Contradictions in the concept of professional culpability.

Increasing recognition of adverse events in health care is wide spread. Implementing improved system arrangements, which prevent adverse events taking place rather than focussing on individual culpability is increasingly being recognised as a more effective preventative strategy. But does such a perspective mean individual health practitioners remain accountable for their practice? This article explores the philosophical, psychological and professional contradictions inherent in attempting to understand where the responsibility for our actions lies and concludes by arguing that while the case for the system approach to adverse event reduction is strong, the notion of individual professional culpability needs to be maintained.