Samuel Gorovitz

Toward a theory of medical fallibility.

N o species of fallibility is more important or less understood than fallibility in medical practice. The physicians propensity for damaging error is widely denied, perhaps because it is so intensely feared. Patients who suffer at the hands of their physicians often seek compensation by invoking the procedures of malpractice claims, and physicians view such claims as perhaps the only outcomes more earnestly to be avoided than even the damaging errors from which they presumably arise. Malpractice insurance rates soar, physicians strike, legislatures intervene, and, in the end, health care suffers from the absence of a clear understanding of what medical error is, how it arises, to what extent it is avoidable, when it is culpable, and what relationship it should bear to compensation for harm. It is to this cluster of questions that we direct our efforts. We seek to provide the basic outlines of a theory of medical fallibility. Such a theory, to be accepted as adequate, must account for certain basic data. Those data include the fact that medical error not only occurs, but seems unavoidable; that some medical error seems innocent even when severely damaging, whereas other medical error seems culpable; that the harm that results from medical error seems some-

Why you don't owe it to yourself to seek health.

Sider and Clements provide a critical response to my view that there is no independent obligation to seek ones own health. They then argue that such an obligation exists. They are incorrect in their characterisation of my view; their critical discussion of the view they erroneously attribute to me is unconvincing; the positive argument they offer for their own view is unsatisfactory; they misjudge the significance of what is at issue; and they conclude by affirming a position that lacks a due regard for the rights of patients.

Is caring a viable component of health care

The attitudes and behaviours that constitute caring affect both the quality of the patients experience and the outcomes of medical care. They can be identified and can be nurtured or discouraged by the structures of organisation and financing within which health care is provided. They have costs, so their viability is threatened as pressures increase to make health care more economically efficient. Yet the value of caring behaviour may justify what is necessary to sustain it. This issue deserves prompt and extensive debate as health care systems undergo revision throughout the world.

The Physician as Moral Arbiter

When asked to comment about the physician as moral arbiter, I thought it useful to begin by considering just what a moral arbiter would be. To speak of someone as a moral arbiter, or to speak of some group as functioning in that role, is to say that there is arbitration and that it concerns moral matters.

The St. Petersburg Puzzle

The standard Bayesian account of rational decision-making leads to the St. Petersburg paradox. Jeffrey’s response to the paradox suggests a modification of the St. Petersburg game. The puzzle is that it seems reasonable to refuse to play the game, contrary to Bayesian analysis, yet the game is immune to Jeffrey’s original objections. A partially systematic account of the rationality of refusal can be based on the observation that in making decisions there is an implicit level of likelihood below which possible events are discounted, and properly so. A thorough account of rational decision-making should incorporate some standard of how the refusal to consider extremely unlikely contributions to expected utility can be warranted.

The artificial heart: questions to ask, and not to ask.

Recent developments in the artificial health program, such as the transplantation of the Jarvik device into Dr. Barney Clark, have prompted a re-evaluation of this technology. Gorovitz discusses the artificial heart in the contexts of patient autonomy and resource allocation. He sees the heart as an example of new medical capabilities that could increase the divergence between the values of physician and patient, and tension between individual interests and the social good. He raises several points to be considered in the debate about the costs and benefits of the heart program, and cautions against prematurely establishing criteria by which to ration artificial hearts.

Improving Academic Writing

nouns should be fought like the devil, especially by philosophers. This is among the reasons for favoring the Anglo-Saxon. Because we so often need abstract terms (which typically come from Latin or Greek), we should avoid them where we can. This is from a reputable journal: A more abstract exploration of the formulations’ implications for each other, however, will reveal that each is unacceptable. Of five consecutive words, three end in ‘ation’; it looks terrible, and is dreary to read. Compare: If we explore more abstractly what each formulation implies for the others, we see that none is acceptable. Not great, but it is better. Before submitting anything for publication, Bennett also asks the software to reveal every instance of ‘ation’, ‘ness’, ‘ism’, ‘ility’ and their plurals—and asks of each, ‘Is this earning its keep?’ Often the answer is ‘No.’ Another published example: None of these positions would make the distributive hybrid vulnerable to the objection to utilitarianism dealing with distributive justice. For that objection, as I have said, arises ultimately in response to the utilitarian conception of the overall good, which ranks states of affairs according to the amount of total satisfaction they contain. And the distributive hybrid’s rejection of that conception of the overall good is unequivocal. Its institutional principles, whatever they may be, rely on the distributive principle for ranking overall states of affairs. Thus none of the possible institutional principles would require that some people’s life prospects be sacrificed in order to increase the non-essential satisfactions of other people whenever that would serve to maximize total aggregate satisfaction. For they all reject the conception of the overall good which leads utilitarianism to require just that. [137 words]

A comparative health policy travelling seminar

The analysis of health care is now taught across the globe, but neither the teaching nor health care itself is a clearly defined activity. Thus, the teaching of analytical skills to health workers takes many different forms, and is done in widely divergent institutions and cultures. In what follows Professor Samuel Gorovitz describes a particularly innovat ive-and obviously highly stimulating--international initiative designed to equip students with a better understanding of this diversity.

Reflections of a Practical Philosopher@@@Drawing the Line: Life, Death, and Ethical Choices in an American Hospital

Book reviewed in this article: Drawing the Line: Life, Death, and Ethical Choices in an American Hospital. By Samuel Gorovitz

Global Objections to Kidney Sales

A legal prohibition against a commercial market in transplantable organs became law on October 19, 1984, when President Reagan signed S2048, incorporating that provision of HR4080 in support of which I argued with the testimony reprinted here. Professor Humber has tried to refute the position taken in that testimony, but I find his objections unconvincing. I appreciate his providing me this opportunity to explain why.