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Correspondence |

Ethics of the Malpractice SystemEthics of the Malpractice System FREE TO VIEW

Michael T. Vest, DO, FCCP
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine, Christiana Care Health System.

Correspondence to: Michael T. Vest, DO, FCCP, Christiana Care Pulmonary and Critical Care Medicine, 4745 Ogletown Stanton Rd, Medical Arts Pavilion 1, Ste 220, Newark, DE 19713; e-mail: mvest@christianacare.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1835. doi:10.1378/chest.13-0263
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To the Editor:

Dr Hyman and Prof Silver’s1 article published in the Medical Ethics section of CHEST (January 2013) states that the system of resolving malpractice complaints is expensive. However, there was no discussion of the ethical dilemmas raised by the facts they present.

In medical ethics, the principle of justice is often used to discuss the distribution of resources. Our fault-based system starts with the premise that a person injured by negligence is entitled to more resources than a person with an identical injury due to bad luck. This reflects a value judgment, and the system that arises from that judgment is expensive.

The authors state that the direct costs of the malpractice system are about 2% of total health-care spending (ie, 2% of perhaps $2.6 trillion).1 Mello et al2 estimated that the cost of the malpractice system in 2008 dollars was $55.6 billion annually. The authors report that in a state of 25 million people (Texas) about 5,300 malpractice claims were made annually, and 20% resulted in payment, with an average jury verdict of $3 million.1 This means that about 1,060 claimants (0.0042% of the Texas population) were compensated by this system in Texas. So, our system spends $55.6 billion (a figure greater than the entire health-care budget in some developing countries) to benefit a very small proportion of the population.

There are a variety of reasons for the cost. However, one reason cited by the authors is potentially ethically troubling for physicians: the high cost of expert witnesses.1 This raises the question: Even if the market will allow it, is it ethical for a physician to charge more per hour for services as an expert in a malpractice case than he or she is paid per hour for patient care services?

Some might argue that no expense should be spared to compensate an injured patient, since no amount of money will ever be enough to make up for an injury. They might believe that $55.6 billion annually is too small an investment in the malpractice system. Others might suggest that the $55.6 billion could be better spent on improving public health or patient safety here in the United States or be spent on health care in resource-poor nations. Whatever your opinion, it is important to remember that the choices we make reflect our values.

References

Hyman DA, Silver C. Five myths of medical malpractice. Chest. 2013;143(1):222-227. [CrossRef] [PubMed]
 
Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29(9):1569-1577. [CrossRef] [PubMed]
 

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References

Hyman DA, Silver C. Five myths of medical malpractice. Chest. 2013;143(1):222-227. [CrossRef] [PubMed]
 
Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29(9):1569-1577. [CrossRef] [PubMed]
 
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