A group in a developed country performed an audit of pregnancy and its outcome in a group of 250 women with congenital heart disease. There were four maternal deaths of women in the series. It was decided to write up the audit. The paper reports aggregated statistics classified by diagnosis, but also contains a brief account of the factors associated with the four deaths (an account of one of these deaths has already been published in considerably more detail in the confidential enquiry into maternal deaths). Because of the unusual and complex nature of the lesions, these cases will probably be identifiable to medical staff involved in their care, and to close family members. Permission for publication cannot be obtained from the patients, for obvious reasons.
Do the committee consider that the local ethics committee should review the paper before it is submitted for publication? The policy of the local committee specifically excludes audits from its remit.
This case provoked a lively discussion on the legal and moral rights of the dead. Although legally the right to privacy dies with the patient, the committee felt that morally, consent from the next of kin should be sought. In this case it would seem that there is a strong public interest in publishing the cases in an attempt to prevent future avoidable deaths. Balancing the ethical considerations against the public interest, the majority of the committee thought that the audit should be published if it were impractical to obtain consent from the next of kin.
As recommended by the COPE committee, the paper has been referred to the local ethics committee for their comments. The journal is awaiting their comments before proceeding.
The journal was unable to follow-up the case and it is now considered closed.