A surgeon discusses the risks of an operation with a patient in a difficult fix. Although it’s possible there will be an excellent result there’s a big chance, perhaps 25%, that it will make matters worse.  The surgeon makes quite sure that the patient understands this and that he really wishes to take the risk and go ahead.  He does.  They proceed.

Despite the surgeon’s strenuous effort, taking six hours, the surgery fails.  The patient, and his family, are aggrieved.  Should the surgeon apologise for the manifestly disappointing outcome?

Official policy is that apologising is the very first thing the surgeon should do.  This is as recommended, for example, by the doctors’ insurance mutual society, the Medical Protection Society: https://mpscdnuks.azureedge.net/resources/docs/mp/Factsheets/apologies.pdf.

In this case the MPS would recommend that the surgeon does not admit any personal fault in the poor outcome, but is to give an “appropriate apology”, such as “I am sorry that this has happened to you”.

Another surgeon is performing a fairly routine procedure, low-risk, fully informed consent obtained, when in a moment of distraction, he misidentifies a structure and mistakenly incises it.  This leads to a complex repair that will delay full recovery by weeks or possibly months.  The surgeon suffers an agony of remorse.  He is frank with the patient afterwards and offers repeated, heartfelt apologies.

The first apology, if it is an apology, cannot be sincere; the second certainly is.  The first apology is so routine that it effectively devalues the second.  In fact, the first “apology” is not really an apology at all; it is just an expression of regret about the world, where “shit happens”.  However, it does contain the word “sorry”, which in English is conveniently ambiguous.  (“I am sorry to hear of your loss” versus “I am sorry; I was wrong”.)

Taking another medical example: several psychiatrists, in consultation, agree that a patient’s risk of suicide is low.  They make this assessment using a set of criteria that have been published, and that are based on an accumulation of clinical experience.  However, these criteria are assessments of risk, not of certainty, and the scientific consensus is that they are the best criteria available, but still imperfect and capable of improvement through further research.  The psychiatrists have a binary choice: they must either discharge or retain the patient, and a prolonged hospital stay has many associated harms.  They opt for discharge.  The patient commits suicide the following day.  Should the psychiatric hospital apologise?  A later review concludes that guidelines were followed scrupulously.

I think that sincere apologies are intensely valuable, and that their value must be protected.  Too many apologies, given when there is no objective justification for them, devalue the real apologies.  I think that any listener and reader of the daily news, of a sceptical cast of mind, hearing the word used so often, might come to the same conclusion.

However – and here I come close to arguing against myself – there are times when the less-than-sincere apology, while devaluing the heartfelt kind, is nonetheless a brake on the escalation of conflict.  This is most likely to be when there is a huge difference in power and status between the injured party and the injurer.  We see this here:

Motor vehicles collide every day.  Apologies are seldom demanded or given; insurance company details are exchanged and those companies sort out the liabilities.  However, if one of the parties happens to be the 97-year-old prince-consort of the sovereign with the low winter sun in his eyes, the injured party, a commoner, demands an apology.  This is no more objectively needed than in a humdrum fender-bender between two citizens.  This is clearly the view of the prince – but, aided by the feverish press, the conflict is rapidly escalating.  So, the prince writes his personal letter of apology and the story tails off.  This is an example of the use of apology, of any degree of sincerity, in conflict resolution.

I still believe that the overuse of apology devalues a most valuable piece of our humanity, the true, heartfelt apology.  What do you think?