"I would have everie man write what he knowes and no more."—MONTAIGNE
BRITISH
JOURNAL
OF
ANAESTHESIA
VOLUME 47, No. 5
MAY 1975
EDITORIAL RESPONSIBILITY AND ACCOUNTABILITY
is no sign that any one, individual or organization, has accepted responsibility for failing to provide supervision sufficient to have prevented her death. The committee system in this country is so structured, whether by accident or design, that it is virtually impossible for a private individual, however well informed, either to establish the source of a particular decision or to have it altered. An approach to the chief administrative officer in any Government Department, either local or central, is likely to be met with the reply that while the officer himself is in complete agreement with the views being expressed he is in the hands of the committee, whereas an approach to the Chairman of that committee is just as likely to elicit the answer that while the chairman agrees entirely he must accept the advice given to him by his permanent officers. Such evasions combined with the highly skilled use of procrastinating tactics are used very effectively to prevent the private citizen having any real influence on policies, regardless of how directly they may affect him. Further, when an individual clinician makes an error of some magnitude he faces the sanctions of the court, and rightly. When a committee makes such an error what redress is there? In bygone years, the members concerned would probably have resigned if their views were unacceptable, but our modern committee members rarely adopt this honourable solution but cling to office regardless of the effect on the committee's credibility. And, as always, the permanent officers go about their business safe in the knowledge that they will not be called to account for their decisions personally. We have heard a great deal recently about "open government". Perhaps the time has come for us to see it in practice. In particular, those whose decisions affect all our lives should be held individually
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on June 6, 2015
In an age when the committee structure is steadily eroding individual responsibility some recent developments in medicine and its associated disciplines give serious cause for concern. Over the past year or so substantial awards have been made against Hiniriang, mostly anaesthetists, either when negligence was admitted or when it was established by the courts. By the nature of their calling anaesthetists, and perhaps to a lesser extent surgeons, are more vulnerable than their colleagues in other specialties where the consequences of error may develop more insidiously and indeed may be quietly buried. Accordingly, when a statutory body such as the Committee on Safety of Medicines makes a pronouncement on the clinical use of drugs which affects anaesthetists it has a duty not only to be right in its pronouncement but also to be sure of the consequences. In the case of the current halothane controversy the Committee manifestly railed in these respects, as witnessed by the widespread condemnation of their circular letter (Mansell-Jones, 1974) by informed and responsible anaesthetists. The consequences of the Committee's precipitate action are still being suffered by patients throughout the United Kingdom and further afield. Unfortunately, too, this is not a rare example. Recently the national newspapers reported in terrifying detail the tragedy of Maria Colwell, the small girl beaten to death by her stepfather. As a result of the general outcry a public enquiry was held, at the end of which the newspapers carried the message "No-one to blame: the system at fault" (Daily Telegraph, 1974). But was it? The system did not invent itself; individuals devised it and Maria's condition had been reported not only by her neighbours but also by her school-teacher, yet no effective action was taken and Maria died. There
532 accountable for those decisions and should not be allowed to shelter behind the anonimity of a large committee or even a government office door. Clinicians are personally accountable for their actions and may even have to stand trial because of them. A greater willingness on the part of our administrators to accept similar responsibility would do
BRITISH JOURNAL OF ANAESTHESIA much to improve standards within the Health Services and at no extra cost J. P. Payne REFERENCES
Daily Telegraph (1974). September 5. Mansell-Jones, D. (1974). CSM/AR/S/121. January 3.
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on June 6, 2015
BRITISH
JOURNAL
OF
ANAESTHESIA
VOLUME 47, No. 5
MAY 1975
EDITORIAL RESPONSIBILITY AND ACCOUNTABILITY
is no sign that any one, individual or organization, has accepted responsibility for failing to provide supervision sufficient to have prevented her death. The committee system in this country is so structured, whether by accident or design, that it is virtually impossible for a private individual, however well informed, either to establish the source of a particular decision or to have it altered. An approach to the chief administrative officer in any Government Department, either local or central, is likely to be met with the reply that while the officer himself is in complete agreement with the views being expressed he is in the hands of the committee, whereas an approach to the Chairman of that committee is just as likely to elicit the answer that while the chairman agrees entirely he must accept the advice given to him by his permanent officers. Such evasions combined with the highly skilled use of procrastinating tactics are used very effectively to prevent the private citizen having any real influence on policies, regardless of how directly they may affect him. Further, when an individual clinician makes an error of some magnitude he faces the sanctions of the court, and rightly. When a committee makes such an error what redress is there? In bygone years, the members concerned would probably have resigned if their views were unacceptable, but our modern committee members rarely adopt this honourable solution but cling to office regardless of the effect on the committee's credibility. And, as always, the permanent officers go about their business safe in the knowledge that they will not be called to account for their decisions personally. We have heard a great deal recently about "open government". Perhaps the time has come for us to see it in practice. In particular, those whose decisions affect all our lives should be held individually
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on June 6, 2015
In an age when the committee structure is steadily eroding individual responsibility some recent developments in medicine and its associated disciplines give serious cause for concern. Over the past year or so substantial awards have been made against Hiniriang, mostly anaesthetists, either when negligence was admitted or when it was established by the courts. By the nature of their calling anaesthetists, and perhaps to a lesser extent surgeons, are more vulnerable than their colleagues in other specialties where the consequences of error may develop more insidiously and indeed may be quietly buried. Accordingly, when a statutory body such as the Committee on Safety of Medicines makes a pronouncement on the clinical use of drugs which affects anaesthetists it has a duty not only to be right in its pronouncement but also to be sure of the consequences. In the case of the current halothane controversy the Committee manifestly railed in these respects, as witnessed by the widespread condemnation of their circular letter (Mansell-Jones, 1974) by informed and responsible anaesthetists. The consequences of the Committee's precipitate action are still being suffered by patients throughout the United Kingdom and further afield. Unfortunately, too, this is not a rare example. Recently the national newspapers reported in terrifying detail the tragedy of Maria Colwell, the small girl beaten to death by her stepfather. As a result of the general outcry a public enquiry was held, at the end of which the newspapers carried the message "No-one to blame: the system at fault" (Daily Telegraph, 1974). But was it? The system did not invent itself; individuals devised it and Maria's condition had been reported not only by her neighbours but also by her school-teacher, yet no effective action was taken and Maria died. There
532 accountable for those decisions and should not be allowed to shelter behind the anonimity of a large committee or even a government office door. Clinicians are personally accountable for their actions and may even have to stand trial because of them. A greater willingness on the part of our administrators to accept similar responsibility would do
BRITISH JOURNAL OF ANAESTHESIA much to improve standards within the Health Services and at no extra cost J. P. Payne REFERENCES
Daily Telegraph (1974). September 5. Mansell-Jones, D. (1974). CSM/AR/S/121. January 3.
Downloaded from http://bja.oxfordjournals.org/ at University of Arizona on June 6, 2015
