{"id":4809,"date":"2026-09-22T02:26:10","date_gmt":"2026-09-22T01:26:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4809"},"modified":"2026-09-22T02:26:10","modified_gmt":"2026-09-22T01:26:10","slug":"three-moral-logics-in-responding-to-adverse-events-in-healthcare","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/09\/22\/three-moral-logics-in-responding-to-adverse-events-in-healthcare\/","title":{"rendered":"Three moral logics in responding to adverse events in healthcare"},"content":{"rendered":"

By Laura Hartman<\/span><\/p>\n

Unintended and unwanted outcomes are an inevitable part of healthcare. When something goes wrong, organisations face difficult questions: How should they respond? How can they do justice to those involved? And how can they improve care while maintaining trust?<\/p>\n

In our recent paper, we develop a conceptual framework that distinguishes three moral logics underlying organisational responses to adverse events: norm enforcement<\/strong>, learning<\/strong>, and repair<\/strong><\/p>\n

Norm enforcement<\/strong> focuses on accountability when professional or legal standards have been breached. Its primary aim is to protect patients and uphold the quality of care through fair and transparent procedures.<\/p>\n

Learning<\/strong> focuses on understanding how an event occurred and what can be done to prevent similar incidents in the future. Rather than concentrating solely on individual actions, it examines the broader organisational and systemic context. Learning depends on openness, reflection, and psychological safety.<\/p>\n

Repair<\/strong> focuses on addressing harm and restoring trust. It acknowledges that adverse events can affect not only patients and their families, but also healthcare professionals involved. Repair seeks recognition, dialogue, responsibility, and efforts to rebuild damaged relationships.<\/p>\n

Although these three moral logics are analytically distinct, they frequently overlap in practice. This can create tensions. Procedures designed to establish accountability may discourage the openness needed for learning. Regulatory systems often devote considerable attention to enforcement and learning but less to repair. At the same time, public demands for transparency can make it more difficult to create the safe spaces required for reflection and restoration.<\/p>\n

The framework does not argue that one moral logic is superior to the others. Rather, it helps make visible the different understandings of justice, accountability, and responsibility that shape organisational responses to adverse events. Recognising these distinctions can help healthcare organisations, policymakers, regulators, and professionals better navigate the tensions that arise when responding to harm.<\/p>\n

This paper is based on earlier work conducted at the Dutch Centre for Ethics and Health (CEG) and was developed in collaboration with CEG staff and CEG council members. We dedicate the paper to health law scholar Aart Hendriks, whose insights helped shape the framework and who sadly passed away before its publication.<\/p>\n

Paper: <\/strong>Norm enforcement, learning and repair: three moral logics in organisational responses to unintended and unwanted healthcare outcomes\u00a0<\/a><\/p>\n

Authors<\/strong>: Laura Hartman (1), <\/span>Geranne Lautenbach (2), Eva van Baarle (3)<\/p>\n

Affiliations<\/strong>:<\/p>\n

    \n
  1. Department of Public Health, Erasmus Medical Center, Netherlands<\/li>\n
  2. University of Amsterdam, Netherlands<\/li>\n
  3. Netherlands Defense Academy and Amsterdam University Medical Center, Department of Medical Humanities<\/li>\n<\/ol>\n

    Conflict of Interest<\/strong>: None to Declare<\/p>\n","protected":false},"excerpt":{"rendered":"

    By Laura Hartman Unintended and unwanted outcomes are an inevitable part of healthcare. When something goes wrong, organisations face difficult questions: How should they respond? How can they do justice to those involved? And how can they improve care while maintaining trust? In our recent paper, we develop a conceptual framework that distinguishes three moral […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":522,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8130,8088],"tags":[],"class_list":["post-4809","post","type-post","status-publish","format-standard","hentry","category-ethics","category-healthcare"],"yoast_head":"\nThree moral logics in responding to adverse events in healthcare - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/09\/22\/three-moral-logics-in-responding-to-adverse-events-in-healthcare\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Three moral logics in responding to adverse events in healthcare - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Laura Hartman Unintended and unwanted outcomes are an inevitable part of healthcare. 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