J Med Ethics 31:106-108 doi:10.1136/jme.2003.005538
  • Teaching and learning ethics

Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error

  1. N Berlinger1,
  2. A W Wu2
  1. 1The Hastings Center, Garrison, New York, USA
  2. 2Department of Health Policy and Management, School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
  1. Correspondence to:
 N Berlinger
 The Hastings Center, 21 Malcolm Gordon Road, Garrison, New York 10524, USA;
  • Received 25 June 2003
  • Accepted 24 October 2003
  • Revised 22 October 2003


This article proposes that knowledge of cultural expectations concerning ethical responses to unintentional harm can help students and physicians better to understand patients’ distress when physicians fail to disclose, apologise for, and make amends for harmful medical errors. While not universal, the Judeo-Christian traditions of confession, repentance, and forgiveness inform the cultural expectations of many individuals within secular western societies. Physicians’ professional obligations concerning truth telling reflect these expectations and are inclusive of the disclosure of medical error, while physicians may express a need for self-forgiveness after making errors and should be aware that patients may also rely upon forgiveness as a means of dealing with harm. The article recommends that learning how to disclose errors, apologise to injured patients, ensure that these patients’ needs are met, and confront the emotional dimensions of one’s own mistakes should be part of medical education and reinforced by the conduct of senior physicians.


  • Dr Berlinger’s work was funded by a grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. Dr Wu’s work was funded by the US Department of Health and Human Services Agency for Healthcare Research and Quality, grant number U18HS11902-01.

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