Forensic Research & Technology

Biography

Biography: Gilbert Lau

Abstract

Primum non nocere – First, do no harm – is an age-old dictum which not only enshrines the primacy of ethical conduct among medical practitioners, but also implicitly emphasises the fundamentally hazardous nature of medical practice. In reality, every form of medical intervention carries a risk of an adverse outcome, one which is heightened by a combination of multi-morbidity and polypharmacy and further aggravated by a prevailing clinical penchant to treat gravely ill patients at both ends of the age spectrum with intrinsically toxic or invasive methods, which inevitably predispose them to considerable iatrogenic risk. There can be little doubt that healthcare has become extremely complex, both in terms of practice and delivery, with individual and systemic errors conspiring to negate this very guiding principle. Moreover, it could be argued that over-reliance on technology and clinical pathways or protocols might engender a false sense of security, while, in essence, heightening the risk of iatrogenesis and medical errors. The medico-legal investigation of almost any iatrogenic death could well present a forensic pathologist with a challenging prospect, as it often extends beyond the conduct of a complete autopsy, supplemented by various ancillary investigations – including post-mortem histopathology, which does not particularly excite this species of pathologists – to include a protracted process of clinico-pathological correlation. In principle, not all fatal adverse medical events are necessarily iatrogenic in nature. Even when an iatrogenic injury is demonstrable at autopsy, the attending pathologist is obliged to weigh the implications of such a finding against the underlying natural disease processes that prevailed at the time to death, so as to determine its actual significance in relation to the causation of death, which may be due to a combination of iatrogenic and natural causes. While it is not given to a forensic pathologist to opine on matters pertaining to standards of care, it is entirely proper for one to draw attention to any cause for concern revealed by the post-mortem examination. As the information obtained from these, admittedly tedious and onerous, autopsies serves to inform medical audit and enhance patient safety, the entire process may be regarded as an expansion of the traditional roles of forensic pathology in serving the administration of justice and promoting public safety in general.