Avoiding cheap grace. Medical harm, patient safety, and the culture(s) of forgiveness.

November-December 2003 The title of the Institute of Medicine’s report on medical error, To Err is Human: Building a Safer Health System, is derived from Alexander Pope’s “Essay on Criticism” (1711): “To err is human; to forgive, divine” (l. 525).1 Given how familiar this proverb is in its entirety, it is striking that the IOM report itself contains no reference to forgiveness, divine or otherwise, in its treatment of medical error, even as its title hints that error and forgiveness are fundamentally related. A “systems approach” to medical error, the approach advocated by the IOM and the patient safety movement alike, may similarly “forget” to engage forgiveness as a tool for Grace Avoiding Cheap