Risk and Accountability

Do no harm,” is the core conduct of civility that allows some semblance of peaceful coexistence.  This ethical tenet is foundational to the human condition.  An event in the past week has violated this often unstated, but understood code of decency.

None of us ever knows with absolute certainty what will happen from one moment to the next.  As we leave the doors of our “safe” homes, just what is in store for us?  The world is full of potential harm.  Risk is inherent in everything we do.  Harm to self, harm to others, harm by self, harm by others.  Harm can be physical, emotional, financial, or relational.  I can be intentional or unintentional. 

Every time since 9/11/2001 when I board a plan, I participate in an effort to mitigate risk of harm by terrorist activity by going through a security checkpoint.  I don’t fancy the drill, but at the same time I don’t mind knowing my flight might be a bit safer. 

This week Malaysia flight MH17 was reportedly struck by a surface to air missile in the Ukraine that killed all 298 people on board.  I would imagine these passengers probably initially felt that same aforementioned degree of safety I do when they boarded their plane.  And then the unfathomable and the unexpected happened.   

The plane was generally considered to be in a “safe” zone from risk (> 32,000 feet) along this route even though there had been two military planes shot down in that area in the past week.  This was a gross miscalculation of risk.  This is one occasion where there was not any human error by the pilots or mechanical failure of the plane.  It was a systems issue.  Why was this air space considered safe in light of what had transpired the week before?  Was it negligent or reckless behavior to believe it was safe space?

In my work, I see the risk of potential harm in healthcare too often.  The potential of the wrong patient, the wrong procedure, the medication administration error, hospital-acquired infections, etc. is alive and well in all U.S. hospitals.   I read the transcripts of congressional hearing around patient safety held last week and had correspondence with one of the presenters after the hearing.  The patient safety advocate’s position is to increase efforts to reduce the risk of harm that kills up to 400,000 patients each year.  They believe the only way to effectively mitigate this risk is to get the government involved.  The airline has a national safety board sponsored by the FAA that has proven to drastically make commercial airlines safer and healthcare should have the same type of oversight. 

There are only so many finite resources.  Choices have to be made over which values are more important than the others which compete with each other for those resources.  To date, the U.S.  has allocated much in the name of safety.  Yet, we have a constant battle of political posturing over too much government versus no government oversight.  That’s not the issue…the issue is what is the right thing to do?”  The right thing is “do no harm.”  This should be the overarching value of our civil existence and our policy.    

So this is where the accountability comes into play.  Should there be a global organization that identifies at-risk airspace and restricts commercial planes from that area?  The events that have occurred since the plane came down have been criminal. There has been blatant disrespect for people (the passengers and their surviving families) and intentional efforts to mask the truth.  The fingers are pointing at the Ukrainian separatists who are allegedly supported by Russia.  It is a diplomatic firestorm that the world is now engaged in.  Which organization or country or countries will take the lead in attempting to reconstruct what just happened and punish those found guilty of the crimes committed? 

It’s times like these where the eternal optimist becomes a bit cynical and jaded about the internal goodness of his/her fellow humans.