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“I could have caught it sooner”: what is a carer’s regret actually claiming?

Elin Hedqvist Fellow
· 5 replies
Possibility & necessityAnalyticBuddhist#counterfactuals#moral-luck#nursing#regret
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Something from work that I keep returning to. One of our residents got worse overnight. Looking back, there was a sign at 2 a.m. that, in hindsight, meant he was seriously ill. I noticed it, it didn't seem much, I did not call the nurse on duty. By six he was much worse. He survived, but I have replayed that night many times.

Regret seems to need a "could". I would not regret the weather. So when I say "I could have caught it", what am I claiming? That with the same information, the same tiredness, the same corridor, a different decision was available to me? Or only that a different colleague, or a less tired me, would have done differently?

Those are very different claims. The first is about my freedom at 2 a.m. The second is about other possible versions of me, and I am not sure why I should regret what a different person would have done.

I don't want comfort, exactly. I want to know what kind of "could" regret uses, and whether it is ever true in the sense I mean when I lie awake.

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5 replies

  1. Nadia Haddad

    Fellow

    Elin, I have had a night much like that on the unit. What helped me was noticing that "could have" in regret is usually not about metaphysics at all. It is about whether the information was available to me. If the sign was there and within the range I had been told to expect, then a reasonable person in my position would have done what I did. The "could" I torture myself with assumes I knew at 2 a.m. what I only knew at 6.

    Helpful · 3
  2. Alistair Gow

    Fellow

    Having sat in on case reviews at a GP surgery for years, I still think the most dangerous word in one is "obviously". Hindsight makes the alternative look present at the time when it was not.

    Philosophically, I'd say regret runs on a counterfactual: "had I escalated, he would have been better off". That can be true without implying anything about whether you were free to escalate. It is a claim about how the world depends on what you did, and it is often true. Whether you are to blame is a separate question, and much harder.

  3. Hamza Qureshi

    Fellow

    The law separates these quite deliberately. In negligence, one question is causation: "but for" your omission, would the harm have occurred? Another is the standard of care: what would a reasonably competent practitioner have done? In English law the medical version was shaped by the Bolam case. You can satisfy the first (it made a difference) and still be entirely within the second (any competent nurse might have done the same). Regret tends to collapse the two. A court would not.

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  4. Nirmala Jayasekara

    Fellow

    In the Abhidhamma there is a mental factor called kukkucca, usually translated as worry or remorse, the agitation over what was done or left undone. It is listed among the hindrances, paired with restlessness. That does not mean you should feel nothing. Recognising a fault and resolving to act differently is wholesome. But the replaying, the circling at night, is treated as an obstruction rather than as a debt paid.

    So my tradition would say: learn what the 2 a.m. sign teaches, and then put the replaying down. It does not make the patient better and it does not make you better.

    Helpful · 2
  5. Elin Hedqvist

    Fellow

    Alistair's point clears something up: "it made a difference" and "I could have done otherwise" are two separate claims, and I have been treating the truth of the first as proof of the second. And I will think about the difference between learning and replaying. I suspect I have been calling the second the first.

    Helpful · 3