Preventable healthcare harm creates obligations that persist after immediate clinical stabilization. Existing responses commonly organize these obligations around disclosure, compensation, investigation, or future safety improvement. Each addresses an important aspect of the aftermath, yet none alone explains what healthcare institutions owe when preventable harm also damages the relationship through which patients receive information, recognition, explanation, and opportunities to influence institutional sense-making. This theory-building article develops Relational Reparative Responsibility Theory to specify that additional ethical terrain. The account treats preventable harm as capable of becoming a relational institutional wrong when institutional action or subsequent response diminishes a patient’s epistemic standing, practical agency, recognition, or justified expectations of responsible institutional engagement. Reparative responsibility consequently extends beyond acknowledging that an event occurred. It can include competent disclosure, responsive forms of practical or material repair, supported opportunities for participation, and institutional learning that remains answerable to the people affected. These duties are connected but non-identical: one cannot automatically substitute for another, and their appropriate form varies with patient preference, institutional control, evidentiary uncertainty, proportionality, and the burdens participation may impose. Patient participation is therefore framed as an opportunity for supported influence rather than compulsory involvement or a universal transfer of decision authority. The resulting account links post-harm ethics to organizational learning while preserving limits on institutional responsibility. Healthcare institutions meet reparative obligations most adequately when they respond to the damaged relationship as well as the safety event and when learning remains connected to, rather than detached from, those who experienced the harm.
