True story: when I first heard the phrase 'heroic responsibility', it took me about five seconds and the question, "On TV Tropes, what definition fits this title?" to generate every detail of EY's definition save one. That detail was that this was supposed to be a good idea. As you point out - and eli-sennesh points out, and the trope that most closely resembles the concept points out - 'heroic responsibility' assumes that everyone other than the heroes cannot be trusted to do their jobs. And, as you point out, that's a recipe for everyone getting in everyone else's way and burning out within a year. And, as you point out, you don't actually know the doctor's job better than the doctors do.
In my opinion, what we should be advocating is the concept of 'subsidiarity' that Fred Clark blogs about on Slacktivist:
Responsibility — ethical obligation — is boundless and universal. All are responsible for all. No one is exempt.
Now, if that were all we had to say or all that we could know, we would likely be paralyzed, overwhelmed by an amorphous, undifferentiated ocean of need. We would be unable to respond effectively, specifically or appropriately to any particular dilemma. And we would come to feel powerless and incapable, thus becoming less likely to even try.
But that’s not all that we can know or all that we have to say.
We are all responsible, but we are not all responsible in the same way. We each and all have roles to play, but we do not all have the same role to play, and we do not each play the same role all the time.
Relationship, proximity, office, ability, means, calling and many other factors all shape our particular individual and differentiated responsibilities in any given case. In every given case. Circumstance and pure chance also play a role, sometimes a very large role, as when you alone are walking by the pond where the drowning stranger calls for help, or when you alone are walking on the road to Jericho when you encounter the stranger who has fallen among thieves.
Different circumstances and different relationships and different proximities entail different responsibilities, but no matter what those differences may be, all are always responsible. Sometimes we may be responsible to act or to give, to lift or to carry directly. Sometimes indirectly. Sometimes our responsibility may be extremely indirect — helping to create the context for the proper functioning of those institutions that, in turn, create the context that allows those most directly and immediately responsible to respond effectively. (Sometimes our indirect responsibility involves giving what we can to the Red Cross or other such organizations to help the victims of a disaster.)
The idea of heroic responsibility suggests that you should make an extraordinary effort to coerce the doctor into re-examining diagnoses whenever you think an error has been made. Bearing in mind that I have no relevant expertise, the idea of subsidiarity suggests to me that you, being in a better position to monitor a patient's symptoms than the doctor, should have the power to set wheels in motion when those symptoms do not fit the diagnosis ... which suggests a number of approaches to the situation, such as asking the doctor, "Can you give me more information on what I should expect to see or not see based on this diagnosis?"
(My first thought regarding your anecdote was that the medical records should automatically include Bayesian probability data on symptoms to help nurses recognize when the diagnosis doesn't fit, but this article about the misdiagnosis of Ebola suggests revising the system to make it more likely for doctors see the nurses' observations that would let them catch a misdiagnosis. You're in a better position to examine the policy question than I am.)
I have to admit, I haven't been following the website for a long while - these days, I don't get a lot of value out of it - so what I'm saying that Fred Clark is saying might be what a lot of people already see as the meaning of the concept. But I think that it is valuable to emphasize that responsibility is shared, and sometimes the best thing you can do is help other people do the job. And that's not what Harry Potter-Evans-Verres does in the fanfic.
As you point out - and eli-sennesh points out, and the trope that most closely resembles the concept points out - 'heroic responsibility' assumes that everyone other than the heroes cannot be trusted to do their jobs.
This would only be true if the hero has infinite resources, actually able to redo everyone's work. In practice, deciding how your resources should be allocated requires a reasonably accurate estimate of how likely everyone is to do their job well. Swimmer963 shouldn't insist on farming her own wheat for her bread (like she would if she did...
[Originally posted to my personal blog, reposted here with edits.]
Introduction
Something Impossible
The Well-Functioning Gear
Recursive Heroic Responsibility
Heroic responsibility for average humans under average conditions
I can predict at least one thing that people will say in the comments, because I've heard it hundreds of times–that Swimmer963 is a clear example of someone who should leave nursing, take the meta-level responsibility, and do something higher impact for the usual. Because she's smart. Because she's rational. Whatever.
Fine. This post isn't about me. Whether I like it or not, the concept of heroic responsibility is now a part of my value system, and I probably am going to leave nursing.
But what about the other nurses on my unit, the ones who are competent and motivated and curious and really care? Would familiarity with the concept of heroic responsibility help or hinder them in their work? Honestly, I predict that they would feel alienated, that they would assume I held a low opinion of them (which I don't, and I really don't want them to think that I do), and that they would flinch away and go back to the things that they were doing anyway, the role where they were comfortable–or that, if they did accept it, it would cause them to burn out. So as a consequentialist, I'm not going to tell them.
And yeah, that bothers me. Because I'm not a special snowflake. Because I want to live in a world where rationality helps everyone. Because I feel like the reason they would react that was isn't because of anything about them as people, or because heroic responsibility is a bad thing, but because I'm not able to communicate to them what I mean. Maybe stupid reasons. Still bothers me.