Investigators should be trained to “think dirty” about cause of death, Shipman report says
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7407.123-c (Published 17 July 2003) Cite this as: BMJ 2003;327:123All rapid responses
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One needs a complete differential diagnosis in determining the cause
of every death and that includes foul play. The issue is more pressing
today than ever before because covert methods exist for causing deaths
from "natural causes". The possibility that Dr Kelly's "suicide" was
forced upon him by covert methods needs to be seriously considered given
the highly political nature of his work.
The first step should be a complete and full disclosure about the
covert methods that have been and are being employed for political and/or
monetary gain. I suspect Dr Kelly was in a better position than most to
make that disclosure. That is motive enough for someone to want to kill
him. He did not leave a suicide note.
Competing interests:
None declared
Competing interests: No competing interests
Editor,
Your legal correspondent Clare Dyer says “Investigators should be trained
to "think dirty" about cause of death”
Is this gratuitous advice she is giving the Medical Profession or is
she quoting of paraphrasing some legal authority?
“Think rationally” is what one should be advocating.
As Editor perhaps you should dissociate yourself from her remark. It
is unworthy of a prestigious Medical Journal to promulgate such profanity.
Enough harm has been done to innocent families, as Drs Mark Struthers
and John Fryer have already pointed out, by the proponents of “think
dirty”.
Let us have no more of it.
Michael Innis
Competing interests:
None declared
Competing interests: No competing interests
It is interesting that the inquiry into the crimes of Harold Shipman
should use the adage 'think dirty' in the pursuit of causes of death. It
is intriguing that Clare Dyer, the legal correspondent of the BMJ should
be 'thinking dirty' in the first paragraph of her report into that
inquiry. It cannot have been far from her mind that 'dirty thinking' over
infant deaths has been the cause of enormous injustice in the British
courts in recent years. Who will be the victims of the next round of dirty
thinking? That isn't far from my mind.
Competing interests:
None declared
Competing interests: No competing interests
The report and its conclusions appear sensible.
The heading "Think dirty" conjures up ideas of yet further injustice.
"I think, therefore I am," would translate to: "I think dirty, therefore I
am dirty."
What is essential and comes out in the report is the absolute need to be
thorough, objective and examine all of the facts.
The need is therefore to return to basic good scientific investigation and
to use knowledge and not emotion or "I think," in any investigation.
And certainly not "I think dirty".
Too many mums are in prison after losing their infants, because of this
"think dirty" campaign of recent years.
On reflection and good science, we see Sally Clark back in society as a
loving mum and Trupti Patel spared such an incarceration.
Let us hope other mums come out of prison soon.
And let no - one, "Think dirty" but everyone, stop and just think first.
Competing interests:
None declared
Competing interests: No competing interests
Do not "Think dirty" about infant deaths
Your legal correspondent reports that the Shipman inquiry calls for
coroners’ investigators to “think dirty” about the causes of death (19
July). It is important to point out that Dame Janet Smith, who heads the
inquiry, made clear in her Discussion Paper of October 2002 that the
investigation of unexpected deaths of infants has to be handled
differently.
Calls to “think dirty” have been part of the problem in the
investigation of sudden unexpected death in infancy (SUDI), leading to
insensitive treatment of bereaved parents, inadequate investigations,
incorrect diagnoses, and loss of information about the causes of the
majority of SUDI that are natural.
In SUDI, suspicion should be the end point, not the starting point,
of any coronial investigation. The Foundation for the Study of Infant
Deaths (FSID) has been encouraging medical and forensic professionals to
cooperate in undertaking comprehensive, standardised and thorough
investigations of SUDI. FSID gave evidence to the Shipman inquiry to try
to ensure that any changes recommended in the coronial investigation
process in response to Shipman do not adversely affect handling of SUDI
and requesting the inquiry to take advantage of the opportunity to
improve investigation of infant as well as adult deaths. The Shipman
Report’s overall recommendations are welcome, in particular the provision
for medical expertise in coronial investigations. Dame Janet said in the
October 2002 paper that a new coroners’ service should develop protocols
for special handling of SUDI and we concur.
It would be extremely unfortunate if general reporting of the Shipman
inquiry gave renewed life to the “think dirty” catchphrase which has
caused so much harm in the investigation of infant deaths.
Competing interests:
None declared
Competing interests: No competing interests