LEFO - Legeforskningsinstituttet

Institute for Studies of the Medical Profession

IPOQ 2013: Research on health and working conditions of the medical profession

Terje Mesel

When things go wrong. Stories of guilt, shame and responsibility in medical practice
7. november 2013

Terje Mesel, PhD, is an associate professor in ethics at the institute of philosophy, religion and history at Agder University, and researcher at Sørlandet Hospital, Kristiansand, Norway. In his doctoral dissertation (2009) he analyzed the ethical reflection of a qualitative sample of Norwegian hospital doctors. Earlier this year he edited the book Makt og avmakt. Etiske perspektiver på feltet psykisk helse (2013). By winter 2014 he will publish a monograph with the working title When things go wrong. Stories of guilt, shame and responsibility in medical practice. The book is a philosophical narrative analysis of 25 doctors, psychologists and nurses´ experience of adverse events.

When things go wrong. Stories of guilt, shame and responsibility in medical practice
Adverse events unfortunately happens in health care. For the doctor such tragic events can activate emotional responses and inadequate coping mechanisms where the moral implications of the situation are not fully met. The preliminary thesis of the study is that: a) Such events are constitutive for how they will later understand and practice their work. b) A contextual clarification of the concepts of guilt, shame and responsibility can facilitate for better handling and better coping. The study is based on in-depth interviews with 25 health workers from different professions/specialities whose narratives involves situations where things went terribly wrong. The analysis rests on a presentation of 8 narratives.
The analysis so far has shown that it is necessary to make a clear distinction between responsibility and guilt. Being responsible implies moral lucidity and a willingness to make clear ones reflection and action in the given situation. However, it does not imply guilt. Secondly, the question of guilt is complex, especially in health care where so many factors are outside our control. This fact, however, does not diminish our responsibility for what is outside our control. Thirdly, other –oriented feelings of guilt provides a much better ethical bridging than self-oriented feelings of shame. Thus, it is important both to recognize and facilitate for feelings of guilt rather than to facilitate for feelings of shame. However, excessive feelings of guilt can be crippling, and it ought to be a responsibility for the professional community to contribute to emotional calibration in order to facilitate individual coping mechanisms that meet the moral implications of the events.

Look at Terje Mesel´s presentation in the attached file (pdf).
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