Arthur L. Caplan, PhD | Mar 13, 2013
Hi. I’m Art Caplan from the New York University Langone Medical Center, where I head the Division of Medical Ethics. I want to talk about an interesting phenomenon that comes up occasionally in healthcare, and that is the apology. We often hear people say, “If you commit a mistake, if you make an error, you should apologize to the patient.” Generally I support that, and the reasons for it are made very clear by someone who hasn’t spent a lot of time at the hospital but has certainly spent a lot of time around needles and people peddling drugs. That is Lance Armstrong.
We know that Armstrong has admitted to cheating. He blood-doped, he took performance-enhancing drugs, and he went to the church of Oprah Winfrey and confessed all of this on national television. He said, “I’m sorry I cheated,” but then he said, “You know, everybody else does this.” So he did it, but he was hinting that maybe it wasn’t so bad because he was in a sport (cycling) in which cheating was rampant and performance-enhancing drugs were being used all the time. In one sense, he is right.
However, I found his national confession on television very unsatisfying. Not only did Lance Armstrong cheat, but he went after people who tried to tell the truth. He tried to sue the newspapers that published stories that said there was pretty good evidence that he was doping. He threatened with lawsuits and tried to ruin the careers of teammates who came out and said that he doped. He even assassinated the character of and sued the masseuse who said she had obtained drugs for him.
Lance Armstrong was vicious in trying to go after people who crossed him and tried to tell the truth. When he made that televised confession, he did not apologize to those people. It’s one thing to say, “Hey, I made a mistake; I cheated in a sport where there is a lot of cheating.” What he should have said was, “I cheated in a sport where there is a lot of cheating, and I apologize specifically to the people I hurt.” But he has not done that, and that seems to me to be the flaw in the great Lance Armstrong confession story. And it holds a lesson: If you harm or hurt someone and you know who that is and you are responsible for the harm, you have to apologize.
Lance Armstrong didn’t apologize, but it’s prudent for doctors and nurses who harm someone accidentally to apologize specifically to them.