Do As I Say, Not As I Do: Why Bioethecists should Seek Informed Consent for Some Case Studies‪.‬

In 1993, The British Journal of Psychiatry published a medical case study that resulted in a disciplinary hearing against the authors who had submitted it for publication. While the relationship between eating disorders and self-mutilation is well recognized, "Blood-Letting in Bulimia Nervosa" reported three cases of a novel form of self-mutilation: deliberate blood-letting by venipuncture or insertion of intravenous cannulae. The patients' names or initials were not revealed, but other potentially identifying information was. One of the patients, "Ms C," was described as "a 26-year-old pre-registration doctor," and important details about the patients' histories and symptoms were included. (1) The case noted, for example, that "Ms C states that she was sexually abused by her father between the ages of 4 and 13 but the authenticity of this claim is in doubt." The professional affiliation of the authors was noted, and a third physician was acknowledged for allowing the authors to report on one of his patients. The patient identified as Ms. C became aware of the report after its publication and filed a complaint against the physicians. A newspaper in the community where the physicians practiced reported on the article, and one of Ms. C's friends recognized her. (2) Ms. C acknowledged giving verbal consent to have certain details of her condition used for research, but she objected that her identity was not disguised and that the facts were inaccurate. The General Medical Council, the body that regulates British doctors, considered charges of serious professional misconduct. The physicians contended that the patient had given verbal consent for the writing of a case report and that all the published details were highly pertinent. They were found not guilty. (3)