Open disclosure: ethical, professional and legal obligations, and the way forward for regulation

Open disclosure: ethical, professional and legal obligations, and the way forward for regulation

Angus J F Finlay Cameron, L Stewart BEc, LLB(Hons), Ph.D.,  Malcolm Parker MB BS, MLitt, MD, https://doi.org/10.5694/mja12.10734

Summary

  • Open disclosure (OD) after adverse health care events is the subject of a national standard implemented in state health policy documents and is included in the Medical Board of Australia’s code of conduct for doctors.
  • Nevertheless, doctors have been slow to embrace the practice of OD.
  • There is a strong ethical case for implementing OD in the primary interests of patients, and additionally from a medicolegal risk management point of view.
  • There are no statutory requirements in relation to OD, but ordinary law judgments have imposed a duty of OD in tort and contract.
  • There are a number of barriers to the better uptake and implementation of OD, including perceptions of legal risk, lack of education and training, reluctance to admit error, uncertainty concerning what and how much to disclose, and the variations in state and territory “apology laws”.
  • The implementation of OD could be improved by making apology laws consistent across jurisdictions, including providing “blanket” cover for admissions of fault; preventing insurers from voiding contracts when apologies are made, either through self‐regulation or legislation; and inserting OD obligations into different structures within the health system.

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