The Bystander Effect | PatientSafe Network

The Bystander Effect | PatientSafe Network

Bystander Effect:
the greater the number of people present,
the less likely people are to help.

The bystander effect was first demonstrated following the murder of Kitty Genovese in 1964. The New York Times published a report conveying a scene of indifference from neighbors who failed to come to Genovese’s aid, claiming 38 witnesses saw or heard the attack and did nothing.

Psychologists launched a series of experiments resulting in one of the strongest and most replicable effects in social psychology. 

Though this post comes from a blog about healthcare safety, it is just as applicable to the current drive toward “opioid safety”.

Diffusion of Responsibility:

When so many are in charge no one is. Where there are many observers, individuals do not feel as much pressure to take action.

There are numerous groups involved with healthcare safety at international, national, state, regional, hospital and individual department level.

The same is true of the many groups competing to set the most restrictive limits on opioids.

Each of these groups are made up of further subgroups of individuals. Further still these subgroups are not static – a constant flux of staff members into different roles stifles effective response.

Acceptable Behaviour:

The need to behave in correct and socially acceptable ways. When other observers fail to react, individuals often take this as a signal that a response is not needed or not appropriate.

The social norm is to blame pain patients for the spread of opioid addiction and overdose deaths.

Because doctors are not decrying the injustice of taking away pain relief from suffering patients, the authorities believe their policies are effective.

If pressed on an issue individuals or groups may introduce barriers allowing them to delay action sufficiently, in effect not acting at all, thus maintaining perceived acceptable behaviour.


Research demonstrates onlookers are more likely to act if they have a personal connection to the victim.

Most people taking opioids for pain often do so secretly. 99% of the people that see me don’t have a clue that I take opioids – in fact, they don’t even know that I’m in pain.

The average person cannot know how many people are suffering with disabling pain because if we’re lucky enough to have opioid medications, we can persist in spite of our pain and, if it’s bad enough, we’re not in public to be viewed – we’re at home trying too take care of it.


Researchers have found that onlookers are less likely to intervene if the situation is ambiguous. In the Kitty Genovese case many witnesses reported it sounded like a “lover’s quarrel,” and claimed to not realise the young woman was being murdered.

This is the excuse for letting us suffer without feeling any guilt. If we claim to need opioids for pain, we are simply assumed to be lying addicts.

Self Preservation:

For some bystanders in the Kitty Genovese murder what they experienced would not have been ambiguous. Yes, someone was being stabbed to death in front of them. Self preservation may have hindered their want to act – they too may then be at risk.

This has been the effect of the DEA witch hunt to discourage anyone still wanting to prescribe their suffering patients opioids.

To bring about effective safety change where previously there’s been none requires challenging the status quo, ‘rocking the boat’, in effect potentially threatening ones own career – upset the wrong people and the consequences could be grave. Many of us have mouths to feed and mortgages to pay – are we really going to put that at stake in a futile attempt to change something no one’s been able to change before?

The DEA has shown it has no compunctions about destroying the career and reputation of any doc still willing to prescribe opioids in sufficient amounts to control severe pain. (See DEA Raids Dr. Forest Tennant’s Pain Clinic)

Governing bodies often resort to interventions which are safe for them. They shy away from, for example, recalling an unnecessary workplace hazard. They may fear legal ramifications from the manufacturer and resultant heat from their employer (the health minister).

Often instead the governing body may write a policy or instrument further education in a vain attempt to avoid the hazard.

Governing bodies need to understand the human factors approach and have the courage to introduce effective solutions for patient safety.

Original article: The Bystander Effect | PatientSafe Network


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