Written by Sifelani Tsiko
The death of Zanele, the daughter of Higher and Tertiary Education, Science and Technology Development Minister Professor Jonathan Moyo, who was found unresponsive in her Cape Town apartment on October 17, has set off a powerful debate over the need to secure the confidentiality and integrity of deceased persons as required by the ethical code for pathologists.
The high profile death case, which is still under investigation and saw a second post-mortem which was conducted here in Zimbabwe revealed that her heart had been removed in the first post-mortem that was conducted by Dr Sipho Mfolozi at the Salt River Forensic Pathology Laboratory in Cape Town, went into the heart of the debate on pathology and ethics in Zimbabwe and the region.
Dr Salvator Mapunda, a former chief government pathologist who is now a consultant forensic pathologist for the Botswana Police Service, told participants at a symposium to mark the International Pathology Day in Harare recently that South African pathologists erred by removing the heart of Zanele without the consent of the family.
“You do not do that in secrecy but by also informing the family of the deceased person,” he said.
“Confidentiality does not end when a person has died. The relationship between a doctor and a patient is underlined by issues of ‘consent’. The doctor has to keep secrets even if when the patient has died.
“Confidentiality is absolute and with no compromise and exception save for very limited circumstances when it’s in the public interest or required by the court of law.”
Dr Mapunda, a veteran forensic pathologist, said the confidential nature of the relationship between the patient and doctor does not end with the demise of the patient.
He said: “The Declaration of Geneva states: ‘I will respect the secrets which are confided in me, even after the patient has died’.” He further said that the International Codes of Medical Ethics was even more severe in its description: “A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died.”
A pathologist is a medical doctor who specialises in the diagnosis and classification of diseases by looking at tissue or cells under a microscope and by interpreting medical laboratory tests.
The pathologist also is the doctor who examines specimens removed during surgery for conditions such as cancer, to determine whether a tumor is benign or cancerous, and if cancerous, the exact cell type, grade, and stage of the tumor.
In cases of murder or mysterious deaths, forensic pathologists play a key role in providing evidence before the courts. Zanele was laid to rest at the Glen Forest Memorial Park in Harare on October 22 and the missing heart prompted her family to write to both the South African police and the Cape Town laboratory seeking answers.
The Moyo family lawyer, Terrence Hussein, in a letter of complaint reported in the local media, said the discovery that Zanele’s heart was missing “had only compounded the grief that they have had to endure”.
“At no point did our clients consent to the removal of any organ, nor were they even informed of this.”
He said the Moyo family felt “their beloved daughter had been disrespected and violated” in ways that “seriously violate their cultural beliefs and sensitivities.”
“You now see that the pathologist owes a duty to next-of-kin or else who consented to the autopsy,” Dr Mapunda said.
“An ethical guideline would emphasise that, ‘the doctrine of consent’ must be legislative in order to protect the particular nature of human right, confidentiality being one of the components in that right.”
He said the medico-legal expertise of the dead just like of the live was a completely different matter as it was performed at the request of either the coroner, or the police or a magistrate and any duty of confidentiality would presumably be owed to the requesting party. However, in certain instances death cases were quite problematic as pertains to confidentiality and the pathologist.
“It would seem unlikely that the doctor owes any duty to the relative under these circumstances,” the forensic pathologist said.
“It is contended that no information can be released to the next-of-kin if the information has a bearing on the case even if potentially useful to the relatives.
“The argument may be taken a step further to say that because there is no direct relationship-between the relatives and the doctor, no information may be released to the relatives under any circumstances.”
He cited a case in England, of a publication of a book entitled “Churchill”, written by Lord Moran, Churchill’s physician, which caused an uproar.
Lord Moran was censured by the General Medical Council for revealing Churchill’s medical condition notwithstanding that it was long after the death of the of the famous prime minister of Britain.
“The question raised at this point is whether or not this duty to the dead patient is recognised by the court,” said Dr Mapunda.
“The personal nature of the confidential relationship would indicate that the legal duty would not survive death. There can be no harm to the individual personally if information is released after his death. It is therefore contended that although this duty of continued confidentiality is recognised by the profession, it is not legally actionable.”
He said it was now important for relevant professional bodies such as the Health Professions Councils, the Attorney Chambers, The Society of Pathologists, the police, insurance bodies and others to develop a set of guidelines or rules pertaining to the disclosure of information.
“This should be drawn up,” Dr Mapunda said. “This would serve as the standard of pathology practice accepted by the profession which, while legally binding, would then be recognised by the courts.”
Debate on the specific issue of ethical conduct for pathologists sought to heighten sensitivity and increase awareness among practitioners in the country.
No matter how controversial the facts and circumstances surrounding a particular issue may be, other pathologists said preservation of the highest ethical standards is vital to the conduct of independent judgment and professional practice by pathologists.
“Ethics are ultimately to the dignity of the profession,” said a Harare-based pathologist.
“Conflicts of professional interest and violation of ethics erode the public’s trust in both the professional and the profession. For these reasons, the breach of ethics must be avoided whenever possible and where they cannot be avoided, they must be managed in an open and cooperative way.”
The International Pathology Day, held annually on November 18, every year offers an opportunity to celebrate the vital work of pathologists and demonstrate to the public the important role of pathology in their lives.
Throughout the week, pathologists and laboratory scientists across the world run a variety of events to improve public awareness and understanding of the science behind the cure.
Celebration this year, were held under the theme: ‘Pathology: The Science Behind the Cure.’