The Tragedy of Moral Mistakes

A tragic case was recently reported of a man who died following botched care via the NHS’ telephone helpline. Suffering from blood poisoning, a series of errors, mis-recording and failure to listen meant that he was told simply to take the remedy ‘Gaviscon’. He died shortly afterwards.  This was rightly widely reported in the press as a major failing of the health system. Many such catastrophic errors in medicine are reported in the press, and wherever possible safeguards put in place to prevent their re-occurrence.

However, we seem to accept deaths that occur not through medical mistakes but through what I will call moral mistakes. For example, each day 3 people die on the waiting list to receive organ transplants. Many of those could be saved if all those eligible and consenting to give organs did so. But instead, organs are withheld even when those who have opted in to organ donation die, because their families decide against it. Others are withheld because we have failed to introduce an opt out system of consent, meaning that those who simply never got around to signing up are excluded from bringing life to another person.

This is just one example of how mistakes in medical ethics can kill people. There are many more.

I have written before about access to medicine. Patients with currently untreatable and imminently lethal diseases may die because they are denied access to new experimental medicine until they have gone through the long process of randomised controlled trials. Whilst these trials are the gold standard both in producing evidence, and protecting patient safety in the majority of cases, applying them dogmatically to this one group of patients who have little to lose and much to gain is a mistake which could, if an effective medicine is developed, mean that some people die even though a medicine that could help them is available, because they were either denied access to the trial, or because they were in the trial but on the placebo arm.

Other patients may die, albeit indirectly, because we do not use the wealth of data we have collected from all patients for research due to overly onerous requirements to obtain consent. There is now a push to collect more data for research. There are many more examples.

As Janet Radcliffe Richards has said: “If you die through mistakes in moral reasoning, you are as dead as if you die through mistakes in medicine”

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8 Responses to The Tragedy of Moral Mistakes

  • edwin says:

    Issues are not as black and white as presented here. The importance of organ doners can not be over stated. Unfortunately not everyone is a willing doner. China is perhaps the best known example, though not the only example.

    http://www.huffingtonpost.com/2009/12/21/israel-admits-harvesting_n_399623.html

    The opt out strategy will encourage problems like Israel and China and make them much harder to deal with. Morally I am willing to have people die because of lack of organs than questions of whether or not someone has been killed in order to produce needed body parts. To stay on the safe side of that question the opt in method is the morally preferable method.

    I don’t think that it is reasonable to assume that “that can’t happen here” wherever here happens to be.

    The issue of experimental drugs is also not so black and white as presented here. It may be worth wile for someone with a terminal disease to risk extreme odds and high cost for some drug with a very low odds of success, but it may not be reasonable for the medical system as a whole to allow such activity. One of the limitations of universal medical care is that medical care is not unlimited. At a certain cost, you will be denied treatment and will potentially die. This is an unavoidable aspect of universal care.

    • Dan says:

      There is a world of difference between an opt out method of organ donation and murder to produce organs. An opt out organ donation scheme would merely allow the many people who are apathetic with regards to organ donations donors. In other words, the system will assume that people who die want their organs to save other people’s lives rather than assuming the dead want to keep their organs for some reason.

      I not only fail to see how an opt out system would encourage murder for organ harvesting, it seems like it would actively discourage it by “flooding” the market with organs so that the demand for black market organs would diminish. And when you examine the rates of organ donations in opt out versus opt in countries, there is no doubt that the opt out system produces vastly more donations.

  • Andrew says:

    However, we seem to accept deaths that occur not through medical mistakes but through what I will call moral mistakes. For example, each day 3 people die on the waiting list to receive organ transplants. Many of those could be saved if all those eligible and consenting to give organs did so. But instead, organs are withheld even when those who have opted in to organ donation die, because their families decide against it. Others are withheld because we have failed to introduce an opt out system of consent, meaning that those who simply never got around to signing up are excluded from bringing life to another person.

    Chess is your typical epistemically complete, zero-sum game where there is no winner unless your opponent makes a mistake of some sort.

    I fail to understand why the quote above exemplifies a moral mistake (although of course I agree that there are moral mistakes) since I fail to understand why you’ve ruled out the possible epistemic incompleteness and subjectivity (i.e. morally relevant personal values that make morality an non-zero-sum “game”) that matter in the decision to withhold organs in some circumstances.

    • Dan says:

      The reason why it is a mistake is described by the post: opt in donation schemes result in people who don’t care one way or another not donating.

      The people who may have morally relevant moral values prohibiting donation are still allowed to opt out in an opt out donation scheme (indeed, that is quite literally the definition of the name). Opt out schemes result in much higher rates of donation without violating a personal right to withhold donation consent (that personal desire is vastly outweighed by the benefit produced by donated organs too, but that is another discussion entirely). Thus, opt in schemes are strictly inferior to opt out schemes.

  • Andrew says:

    The fact the family may decide against donation is not sensitive to the opt-in/opt-out distinction, and for the reasons I gave above, in some circumstances it may be the case that the decision to withold organs from the family does not consist in a mistake — let alone a moral one.

    By the way, I understand how the opt-in/opt-out distinction applies to cases where the person whose consent can be reasonably assumed without asking her to specify the scope of its consent. For instance, if you subscribe to an association’s website it is reasonable to register you to the association’s newsletter not only because it’s reasonable to assume that you’ll be interesting in what happens to the assocation, but also because it is a Yes/No matter.

    But I don’t understand how organ donations can be a Yes/No matter; a responsible health institution will want to enquire about how healthy the organs of the person actually are, and will want to know which organs can be taken. But then the very fact that you have to ask for such details does not seem to leave much room for the distinction. The only difference seems to be between telling the patient that she (i) is free not to give her organs if she so desires or (ii) is free to give her organs if she so desires.

    So what it is the scheme that is strictly superior to opt-in donation schemes?

    • Dan says:

      You have a fundamental misunderstanding about how opt-out donation schemes work. Of course health institutions don’t just use all organs of any and all who did not opt-out of the donation. Honestly, that is so obvious that is shouldn’t have to be said. If you are not an organ donor, they will never have the option to collect your organs after death. If you are an organ donor, then they will collect those organs which are viable and useful after running the appropriate tests on them.

      The difference between opt-in and opt-out schemes is really just that simple, in one they ask you if you want to be an organ donor (and you are only an organ donor if you say yes) while in the other they ask if you do NOT want to be an organ donor (and you are an organ donor unless you say no). The choice is still 100% in the original person’s hands. The difference is that opt-in schemes have 30% donation rate while opt-out schemes have 70+% donation rates. And that is why opt-out schemes are strictly superior to opt-in schemes.

      • Andrew says:

        Interesting, so the distinction boils down to two ways of asking the same question? So the moral mistake consists in picking the wrong way of asking the question?

        • Dan says:

          Exactly. The phrasing of the question has a massive influence on how many people end up donating their organs even though both questions respect a person’s right to hold donation consent.

          So it’s a moral mistake because phrasing the question poorly will result in fewer donations (read fewer lives saved) without benefiting anyone.

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