Research has provided mixed support for the hypothesis that when an incident results in a more severe outcome, more responsibility will be attributed to a potentially responsible actor. This paper uses the techniques of meta‐analysis to examine this literature. The results support the contention that people attribute greater responsibility for the outcome of a negative incident when that outcome is more severe than when the outcome is minor. The direction of this relationship is consistent across methodologies. However, the strength of the correlation varies depending on which type of judgment participants are asked to make. Because many of these variables are tied to legal concepts, the results are discussed in the context of the expectations of the legal system regarding the impact of outcome severity on each variable.

In fact, the percentage of cases that are resolved by trial is declining. See Hope Viner Samborn, The Vanishing Trial, A.B.A. J., Oct. 2002, at 24. These settlements, however, are often not reached before the parties have been subjected to considerable expense-in terms of time, finances, and emotion. As Judge Learned Hand has said, "I must say that as a litigant I should dread a lawsuit beyond almost anything else short of sickness and death." Learned Hand, The Deficiencies of Trials to Reach the Heart of the Matter, 3 LECTURES ON LEGAL TOPICS 89, 105 (1921); see also Thomas 8. Metzloff, Resolving Malpractice Disputes: Imaging the Jury's Shadow, 54 LA w & CONTEMP. PROBS. 43, 59 & n.54 (1991) (finding that many cases settle right before trial). At the same time there is continuing debate about the merits of settling civil cases. See, e.g. , Owen Fiss,

One way in which physicians can respond to a medical error is to apologize. Apologies-statements that acknowledge an error and its consequences, take responsibility, and communicate regret for having caused harmcan decrease blame, decrease anger, increase trust, and improve relationships. Importantly, apologies also have the potential to decrease the risk of a medical malpractice lawsuit and can help settle claims by patients. Patients indicate they want and expect explanations and apologies after medical errors and physicians indicate they want to apologize. However, in practice, physicians tend to provide minimal information to patients after medical errors and infrequently offer complete apologies. Although fears about potential litigation are the most commonly cited barrier to apologizing after medical error, the link between litigation risk and the practice of disclosure and apology is tenuous. Other barriers might include the culture of medicine and the inherent psychological difficulties in facing one's mistakes and apologizing for them. Despite these barriers, incorporating apology into conversations between physicians and patients can address the needs of both parties and can play a role in the effective resolution of disputes related to medical error.

No abstract