{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T12:09:20Z","timestamp":1790856560684,"version":"4.1.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Med Health Care and Philos"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A surgeon performing a retroperitoneal procedure inadvertently begins dissecting the wrong kidney. The error is recognized intraoperatively, the correct structure is identified, and the procedure is completed successfully. The patient suffers no measurable clinical harm. The institution classifies the event as a near-miss, and no disclosure is initiated. This paper argues that the classification, while legally defensible, is morally inadequate. The absence of measurable clinical harm does not eliminate the ethical obligations a serious procedural error generates; it displaces them onto forms of harm\u2014relational, professional, and institutional\u2014that the standard harm-based framework cannot capture. Drawing on Bernard Williams\u2019s concept of moral residue and Nussbaum\u2019s account of shame and concealment, the paper argues that patients have a right to know that a serious error occurred in their care even when it produced no measurable injury, and that the near-miss framework, while valuable as a learning instrument, mischaracterizes the ethical obligations such errors generate. A central section examines the etiology of the error\u2014institutional failure, diagnostic insufficiency, and individual inattention\u2014and defends an invariance thesis: what varies with etiology is the remediation owed and the party who owes it, not the patient\u2019s claim to an honest account of what occurred in her own body. The invariance follows from the framework: an obligation fluctuating with the cause of an error would track culpability rather than the relational structure of the encounter. A framework of relational disclosure is proposed as an alternative grounded in the ethics of trust, recognition, and institutional integrity.<\/jats:p>","DOI":"10.1007\/s11019-026-10405-8","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:50:55Z","timestamp":1790855455000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The harm that wasn\u2019t: moral residue, near-miss events, and the ethics of harmless error in procedural medicine"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6706-4514","authenticated-orcid":false,"given":"Boris","family":"Nikolic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"10405_CR1","volume-title":"Harm to others: The moral limits of the criminal law","author":"Joel Feinberg","year":"1984","unstructured":"Feinberg, Joel. 1984. Harm to others: The moral limits of the criminal law. New York: Oxford University Press."},{"key":"10405_CR2","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1001\/jama.289.8.1001","volume":"289","author":"Thomas H Gallagher","year":"2003","unstructured":"Gallagher, Thomas H., Amy D. Waterman, Alison G. Ebers, Victoria J. Fraser, and Wendy Levinson. 2003. Patients\u2019 and physicians\u2019 attitudes regarding the disclosure of medical errors. Journal Of The American Medical Association 289:1001\u20131007. https:\/\/doi.org\/10.1001\/jama.289.8.1001","journal-title":"Journal Of The American Medical Association"},{"key":"10405_CR3","unstructured":"Honneth, Axel. 1995. The struggle for recognition: The moral grammar of social conflicts. Trans. Joel Anderson. Cambridge: Polity."},{"key":"10405_CR4","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1007\/s11606-007-0227-z","volume":"22","author":"Lauris C Kaldjian","year":"2007","unstructured":"Kaldjian, Lauris C., Elizabeth W. Jones, Barry J. Wu, Valerie L. Forman-Hoffman, Benjamin H. Levi, and Gary E. Rosenthal. 2007. Disclosing medical errors to patients: Attitudes and practices of physicians and trainees. Journal of General Internal Medicine 22: 988\u2013996. https:\/\/doi.org\/10.1007\/s11606-007-0227-z.","journal-title":"Journal of General Internal Medicine"},{"key":"10405_CR5","volume-title":"To err is human: Building a safer health system","year":"2000","unstructured":"Kohn, Linda T., M. Janet, Corrigan, and Molla S. Donaldson. eds. 2000. To err is human: Building a safer health system. Washington, DC: National Academy."},{"key":"10405_CR6","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1377\/hlthaff.2009.0134","volume":"29","author":"Anna C Mastroianni","year":"2010","unstructured":"Mastroianni, Anna C., Michelle M. Mello, Shannon Sommer, Mary Hardy, and Thomas H. Gallagher. 2010. The flaws in state \u201capology\u201d and \u201cdisclosure\u201d laws dilute their intended impact on malpractice suits. Health Affairs 29: 1611\u20131619. https:\/\/doi.org\/10.1377\/hlthaff.2009.0134.","journal-title":"Health Affairs"},{"key":"10405_CR7","first-page":"341","volume":"71","author":"Benjamin J McMichael","year":"2019","unstructured":"McMichael, Benjamin J., R. Lawrence, Van Horn, and W. Kip Viscusi. 2019. Sorry is never enough: How state apology laws fail to reduce medical malpractice liability risk. Stanford Law Review 71:341\u2013409.","journal-title":"Stanford Law Review"},{"key":"10405_CR8","unstructured":"Nagel, Thomas. 1979. Moral luck. In Mortal questions, 24\u201338. Cambridge: Cambridge University Press."},{"key":"10405_CR9","volume-title":"Hiding from humanity: Disgrace, shame, and the law","author":"Martha C Nussbaum","year":"2004","unstructured":"Nussbaum, Martha C. 2004. Hiding from humanity: Disgrace, shame, and the law. Princeton: Princeton University Press."},{"key":"10405_CR10","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1136\/bmj.320.7237.768","volume":"320","author":"James Reason","year":"2000","unstructured":"Reason, James. 2000. Human error: Models and management. British Medical Journal 320: 768\u2013770.","journal-title":"British Medical Journal"},{"key":"10405_CR11","volume-title":"Moral resilience: Transforming moral suffering in healthcare","year":"2018","unstructured":"Rushton, Cynda Hylton, ed. 2018. Moral resilience: Transforming moral suffering in healthcare. New York: Oxford University Press."},{"key":"10405_CR12","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1023\/A:1012048907443","volume":"4","author":"Marian A Verkerk","year":"2001","unstructured":"Verkerk, Marian A. 2001. The care perspective and autonomy. Medicine, Health Care and Philosophy 4: 289\u2013294.","journal-title":"Medicine, Health Care and Philosophy"},{"key":"10405_CR13","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511618024","volume-title":"Moral repair: Reconstructing moral relations after wrongdoing","author":"Margaret Urban Walker","year":"2006","unstructured":"Walker, Margaret Urban. 2006. Moral repair: Reconstructing moral relations after wrongdoing. Cambridge: Cambridge University Press."},{"key":"10405_CR14","doi-asserted-by":"crossref","unstructured":"Williams, Bernard. 1973. Ethical consistency. In Problems of the self: Philosophical papers 1956\u20131972, 166\u2013186. Cambridge: Cambridge University Press. Originally published in Proceedings of the Aristotelian Society, Supplementary Volume 39 (1965): 103\u2013124.","DOI":"10.1017\/CBO9780511621253.013"},{"key":"10405_CR15","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1136\/bmj.320.7237.726","volume":"320","author":"Albert W Wu","year":"2000","unstructured":"Wu, Albert W. 2000. Medical error: The second victim. British Medical Journal 320: 726\u2013727.","journal-title":"British Medical Journal"}],"container-title":["Medicine, Health Care and Philosophy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11019-026-10405-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11019-026-10405-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11019-026-10405-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:50:57Z","timestamp":1790855457000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11019-026-10405-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":15,"alternative-id":["10405"],"URL":"https:\/\/doi.org\/10.1007\/s11019-026-10405-8","relation":{},"ISSN":["1386-7423","1572-8633"],"issn-type":[{"value":"1386-7423","type":"print"},{"value":"1572-8633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"assertion":[{"value":"23 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The author has no competing interests to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This is a theoretical framework paper. The case discussed in Sect. 2.2 is hypothetical and constructed for analytic purposes; it does not report a clinical event and no patient record underlies it.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"No human participants were involved.","order":3,"name":"Ethics","label":"Consent to participants","group":{"name":"EthicsHeading","label":"Declarations"}}]}}