Academic journal article The Hastings Center Report

When Information: Can Save Lives: The Duty to Warn Relatives about Sudden Cardiac Death and Environmental Risks

Academic journal article The Hastings Center Report

When Information: Can Save Lives: The Duty to Warn Relatives about Sudden Cardiac Death and Environmental Risks

Article excerpt

In certain cases of sudden death, forensic experts may discover during an investigation or autopsy that family members of the deceased are also at risk of harm--from genetic disease, for instance. But do they have a duty to warn them? Looking at similar duties of physicians and researchers to warn third parties of risk suggests they do.

If a physician realizes somebody is at genetic risk for a potentially fatal, genetically caused condition, she not only has a duty to warn that person about the risk. She may even have a duty to warn the person's relatives that they may also be at risk. But genetic testing is not the only way we learn about such conditions, and doctors are not the only people who acquire such knowledge. At least in certain cases, forensic experts also acquire important medical knowledge and shoulder a similar burden: they, too, can have a duty to inform family members that they may be at risk for serious harm from, for example, cardiac disease or exposure to environmental toxins. In cases of sudden death and exposure to toxic agents, for example, the forensic expert--who, depending on the country, may be called a medical examiner or a forensic pathologist--is usually the first and only person aware of the risk for family members.

Serious, genetically acquired diseases do not always involve sudden death, of course. If an individual has an aggressive, hereditary form of cancer, knowing about the illness may permit relatives to undergo testing and could lead to early detection and treatment. (1) As the illness will last for some time, however, the family is likely to know about it before the patient dies. In addition, unlike cases in which somebody dies unexpectedly and suddenly, treating physicians--general practitioners, oncologists, and geneticists--will be involved. Most physicians agree that they should explain to patients that the cancer could be hereditary, especially if the disease has struck several times in the same family, or is of early onset, or (in the case of breast cancer) has occurred bilaterally. If the patient undergoes a genetic test for a predisposition to cancer, a positive result has implications for relatives, and oncologists widely accept that the patient's relatives should be told about the risks. (2) Oncologists and geneticists are well aware of the ethical issues, since the duty to warn relatives about genetic cancers has been discussed in the medical literature and because their medical practice makes them sensitive to taking family histories and inquiring about risks to others. (3) In contrast, the investigation of sudden death is left mostly in the hands of forensic pathologists, who define their duties in a more limited way on the grounds of their expert mandate.

In this article we will compare the forensic examination of cases of sudden death and death from exposure to toxic agents to accepted examples of the duty to warn. We will then formulate, on the basis of that comparison, recommendations for forensic pathologists concerning their duty to warn. These recommendations take the form of a protocol that we call the "general warning approach." Finally, we will discuss whether and how similar duties exist for others who might acquire information about a death.

Sudden Cardiac Death

A significant percentage of deaths in Western countries are due to the heart suddenly stopping. A significant percentage of sudden cardiac deaths in the young are caused by genetic diseases that lead to arrhythmia. In many of these cases, death is unexpected, and a forensic investigation--including a detailed autopsy--is warranted.

Sudden death of a relative affects family members. They are not only grief-stricken about the loss of a child, sibling, or cousin, but they might learn that they are themselves at risk for the same disease. Recent studies have evaluated the prevalence of different possible causes for sudden, so-called autopsy negative deaths. …

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