Raising ethical issues in the dead: an exploration of ethical challenges in Forensic Medicine

De Vaal, Celeste (2018-03)

Thesis (MA)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: This dissertation explores ethical challenges in the forensic medicine field. Pivotal to forensic pathology are the deceased and the medico-legal investigation. The unique relationship between forensic doctor and deceased is distinctly different to the doctor-patient relationship of most other medical disciplines. This highlights the importance of focused ethical deliberation in this field, which is long overdue. I argue that the deceased is an entity with moral status worthy of moral deliberation. I demonstrate that five concepts, namely, human properties, relationship considerations, moral agency, symmetry, and cultural and religious considerations, contribute to the deceased’s moral standing. The matter is not whether the deceased has moral status, but the scope of obligation to which such a moral status gives rise. Two questions have guided this thesis: First, do ethical issues exist in the field of forensic medicine in the South African context; and what are some of these issues? Secondly, if there are ethical issues, how can they best be identified and explored? South Africa’s recent history demonstrates the existence of ethical issues in forensic medicine, historically. The first major ethical arena revolves around the conflict of interest conundrum, which is especially prevalent in forensic medicine. Current dual loyalty concerns involve the deceased and the intricately linked judicial system, under which the forensic doctor works. The second area of ethical concerns relates to retained post mortem interests of the deceased. Prior to exploring these ethical issues, a framework had to be identified. No forensic medicine-specific framework was forthcoming in my literature search. In chapter four I argue that the principlism approach is a worthy framework to consider in addressing ethical issues in forensic medicine, in comparison with other prominent bioethics theories. Subsequent chapters illustrate ethical issues in forensic medicine by using principlism. The principle of justice was subdivided to incorporate three important aspects of justice, namely legal justice, rights-based justice and distributive justice. Beneficence as a positive act of doing good was discussed and aligned to the different role players involved in the medico-legal investigation. Non-maleficence was then discussed as related to avoidance of harm. Lastly, the principle of autonomy was deliberated to be applicable to the deceased as certain ante mortem interests remained post mortem. In summary, the two opening questions were answered in the dissertation. Ethical issues do exist in forensic medicine. Some of these issues were identified and subsequently explored in the thesis by means of principlism. Raising ethical issues in the dead is not merely a clever play on words, but indeed a necessary ethical discussion. Since ethical deliberation in forensic medicine is a largely unexplored terrain, recommendations for practice and future exploration are made.

AFRIKAANSE OPSOMMING: Hierdie verhandeling ondersoek die etiese uitdagings wat in forensiese medisyne voorkom. Forensiese patologie fokus op die oorledene en die medies-geregtelike ondersoek. Die unieke verhouding tussen die forensiese dokter en oorledene is by uitstek anders as die gewone dokter-pasiënt verhouding van ander mediese dissiplines. Vandaar die belang van gefokusde etiese beraadslaging in dié veld, wat al lank agterweë gebly het. Ek redeneer dat die oorledene ‘n entiteit is wat morele status het en aanspraak kan maak tot morele oorweging. Ek demonstreer dat vyf konsepte bydra tot die oorledene se morele status, naamlik die menslike eienskappe, verhoudingsoorwegings, morele agentskap, simmetrie, en kulturele en geloofsoortuigings. Die saak gaan dus nie oor of die oorledene morele status het nie, maar die omvang van verpligtinge waartoe die status aanleiding gee. Die tesis handel rondom twee vrae: Eerstens, bestaan etiese kwessies in forensiese medisyne in Suid Afrika, en wat is van die kwessies? Tweedens, as daar etiese kwessies bestaan, hoe kan dit geïdentifiseer en ondersoek word? Onlangse Suid Afrikaanse geskiedenis demonstreer dat etiese kwessies bestaan in forensiese medisyne, histories. Die eerste hoof etiese terrein handel oor konflik van belange, wat veral algemeen is in forensies. Die kwessie van dubbele lojaliteite betrek die oorledene, wat intiem gekoppel is aan die geregtelike sisteem, waaronder die forensiese dokter werk. Die tweede area van etiese kwessies handel oor die behoue nadoodse belange van die oorledene. Voor die bespreking van etiese kwessies, moet ‘n raamwerk geidentifiseer word. ‘n Literatuursoektog het nie ‘n forensies-spesifieke raamwerk opgelewer nie. In die vierde hoofstuk redeneer ek dat die vier beginsel benadering ‘n waardige raamwerk is om etiese kwessies in forensiese medisyne aan te spreek, in vergelyking met ander prominente bio-etiese teorieë. Die daaropvolgende hoofstukke demonstreer etiese kwessies in forensiese medisyne na aanleiding van die vier beginsels benadering. Die beginsel van geregtigheid was onderverdeel om drie belangrike aspekte van geregtigheid uit te lig, naamlik wetlike geregtigheid, regte-gebaseerde geregtigheid en distributiewe geregtigheid. Goedwilligheid as ‘n positiewe aksie om goed te doen, is bespreek en toegepas tot die verskillende rolsprelers wat betrokke is in ‘n medies-geregtelike ondersoek. Nie-kwaadwilligheid is toe bespreek ten opsigte van die vermyding van skade. Die beginsel van outonomie is laastens bespreek in toepassing tot die oorledene, ten opsigte van sekere voordoodse belange wat steeds nadoods belangrik is. Opsommend: die oorspronklike twee vrae is beantwoord in die tesis. Daar bestaan beslis etiese kwessies in forensiese medisyne. Sommige van hierdie kwessies is geïdentifiseer en ondersoek in dié tesis aan die hand van die vier beginsel benadering. Die opwekking van etiese kwessies in die oorledene is nie net ‘n slim woordkeuse nie, maar ‘n noodsaaklike besprekingspunt. Aangesien etiese beredenering in forensiense medisyne grootliks ongekende terrein is, word voorstelle vir praktyk en toekomstige verkenning uitgelig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103736
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