Defense Date


Graduation Date

Fall 12-21-2018


One-year Embargo

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Gerard Magill

Committee Member

Henk ten Have

Committee Member

Joris Gielen


Mandatory Reporting, Medical Error, Organizational Ethics, Preventable Adverse Harm, Patient Safety


The goal of the dissertation is to undertake an analysis in healthcare ethics that focuses upon organizational ethics to resolve problems related to medical error in the U.S. The ethical argument focuses upon justifying a model of mandatory reporting nationally. While countless others have argued in favor of the implementation of a mandatory reporting system, this dissertation presents its model through the lens of organizational theory; arguing first that healthcare organizations are ethically required to invest in patient safety. This premise frames the foundation for this dissertation's central argument; namely, that U.S. healthcare organizations have an ethical imperative to protect the public from undue harm. Only after having established this normative foundation does this dissertation address the primary obstacle to improving patient safety (the current culture of medicine) and offer suggestions for how to begin to build a business case to incentivize decisive action to develop a culture of safety.

The ethical argument explores the justification for developing a centralized, mandatory, non-punitive reporting system that can collect and disseminate adverse event information to a national audience. The analysis relates two foundational concepts to advance this argument: namely, the system-based approach to patient safety and institutional moral agency. The discussion of the systems-based approach to patient safety informs the stance that healthcare organizations are uniquely situated to intervene to reduce medical error. This approach emphasizes the role of system defenses, barriers, and safeguards in preventing errors; recognizing that, because humans are fallible and cannot be made perfect, reform efforts need to focus on system design to prevent harm. The second concept provides a normative framework to hold healthcare organizations morally accountable for failures in system design. Without moral agency, organizations cannot be held accountable for their institutional practices or use of systems. Together, these concepts provide an ethical framework to advocate for greater transparency and the nationwide implementation of a mandatory reporting system for preventable adverse harm.