error in the early stages. Moreover, the fact that the nurse prescribing the medication has to give a plethora of detail to the patient is another way of preventing an error as the therapy process has to be extensively discussed with the individual.
In summary, this paper discusses the legal and ethical implications of medical errors. The main premise of the ethical approach is that in the case of nondisclosure, both the patient and the medical facility are subjected to harm. Legally, the federal government has not issued any legislation requiring the mandatory reporting of medical errors; however, 27 states require such reporting. Hence, a nurse should disclose the medical error.
References
de Araújo, B., de Melo, R., de Bortoli, M., Bonfim, J., & Toma, T. (2019). How to prevent or reduce prescribing errors: An evidence brief for policy. Frontiers in Pharmacology, 10, 439.
Food and Drug Administration. (2019). Working to reduce medication errors. Web.
Melnyk, B., Tan, A., Hsieh, A., Gawlik, K., Arslanian-Engoren, C., & Braun, L. (2021). Critical care nurses’ physical and mental health, worksite wellness support, and medical errors. American Journal of Critical Care, 30(3), 176-184.
Zwitter M. (2019). Medical ethics in clinical practice. Springer.
