Medical errors cannot be avoided completely even when employing the greatest care and applying the most sophisticated medical technologies. They occur when organizational, human, technical, or environmental factors lead to unintentional failures which result in recognizable physical, mental, spiritual, or social harm to patients. Until recently, the medical profession has responded with silence while patients remained uncompensated or resorted to the legal system. Professional distancing undermines transparency and patient safety while medical malpractice litigation ruptures the fragile relationships between patients and healthcare providers in whom patients trust. Philosophically, these responses draw on the framework of deontological liberalism, promoting notions of just deserts and conceptions of freedom that, either when regarded from a Kantian perspective of autonomy or considered as freedom from non-interference, highlight individualism. Metaphors of this paradigm are expressed in a language of rights, which have limited potential to restore personal and social well-being. Drawing on both, the biblical tradition and republican political theory, this dissertation develops a culturally situated principled consequentialist approach, called justice as wholeness. Justice as wholeness responds to the multidimensional effects of medical errors by promoting wholeness as the theory of value. Deeply rooted in the biblical notion of human dignity, it distinguishes between the eschatological meaning of wholeness as a vision and its relative experience in a broken world. The function of justice is to restore the relative experience of the physical, mental, spiritual, and social dimensions of wholeness. A mixed approach to normative ethics, justice as wholeness has two principles that exclude unjust pursuits of its value-goal: a civic republican conceptualization of freedom and a biblical notion of equality. Justice as wholeness is a comprehensive and integrative framework that serves as a philosophical foundation for medical error policies and processes that resonate with the mission and values of faithbased hospitals. Loma Linda University Medical Center serves as a test case for incorporating the vision into policy. Justice as wholeness informs mission integration, the disclosure of medical errors to patients, and processes of restoration while encouraging transparent autonomy in peer review and compassion in hospital culture.

LLU Discipline

Social Policy and Social Research


Social Policy and Research


School of Science and Technology

First Advisor

Gerald Winslow

Second Advisor

Kim Freeman

Third Advisor

David Larson

Fourth Advisor

Susanne Montgomery

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Medical Errors -- dissertations; Malpractice -- United States; Jurisprudence, Medical; Ethics, Medical; Physician-Patient Relations; Physicians -- ethics; Truth Disclosure; Spirituality; Religion and Medicine; Philosophy, Medical.



Page Count

xiv; 332

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives