Ref: Meel B.L. A Role for Forensic Pathologists in the World: Act locally, think globally (Editorial). Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology, 2000; Vol. 1, No. 1 (January - June 2000): ; Published February 25, 2000, (Accessed:
--Dr. B. L. Meel, MBBS, MD, DHSM (Natal), DOH (Wits), Dip HIV/AIDS Management (Stellenbosch),
This is a time for forensic pathologists around the world to be free to communicate about dealing with the multiple problems that confront humanity today. It is our duty to protect our communities and to prevent diseases and promote health.
Forensic pathologists are supposed to be the backbone of a health care system. They have multiple responsibilities, of which I consider two to be most important. The first relates to dealing with criminal issues and the second to human rights. Crime, especially high levels of crime, affects the health of the people of any country, and the more extreme this is, the sicker and unhealthier the people will be. Each year, according to one estimate, criminal injuries account for more than 5 million deaths globally (WHO, 1999). Traumatized survivors of the victims of deaths caused by criminal incidents are 20 times the number of dead annually. This means that annually about 100 million people around the world are traumatized as a direct result of violent crime.
Other forms of violent death are also contributing to the decimation of the world's population. Among these are traffic accidents, drowning, falls, fires, and deliberate acts of violence against oneself or others. The World Health Organization (WHO) estimates that on average, over 1.6 million people lose their lives to random acts of violence worldwide. On an average, 2233 people commit suicide around the globe every day - roughly one person every 40 seconds. In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death of those aged 15-44; and the WHO estimates that during the last two decades, suicide rates have been increasing globally (WHO, 1999), a mortality rate of 16 per 100,000. All these fatalities usually end up in the jurisdiction of forensic pathology.
Crime and violence affects every one of us one-way or other, whether we know it or not. The role of forensic pathologists around the world is to map out the effects of crime and violence on individuals, quantify these effects and make known to the populaces of our communities, the ways these issues can affect each individual, his or her family and the community of which he or she is a member. The history of the world is stained with the blood of enormous human abuses past and present and health professionals, including forensic pathologists, are implicated in these abuses as well, tainted with the deaths of innocent victims of their misdeeds. The collusion of health professionals in human rights abuses around the world is a controversy that condemns them. The role of forensic pathologists is crucial in this regard as they are supposed to be not only medical watchdogs in society but ethical ones as well, and should create a new ethical framework to guide health professionals in the future.
The problem forensic pathologists sometimes face, of simultaneous obligations, real or perceived, to the patient and the state, is a significant challenge for health professionals as well throughout the world. There are many circumstances where problems of dual loyalties arise, especially in relation to the state. Dual loyalty can, however, also mean that the professional is aiding the state in violating the human rights of an individual, especially if the state happens to be a coercive and brutal one that inflicts violence on its own citizens or anyone who expresses dissent towards it. Dual loyalty concerns arise, moreover, even in cases where the state does not act in a coercive manner, such as where a health professional, for ideological reasons, chooses to elevate state interest over the patient's interest. Regardless of the motive for the professional's behavior, if a state purposefully violates a person's human rights, then physician complicity in this state purpose would also constitute a violation of human rights.
The roles of forensic pathologists are multiple, as the profession encompasses a multidisciplinary scope. In some countries forensic pathologists have limited their role as health care practitioners to dealing with autopsies only. It is time for such professionals to take responsibility overall to handling medico-legal practice as well. The responsibilities that ought to devolve on forensic pathologists for caring for their communities are challenging and ought not be shirked. The teaching curriculum in some institutions is shrinking, and this is regrettable. This trend is the direct result of the step-motherly treatment inflicted on forensic medicine by people in authority in most of our institutions. In some our medical schools forensic medicine is only taught but half-heartedly to medical students. There is insignificant contribution to research.
Forensic pathologists have an important role to play in maintaining the health of our communities. The forensic pathologist ought to contribute to the health and well being of individuals in our communities through his skills as an expert witness and an ideal example of honesty, integrity and with sensitivity to his fellow being. The forensic pathologist ought to be a flexible person. Flexibility increases his credibility. Due to the political complexes in different countries, the medico-legal standards of forensic medicine are fragmented throughout the world. Forensic medicine needs a radical change of perspective and delivery of services. The services should be uniform worldwide. To create a more competent, easily accessible user-friendly, independent and cost-effective service to their communities at large, forensic pathologists should strive harder for standards and ethics. The role of forensic pathologists in a changing universal environment as a result of terrorism is crucial. A singular task for forensic pathologists in this scenario is the transformation of their medico-legal services to address new realities.
Terrorism today presents a major challenge to the survival of humanity. Its threat to the survival of humankind can be likened to the eruptions of virulent microbes that surface every now and then and threaten our health. This is a time for forensic pathologists around the world to communicate freely in addressing the multiple problems that confront us today. It is our duty to do the utmost in protecting the communities we live in and to prevent disease as well as promoting health. The working conditions in a majority of countries are far below satisfactory levels, and frustrated forensic pathologists are struggling regularly. We need to be united in our efforts and to communicate with each other and with our communities more frequently than before.
I am told that Professor Anil Aggrawal, a very energetic member of our community, is starting an electronic journal on Forensic Medicine and toxicology. The idea is to be able to publish new and fresh ideas freely, quickly and easily. To the best of my knowledge it would be the first of its kind in our specialty. This is a commendable effort and would undoubtedly go a long way in realizing our dreams outlined earlier. I wish him success in his new endeavor.
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