Systemic error in healthcare has been identified in many countries including Ireland and has been calculated as the 3rd leading cause of death in the US (1)(2).The costs of medical error are enormous and do not appear to be falling (3)(4)(5). Can the medical profession do better by top down regulation or does it need to rethink medical professional behaviour?

In this presentation I will examine the evolution of medical ethics concentrating on the last 60 years and suggest alternative ways to influence medical professional behaviour (6)(7). I will review technological, ethical and behavioural changes that could all contribute to improvements in healthcare safety if we as clinical leaders want to adopt these changes in our working lives. As anaesthetists there are opportunities to provide leadership to our colleagues in other specialties and we should not miss these chances.


1.           Rafter N, Hickey A, Conroy RM, Condell S, O’Connor P, Vaughan D, et al. The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals—a retrospective record review study. BMJ Qual Saf. 2017 Feb 1;26 (2 ):111–9.

2.           Makary MA, Daniel M. medical-error—the-third-leading-cause-of-death-in-the-us. London: BMJ Publishing Group Ltd.; 2016. p. i2139. Available from: http://www.bmj.com/content/353/bmj.i2139

3.           Kohn CT, Corrigan JM, Donaldson MS. To Err is Human. Building a Safer Health System. Washington: Institute of Medicine; 1999.

4.           Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal Trends in Rates of Patient Harm Resulting from Medical Care. N Engl J Med. 2010;363(22):2124–34.

5.           Classen DC, Resar R, Griffin F, Frederico F, Frankel T, Kimmel N, et al. “Global Trigger Tool” Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured. Health Aff. 2011;30:4581–9.

6.           Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 1st ed. New York: Oxford University Press; 1973.

7.           Bolsin S, Faunce T, Oakley J. Practical virtue ethics: healthcare whistleblowing and portable digital technology. J Med Ethics. 2005;31(10):612–8.


Stephen Bolsin, Consultant, Australia


Please note: If you are not a member of the Ethox Team and are planning on coming, please email jane.beinart@ethox.ox.ac.uk in advance.  Spaces on the 24th May are limited.