Written by: Barbara Postol

The Catholic Church has recently made headlines once again regarding Archdiocese Cardinal Roger Mahony’s role at covering up the rapes and abuse of children by priests. Not too long ago Penn State University made the headlines for a horrific sex abuse scandal. This makes many of us wonder, “how could people be aware of such despicable crimes and do nothing?”

Have you ever stopped to think how this might happen more than you realize? In ethics, we talk of a term called complicity, broadly illustrated by people who remain silent despite the fact they are knowingly aware of a wrongdoing, which is occurring; however, they choose to overlook the action. Thus, they are essentially functioning in some manner as an assistant to the offense.

Unfortunately, in health care complicity also exists on varying levels, as does how one cooperates with the action in question. Some examples of cooperation with complicity are clear while others are more removed from the wrongdoing.

Take for example a patient in a nursing home who is being neglected. Perhaps a person who is not directly responsible for a  patient notices that the patient is clearly being neglected. The person who is in charge of the patient’s direct care chooses to overlook the patient knowingly and tends to other more pressing demands of the job. The action is never reported.

This is where the notion of complicity may clearly be illustrated. The person who was directly in charge of the patient is clearly at fault; however, the person who was aware of the neglect and failed to report
it is equally to blame for the patient’s suffering. This is where an important distinguishing principle is applied to shed light on the notion of intent in complicity. This is called the principle of cooperation.

A key factor in the principle of cooperation is intent in conjunction with the wrongdoing. Formal cooperation entails one’s willing cooperation in an action without restriction intending to assist with an action. Material cooperation differs in that the direct intent to participate in the prohibited action is lacking. These distinctions are important when addressing complicity in health care.

All of those who are aware and choose to do nothing have a material cooperation in wrongdoings. How would you feel knowing your loved one had been neglected in a nursing home by one person, but there were 10 other people who knew? How do you think those who knew should be punished?