Iatrogenic Harm : Redress and the NHS

The thesis addresses how effectively or otherwise litigation and NHS complaints procedures redress ‘harm’ suffered by patients through treatment under the NHS. I argue that patients’ entitlement to redress within the NHS is founded on corrective justice principles, requiring one who harms another without justification to indemnify the individual harmed. Entitlement is finite because the NHS is a communal enterprise with limited resources explicitly expected to be shared throughout the population. Accordingly, distributive justice must apply to monetary compensation. For my purposes, harm includes significant adverse events, even where the requirements for actionable negligence necessary to mount successful legal action are not met. The emphasis is on patients’ access to justice, with account also taken of the toll on doctors under the present system.<br/>I explore what patients seek from redress and the possible forms compensation may take. Litigation, curtailed by withdrawal of public funding, can only offer damages for loss. Complaints procedures theoretically offer, inter alia, explanations, apologies and undertakings to repair. Careful consideration of both systems reveals that in their present unconnected form, insufficient congruence obtains between what aggrieved patients with complex needs require and what they receive.<br/>Lack of open disclosure of adverse events perpetuates power differentials between parties and adversely affects patients’ abilities to seek appropriate redress. Analysis of constraints on disclosure highlights the nuanced communication that is necessary and the fears of legal ramifications which apologies engender. After discussing apology- protection legislation in other <br/>common law countries, I argue for the role that full apologies can play in explanation, communication and undertakings to repair, particularly in addressing intangible loss. I also argue that in a universal health service, non-pecuniary losses should not be monetarily compensated because they are uncommodifiable and because of distributive justice demands. The thesis <br/>concludes with reflection on the prerequisites for a just and effective redress system.

Name dc:type.qualificationname

Doctor of Philosophy

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

King's College London

Year dc:date.issued

2013

Author dc:creator

• Goldberg, Rhoda

Advisors dc:contributor.advisor

• Scott, Rosamund Deirdre
• Lee, Maria
• Lunney, Mark

Language dc:language

eng

Identifier

oai:kclpure.kcl.ac.uk:studenttheses/8a6b369d-c59b-4610-8de9-d475d434cd3c

OAI identifier oai:identifier

oai:kclpure.kcl.ac.uk:studenttheses/8a6b369d-c59b-4610-8de9-d475d434cd3c