Seizing a Pap smear to catch a criminal? Ethical issues of forensic use of medical biobanks

By Nina de Groot.

A couple of years ago, during my studies, I assisted with a surgical removal of a benign uterine tumor at a small local hospital. As not much else was happening that day, I decided to follow the tumor out of the operation room all the way down to the pathologist in the basement. After examining the tumor sample, the pathologist opened a couple of doors to the storage rooms. That’s when I found out about the huge archives of tissue material that comprised most of the tiny hospital’s basement. “Oh, but this is not everything”, the pathologist told me, “we keep most of the tissue samples in storage boxes next to the highway”. As the tissue sections were to be stored for 115 years, the archives were bursting at the seams.

Ever since, the vast amount of little human parts scattered across the country has fascinated me. In the years to follow, I would see dusty moving boxes in corridors, high-tech automatically operated storages, and tanks of liquid nitrogen in a hospital’s parking lot. Filled with blood, sperm, tumor samples, or bone tissue, the biobanks are set up for scientific or clinical purposes. It never occurred to me that they could be used for any other purpose, why would they?

However, as hundreds of millions of biological samples are stored across the globe, it is perhaps not surprising that apart from researchers, patients, and clinicians, the utility of these samples would someday attract the attention of law enforcement. DNA profiles can be obtained from this bodily material that can then be compared to DNA profiles from a crime scene. Indeed, there are several cases in which bodily material that had been stored for medical purposes was used during criminal investigations.

One of the most notorious is perhaps that of the ‘Bind Torture Kill’ murderer. This serial killer, who had nicknamed himself ‘BTK’, referring to the methods he used, had taken the lives of at least ten people in the 70s and 80s. For decades, the police had tried to solve the murders, without success. After following a new lead, the police suspected a man called Dennis Rader, but lacked enough evidence. Law enforcement then decided to seize a Pap smear from Rader’s daughter, which had been obtained as part of a cervical cancer screening in the university clinic on the campus where she studied at the time. The DNA profile obtained from her cervical cell material resulted in a close match to DNA found at the murder scenes. Dennis Rader was arrested and sentenced to ten life terms.

Like the BTK case, most instances of (attempted) forensic use of medical bodily material are high-profile cases with a great societal impact. Cases include the search for the infamous Sicilian mafia boss Provenzano, the search for the murderer of a former Swedish minister, and the search for a raider in Norway’s largest ever bank robbery. Although forensic use of medical biobanks has not occurred frequently, it is important to have an ethical debate about this issue as it raises serious bioethical concerns. In our paper, we discuss pressing problems with respect to confidentiality, trust, autonomy and justice. For instance, forensic use of biobanks might lead to a decreased trust in healthcare institutions and to avoidance of care. In this regard, even a few high-profile cases might considerably influence people’s health behavior.

Ultimately, the aim is to provide ethical guidance and to inform the legal, public, and political debate about this challenging issue. This should help avoid hasty – and possibly unwise – decisions in the emotional aftermath of a horrendous crime. Amidst rapidly-evolving technological developments, increasingly used to serve public security, the question is not only what is possible, but also what is just.

 

Paper title: Accessing Medical Biobanks to Solve Crimes – Ethical Considerations

Authors: Nina de Groot, Britta van Beers, Lieven Decock, Gerben Meynen

Affiliations: VU University Amsterdam

Competing interests: None

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