When things go wrong. Stories of guilt, shame and responsibility in - PowerPoint PPT Presentation

Research project: When things go wrong…. Stories of guilt, shame and responsibility in health care. Forthcoming book: Cappelen Damm Akademsk winter 2014 Terje Mesel Agder University Sørlandet sykehus ABUP

Task • To analyse how stories of ” When things go wrong ” shape/constitute both professional identity and practice • To analyse how existential moral concepts are put to play in these stories • Can clarification of these concept be useful for coping with these stories both in relation to self, patients (next-of-kin) and collegues? • Philosophical analysis: – Responsibility, guilt, feeling of guilt, feeling of shame – Scapegoating mechanisms.

A qualitative narrative study • 23 in-depth interviews – 15 doctors, 2 psychologists, 5 nurses • 9 narratives – Thea and the art of balancing (responsiblity) – Per P and the female patient ( guilt and responsibility) – Ellen E and 24 hours of rural practice (calibration) – Kari K and the dead infant (scapegoating and guilt) – Frida F and the suicidal patient (shame and coping) – ……

Summary of findings • Not stories of bad apples (the many contacts). • Stories that change identity and practice – Personal – professional reference points shaping lives – To give up/ get up/ defensive medicine • To balance the concepts on your own: – Responsibility and guilt (bad luck/to find the right viewpoint/e.g. Patient suicide in psychiatry – Calibration of moral guilt – feeling of guilt (non-moral guilt) – Shame and collegial nivellation (ethical bridging)

Ethical sustainability • Sustainable professional responsibility in zones of moral risk, demands a sustainable context for responsibility • Professional shared responsibility or individualised responsibility? – Moral crescendo, moral residue, moral injury • Moral ventilation or procedures for (obligatory) retrospective clinical assement – Focus on facts, responsibility, learning – but also possible blameworthiness.