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Mea Culpa: Apology Legislation, Accountability and Care

  • Karine Levasseur (a1) and Fiona MacDonald (a2)
Abstract

Increasingly, jurisdictions are adopting “apology legislation” that allow medical professionals to apologize to patients and family members when an adverse event occurs while disallowing the introduction of the apology in a liability case as evidence of fault or liability. While apology legislation itself is fairly straightforward, its potential meaning and impact is much more complex. This paper conceptualizes apology legislation from an accountability and ethics of care perspective. These two concepts—accountability and care—are distinct but interrelated concepts and this dual theoretical approach offers a rich analysis on the potential impact(s) of apology legislation. We argue that apology legislation is a mechanism added to the existing accountability regime that can offer important opportunities to express and practise care. As an accountability mechanism, apology legislation creates space for an accountability relationship to emerge between medical professionals and their patients. Apology legislation also addresses long-standing gaps in how we as a society think about health care and respond to patients and families in ways that challenge the dominant “consumer of services” role. It is in this sense that apology legislation has the potential to destabilize traditional notions of social citizenship. Last, we argue that empirical research is urgently needed to know to what degree apologies contribute to accountability and the transformation of health care.

De plus en plus, les provinces et les territoires adoptent des « lois sur la présentation d'excuses » qui permettent aux professionnels de la santé d'exprimer des regrets auprès des patients et des membres de leur famille lorsqu'un événement indésirable se produit, tout en rejetant l'introduction d'excuses dans une affaire de responsabilité à titre de preuve de faute ou de négligence. Bien que la loi sur la présentation d'excuses en soi soit assez explicite, sa signification et ses répercussions potentielles sont beaucoup plus complexes. Le présent article conceptualise la législation sur la présentation d'excuses du point de vue de la responsabilité et de l'éthique des soins. Ces deux concepts - responsabilité et soins - sont des concepts distincts, mais interreliés et cette double approche théorique offre une riche analyse de l'impact potentiel de la législation sur la présentation d'excuses. Nous soutenons que la loi sur la présentation d'excuses est un mécanisme qui s'ajoute au régime de responsabilisation existant et qui peut offrir d'importantes occasions de dispenser et de pratiquer les soins. En tant que mécanisme de reddition de comptes, la loi sur la présentation d'excuses crée un espace pour qu'une relation de reddition de comptes entre les professionnels de la santé et leurs patients puisse émerger. Les lois sur la présentation d'excuses comblent également des lacunes de longue date dans la façon dont nous, en tant que société, pensons aux soins de santé et répondons aux besoins des patients et des familles d'une manière qui remet en question le rôle dominant de « consommateur de services ». C'est dans ce sens que la législation sur la présentation d'excuses peut déstabiliser les notions traditionnelles de citoyenneté sociale. Enfin, nous soutenons que la recherche empirique est nécessaire de toute urgence pour savoir dans quelle mesure les excuses contribuent à la responsabilisation et à la transformation des soins de santé.

Copyright
Corresponding author
Department of Political Studies, University of Manitoba, 532 Fletcher Argue Building, Winnipeg MB R3T 2N2, email: Karine.levasseur@umanitoba.ca
Department of Political Science, University of the Fraser Valley, 33844 King Road, Abbotsford BC, V2S 7M8, email: Fiona.macdonald@ufv.ca
Footnotes
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The authors thank Dr. Stephanie Paterson for valuable comments provided on an earlier draft. They also thank Dempsey Wilford, Research Assistant, University of Fraser Valley. They also thank Dr. Jack Lucas (Assistant Editor) and the peer-reviewers who provided helpful comments to strengthen the analysis. Earlier versions of this paper were presented at Canadian Political Science Association Annual Conference on May 31, 2016, at the University of Calgary, and the Canadian Association of Programs in Public Administration (CAPPA) Conference held at the University of Manitoba, Winnipeg on May 16–17, 2017.

Footnotes
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Canadian Journal of Political Science/Revue canadienne de science politique
  • ISSN: 0008-4239
  • EISSN: 1744-9324
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