Cathryn Miller-Wilson

Bio: Cathryn Miller-Wilson is an academic researcher. The author has contributed to research in topics: Justice (ethics) & Legal ethics. The author has an hindex of 1, co-authored 3 publications receiving 6 citations.

Becoming Poor: Stories of the Real 'Safety Net' and the Consequences for Middle America

Abstract: This article draws from my experiences representing persons with HIV/AIDS and the lessons learned regarding the difficulty that persons encounter in transitioning from full-time work income to disability income. Through a detailed examination of the income options for those who become disabled and are no longer able to work, the paper demonstrates the extreme tenuousness of the so-called “safety net” and the societal consequences, as well as the consequences to the disabled individual. In an effort to determine how and why the safety net has failed the article also traces the rise of the disability insurance industry and explains how that industry has contributed to the problem. Finally, an analysis of the various potential solutions reveals that a closer look should be taken at the various legal standards for determining disability that are in place and how those legal standards have ultimately lead to inaccurate determinations and costly litigation.

Harmonizing Current Threats: Using the Outcry for Legal Education Reforms to Take Another Look at Civil Gideon and What It Means to Be an American Lawyer

Abstract: Drawing from the broad and varied literature on legal ethics, the paper demonstrates that legal education and access to justice concerns can and should be addressed simultaneously in our current political and economic climate. Current threats to legal education, and to lawyering in general, present an opportunity for legal education transformation. Applying legal ethics theory to an analysis of these threats provides support for the creation of teaching law firms, similar in size and scope to teaching hospitals, that will employ clinical teaching methodology, substantially enhance ethics teaching and significantly address the issue of access to justice.

"Harmonizing Current Threats: Using the Outcry for Legal Education Reforms to Take Another Look at Civil Gideon and What it Means to be an American Lawyer"

Abstract: Drawing from the broad and varied literature on legal ethics, the paper demonstrates that legal education and access to justice concerns can and should be addressed simultaneously in our current political and economic climate. Current threats to legal education, and to lawyering in general, present an opportunity for legal education transformation. Applying legal ethics theory to an analysis of these threats provides support for the creation of teaching law firms, similar in size and scope to teaching hospitals, that will employ clinical teaching methodology, substantially enhance ethics teaching and significantly address the issue of access to justice.

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Abstract: Background: In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim: The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS. Methods: This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders' views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure. Results: A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance. Conclusions: There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.

Disclosure of adverse events in pediatrics

Abstract: Despite increasing attention to issues of patient safety, preventable adverse events (AEs) continue to occur, causing direct and consequential injuries to patients, families, and health care providers. Pediatricians generally agree that there is an ethical obligation to inform patients and families about preventable AEs and medical errors. Nonetheless, barriers, such as fear of liability, interfere with disclosure regarding preventable AEs. Changes to the legal system, improved communications skills, and carefully developed disclosure policies and programs can improve the quality and frequency of appropriate AE disclosure communications.

Disclosing clinical adverse events to patients: Can practice inform policy?

Abstract: Objectives To understand patients' and health professionals' experience of Open Disclosure and how practice can inform policy. Background Open Disclosure procedures are being implemented in health services worldwide yet empirical evidence on which to base models of patient-clinician communication and policy development is scant. Design, setting and participants A qualitative method was employed using semi-structured open-ended interviews with 154 respondents (20 nursing, 49 medical, 59 clinical/administrative managerial, 3 policy coordinators, 15 patients and 8 family members) in 21 hospitals and health services in four Australian states. Results Both patients and health professionals were positive about Open Disclosure, although each differed in their assessments of practice effectiveness. We found that five major elements influenced patients' and professionals' experience of openly disclosing adverse events namely: initiating the disclosure, apologizing for the adverse event, taking the patient's perspective, communicating the adverse event and being culturally aware. Conclusions Evaluating the impact of Open Disclosure refines policy implementation because it provides an evidence base to inform policy. Health services can use specific properties relating to each of the five Open Disclosure elements identified in this study as training standards and to assess the progress of policy implementation. However, health services must surmount their sensitivity to revealing the extent of error so that research into patient experiences can inform practice and policy development.

Health professionals' perceptions and experiences of open disclosure: a systematic review of qualitative evidence.

Abstract: Review question/objective The objective of this systematic review is to synthesise the best available qualitative evidence available exploring health professionals’ perceptions and experiences of open disclosure of medical errors to patients Consequently the question to be addressed is: What are the perceptions and experiences of health professionals regarding open disclosure of medical errors to patients? More specifically to explore where possible: What are the perceptions and experiences of barriers to open disclosure of medical errors to patients by health professionals? What are the perceptions and experiences of facilitators of open disclosure of medical errors to patients by health professionals? Inclusion criteria Types of participants This review will consider studies that include health professionals that are qualified/registered This review will exclude studies that include student health professionals Phenomena of interest This review will consider studies that investigate health professionals’ perceptions and experiences regarding open disclosure of medical errors to patients This review will consider studies that are set in primary, secondary and tertiary settings This review will exclude the following: Study setting involving alternative and complementary therapy

Disclosing medical errors.

Abstract: The commentary on disclosing errors to patients by Wendy Levinson and Thomas Gallagher[1][1] perpetuates the confusion created by others.[2][2],[3][3] Levinson and Gallagher suggest that errors alone lead to harm; if harm is not caused, it is “by chance or because the error was corrected before