Ethical Crossroads In Forensic Medicine: Our Duty To The Living

You have signed the document. It is obvious what caused the death. Yet, as you walk away, a different kind of discomfort takes hold. The case is closed, but you pause and wonder, have I really fulfilled my duty?

Forensic scientists are taught to be objective and steadfast defenders of the deceased in forensic medicine. Finding the truth about the cause of death is their main goal. However, what happens if the truth we uncover on the autopsy table not only clarifies a previous death, but also indicates a threat to the living in the future? This is one of the most significant ethical crossroads in forensics: the conflict between the obligation to protect the families left behind and the confidentiality of the deceased.

Think of a situation that any forensic pathologist might encounter. A young man who appears to be healthy passes away unexpectedly from a heart attack. The autopsy points to hypertrophic cardiomyopathy, a thickened heart muscle that is often hereditary and can be a serial killer. The relatives of the person might be carrying the same genetic variant in their day-to-day lives without even realising it. The pathologist’s knowledge could literally save the lives of the bereaved family.

This dilemma is not confined to the morgue. In the clinics and hospitals where the living are treated, it is directly comparable. Consider a clinical geneticists identifying Huntington’s disease or another hereditary condition in a patient. The patient, grappling with their own prognosis, refuses to tell their children. The same debilitating disease is 50% likely to be inherited by each child. Now, the doctor must decide whether to uphold the patient’s legally protected confidentiality or take immediate action to alert the vulnerable family members.

The principle of confidentiality is the backbone of medicine, which extends beyond death. In forensics, the family agrees to an autopsy to ascertain the cause and manner of death, not to conduct an unauthorised genetic test on their entire bloodline. Uninvitedly contacting someone with life-changing information can be interpreted as a serious overreach and a breach of the deceased’s privacy.

The duty to prevent harm, however, is a strong moral force that underpins the counterargument. You would yell if you witnessed someone stepping off a curb and into the path of an approaching car. Is this not the same? We have the information that could stop the same family from experiencing the same tragedy twice. The ethical principles of beneficence (to do good) and non-maleficence (to do no harm) extend beyond the person on the autopsy table. Is being aware of a preventable risk and not acting upon it a form of harm?

So, how does a professional navigate this difficult situation? Some medical examiner offices are draughting tactful, pre-written “Family Notification Letters” that recommend a specialist consultation due to a possible familial pattern discovered during the investigation. In clinical settings, healthcare professionals strongly encourage the patient to share the information themselves, often with the support of genetic counsellors.

The question of whether your duty has been fulfilled lingers in your mind, you find yourself at the intersection of a story that has ended and the stories that continue. Navigating through this crossroad is a sign of a diligent and caring professional who recognises that their responsibility, no matter how complicated, is ultimately to life itself.