PRIMUM NON NOCERE : Medicine's Culture of Dealing with and Denial of the Occurrence of Medical Harm

Sammanfattning: The hippocratic principle "primum non nocere" (above all do no harm) has always been and still is the strong foundation of medical conduct. For a long time healthcare professionals created the image of infallibility of medicine. Even within the "closed" hierarchies mistakes and malpractice were never openly discussed. This paper first investigates reasons for medical mistakes and introduces the legislation when malpractice occurs. Secondly ethical questions concerning medical mistakes are discussed through the lens of Beauchamp and Childress' principles of biomedical ethics (nonmaleficence, beneficence, respect for autonomy, justice). Thirdly, an ethically defensible strategy to deal with failure and malpractice is proposed. This proposal stresses how to improve the patient-physician communication by involving patients' experiences in order to increase patient safety and lower costs in the healthcare system. In regard to tackling medical harm there is the strong recommendation to follow four directives: open disclosure and explanation, adequate restorative and/or compensatory actions, fair and square apologies and information about strategies to avoid recurrence.