Environmental Factors Contributing to Wrongdoing in Medicine: A Criterion-Based Review of Studies and Cases

Abstract

In this article we describe our approach to understanding wrongdoing in medical research and practice, which involves the statistical analysis of coded data from a large set of published cases. We focus on understanding the environmental factors that predict the kind and the severity of wrongdoing in medicine. Through review of empirical and theoretical literature, consultation with experts, the application of criminological theory, and ongoing analysis of our first 60 cases, we hypothesize that 10 contextual features of the medical environment (including financial rewards, oversight failures, and patients belonging to vulnerable groups) may contribute to professional wrongdoing. We define each variable, examine data supporting our hypothesis, and present a brief case synopsis from our study that illustrates the potential influence of the variable. Finally, we discuss limitations of the resulting framework and directions for future research.

Keywords:

• professional misconduct
• professional wrongdoing
• moral psychology
• professional ethics

ACKNOWLEDGMENTS

This article was supported by grants UL1RR024992 and 1R21RR026313 from the NIH-National Center for Research Resources and a seed grant from the BF Charitable Foundation. We thank Drs. Michael Mumford, Marvin Berkowitz, and John Chibnall for discussions that have led to the refinement of the psychological variables described in this article.

Notes

¹This is a slightly fictionalized version of a case in our historiometric study. In the real case upon which this vignette is modeled, the physician did not explicitly mention the fear of punishment for disclosing medical errors he committed because he refused to discuss the cases brought before the medical board.