Mistakes and bioethics in nephrology

Abstract

“Acetate intolerance” was one of the first negative signs of acetate hemodialysis registered in the history of the treatment of chronic renal failure. Now we consider an error such an approach to kidney disease. But it was an “institutional” error according to the classification of the Italian historian of Medicine, Ettore De Benedetti, to distinguish it from the “personal” error, committed after the revision of acetate treatment and the introduction of bicarbonate dialysis. The same difference could be considered in the “short hemodialysis” technique for the adverse cardiovascular outcome. Many examples of “institutional” and “personal” errors in nephrology are reported. Errors need to be recorded and to be analysed if we want to discover why they occur and how they must be prevented. If we want to eliminate errors, it is mandatory to overcome certain attitudes, deeply rooted in the profession. Medical attitudes are often determined by medical bioethics and by the principles that determine whether ideas or actions are considered right or wrong. Errors by doctors are common. In order to reduce errors many authorities tried to reduce them giving some methodological advices. Very important are the proposals of a clinician, Neil McIntyre, and a philosopher, Karl Popper, for a “new” professional ethics summarized in ten theses, reported in this article. (Bioethics)