Education And Debate

The injustice of compensation for victims of medical accidents

BMJ 1997; 314 doi: (Published 21 June 1997) Cite this as: BMJ 1997;314:1821
  1. John Harris, professor of bioethics and applied philosophya
  1. a Institute of Medicine, Law and Bioethics, Universities of Manchester and Liverpool, Manchester M13 9PL
  • Accepted 31 January 1997


In most healthcare systems the need to prioritise patients for care and to ration the resources available is now well recognised. Almost the only room left for argument is how to prioritise fairly and where to make the deepest cuts. However, one group of claimants for healthcare resources have been guaranteed top priority for receipt of funds available for health care–victims of medical accidents. This fact has been scarcely noted and its justice seldom questioned.

In the United Kingdom and in many other public healthcare systems successful claims for medical negligence against hospitals or doctors are settled from the health budget and use resources that would otherwise be spent on health care. About 80% of all medical accidents occur in hospitals. In the United Kingdom in 1993-4 the resulting claims were estimated to be £125m ($200m),1 and projections for the remainder of this century are between £250m and £1000m (K Haynes, conference of the Institute of Medicine, Law and Bioethics, Liverpool, April 1996).

Aspects of law

Until the introduction of NHS indemnity in January 1990 the cost of any compensation award against a hospital doctor was shared between the NHS and the doctor's medical defence organisation. And until 1995, when the clinical negligence scheme for trusts was introduced, hospitals effectively insured themselves against claims. But now all hospital negligence claims are paid for by the NHS, reducing the amount available for all other health expenditure.1 2

When judgment is delivered by the courts payment becomes due immediately and hospitals have to pay the compensation awarded against them. Thus successful litigants get immediate and absolute priority in the deployment of public resources allocated for health. This guarantee of access to health resources for successful litigants highlights an important ambiguity when allocation decisions are based on scarcity. When a particular patient's life cannot …

View Full Text

Log in

Log in through your institution


* For online subscription