The imprisonment of Cyril Karabus is deplorableBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6815 (Published 09 October 2012) Cite this as: BMJ 2012;345:e6815
Today a 77 year old paediatric oncologist sits in prison in Abu Dhabi while he waits to be retried for an offence he was originally convicted of more than 10 years ago, in absentia. Although that original conviction has been set aside he has been charged again with manslaughter, even though the courts apparently have no files or contact with the family of the dead patient. His defence lawyers have no access to any documents, which seriously inhibits their preparation of his defence.
Professor Cyril Karabus spent many years as a paediatric oncologist in South Africa, and throughout the apartheid era he worked to save the lives of black children with cancer. After his retirement he worked as a locum, including in the United Arab Emirates (UAE). He returned to South Africa and did not know he had been tried over the death from leukaemia of a 3 year old child and found guilty of manslaughter in the UAE. On his way home to South Africa from a family wedding in Canada, he spent a night in Dubai on a short visa and was astonished to be arrested the next morning (18 August) at passport control. His companions on that flight (his wife, daughter, and son in law) had to leave the country because they had only short term visas, and he has been in prison since then.
Those who witnessed a recent court appearance say he seems to be a broken man. His health is known to be fragile—he has a heart condition. Despite his passport having been confiscated he has not been remanded on bail but is being kept in prison, and he arrived in court in shackles.
What does this mean for other doctors? Firstly, some courts in the UAE will try people in absentia and apparently not inform them of the trial and conviction. Doctors in whose care a patient has died in countries other than their own, therefore, need to be aware of the attitude of courts and the risk of similar undefended charges. If the patient was well connected, from a wealthy or royal family, the risk may be even greater. The South African Medical Association has already warned its members to beware of working in the UAE.
Because medical knowledge is imperfect there is always a risk of a patient dying, however good the doctor and regardless of whether he or she used the best evidence based practice. Patients with cancer are particularly at risk of dying, as may be those with conditions such as congenital heart defects. If manslaughter charges are too easy to bring, patients’ lives will be more likely to be lost because the safest way to practise will be to avoid helping the sickest and most fragile patients. Unless the evidence that is presented is clear and unambiguous the threat of such charges is likely to lead to the defensive practice of medicine, which could include a refusal to treat patients with a poor prognosis.
Should doctors be advised not to practise in the UAE? Although this case is a “one off,” the court system does not seem to recognise the nature of medical practice and it has not offered those who are accused the chance to defend themselves.
Those who plan to work in the UAE will now watch with interest how the courts handle the evidence, assuming that the files relating to the charges are found. The outcome of the case will either reassure or worry them.
The way in which Karabus is being held—in prison, attending court in shackles, with inadequate attention to his health problems and his poor ability to cope with the high temperature in the UAE—is also important. Such treatment is unacceptable.
The BMA, and colleagues around the world, work with others to draw attention to abuses of human rights, especially in relation to healthcare professionals and the health and wellbeing of prisoners. We protest when we hear, for example, of prisoners who are held in conditions that endanger their lives, especially when an existing medical condition is untreated or managed inappropriately.
This case brings both these concerns to the fore. Karabus is an elderly man in a fragile state of health, who is being held in conditions designed to break him and to weaken his health further. He is also a doctor being held in prison over his medical practice, apparently because that practice did not lead to a 100% success rate.
The BMA is protesting about the conditions in which he is being held and will carefully monitor the hearings in relation to the allegations. Both concern us, and our concerns are shared by the World Medical Association and its members who are joining us in writing letters of protest. Doctors considering working in the UAE should be aware that the conclusion of this case may have implications for how they practise.
Cite this as: BMJ 2012;345:e6815
Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.