The Hippocratic Oath
(Modern Version)

I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.

MEDICAL PROFESSIONALISM IN A CHANGING SOCIETY
Professor Yosuf Veriava
School of Clinical Medicine
Faculty of Health Sciences
University of Witwatersrand

Doctors in South Africa face many challenges, challenges that we have come to know all too well; the burden of disease made all the more onerous today by the emergence of new viruses and the pressures of climate change, as well the problems wrought by the very dysfunctionalities within our health care system. But there is also the ever-present challenge of sustaining medical professionalism, a challenge that we should face every day as a profession and as individual health practitioners. It is this challenge that I want to talk about tonight.

Recently, many public sector doctors went on strike in response to the delay by the department of health in implementing occupational specific dispensation. This was an important moment in our profession, not only for how it came to highlight issues around the remuneration of doctors working in the public sector, but perhaps even more importantly, and we should add urgently, for the ethical questions it posed for the profession as a whole. Whilst the community appeared sympathetic to the plight of doctors, it also expressed real concerns over the consequences of such actions on patient care, particularly for the indigent, and all those who rely solely on the public sector for health services.

We, in the past, never contemplated strike action even when, as Black public sector doctors, we received lower salaries than our white colleagues and were subject to humiliating and often arbitrary discriminatory practices. But we were not docile either. Many of us would in fact come to recognise our struggle, not as a separate one, but as part of the wider struggle of our communities, a struggle against the injustices of apartheid and the extension of those policies into the health care system. And if we came to see the enemy as apartheid, we could not accept that the very communities from which we came should be victims of how we chose to fight against it.

Today we live in a democracy, but one in which we are still faced by the legacy of the past, a legacy that continues to be felt in the dysfunctionality of the heath sector and the poverty and disease that ravage our communities. Our responsibility, indeed our struggle, today must be to direct our efforts at reconstructing our health services and not to destroy them.

In his ‘Critique Of Violence’, the early 20th century Marxist theorist and critic, Walter Benjamin, would find cause to reflect on the doctors’ strike that crippled a number of German cities, likening it to a blockade that, in his words, “showed a repellently unscrupulous use of violence - positively depraved on the part of a professional class that... without the least attempt at resistance, ‘secured death its prey’, only to abandon life of its own volition at the first … opportunity”. These German doctors, like our own, perhaps forgot the most basic principle of our profession - ‘Do no harm’.  

In South Africa, the injustices of our not so distant past have meant that, as doctors, we have had no shortage of occasions for reflecting on the ethics of the medical profession. And in the 42 years that I have enjoyed the very real privilege of serving the South African community as a medical doctor, I have also been fortunate enough to have been able to make a contribution to this profession, albeit a modest one. So today, as I go reluctantly, some (my kids especially) might even say kicking and screaming, into retirement, of the things I am most proud of, is having had the opportunity to participate in different ways in three important cases that go to the heart of the ethical responsibility and challenges that face our profession.   

Steve Biko, a well known and popular political activist in the 1960’s and 70’s, died in detention in September 1977 of severe head injuries following assaults by the security police.  Whilst still alive, but badly injured, Biko was under the medical care of two district surgeons. These doctors failed in their professional responsibility, putting the interests of the security police before those of their patient, Steve Biko. The case received extensive publicity, both locally and internationally, casting a negative light on the profession. But the case of Steve Biko also demonstrated the profession’s capacity for self-regulation and it ability to meet the ethical challenges presented by apartheid. And it was because of the intervention made by six doctors, five of whom were from Wits, that the SAMDC (now the HPCSA) were forced to convene a disciplinary hearing. The doctors who failed Biko and their profession were eventually found guilty of unprofessional and disgraceful conduct. This was a minor victory in the wider struggle against apartheid, but it was an important one for our profession.

Another important case arising out of the apartheid era was that of a senior doctor and the involvement of medical practioners in biological warfare. In 1981, This doctor accepted an appointment by the surgeon general of the South African Defense Force to serve as an officer in charge of “Project Coast”, which involved chemical and biological warfare research. He participated in the project and co-ordinated this research until 1993. My understanding of this project is that it was not of a defensive nature as its mission was to test, design and manufacture toxic and biologically active weapons which would be directed at populations and which had disabling and in, some cases, lethal effects. The HPCSA in its disciplinary hearing will have to determine whether this doctor, by not differentiating between his duties as a physician and his duties as a soldier, violated numerous and long established ethical norms as he applied his medical knowledge.

However, if the Biko and the latter case illustrate the ethical responsibility of doctors in maintaining their professional autonomy from a repressive state, in more recent times new ethical challenges have emerged as the very fabric that makes and sustains life comes to be traded on the international market as any other commodity.

Recently, a number of medical practitioners in Kwazulu Natal were investigated on allegations of human organ trafficking. It was believed that these practitioners played an active role in an international kidney trade syndicate which recruited financially disadvantaged individuals (mainly Brazilians) as donors of organs to be implanted in wealthy (mainly Israeli) citizens. Such transplants were in fact carried out in hospitals in Johannesburg, Cape Town and Durban. Many of these have taken place in Durban between the period 2001 – 2003.  As consequence of this case, South Africa, is now listed as one of the countries involved in organ trafficking. According to our local and international code of ethics, trading in human organs is one of the most serious crimes that can be committed in the medical profession.

Questions of medical ethics are however not only the stuff of high profile cases like these, or simply a historical record of our exceptional past, but is the very stuff of everyday practice…dare I say, the stuff that makes a good doctor.

There are in fact few professions where day to day practice calls for nothing less than a commitment to:

• Integrity,
• Compassion,
• Altruism,
• Continuous Improvement,
• Working in partnership with members of a wider community, and
• Excellence.

And if these values and traits imply a greater responsibility than those expected of lawyers, journalists and politicians, it is also matched by the tremendous public trust and regard given to doctors.

There are, however, more and more reports of dissatisfaction with the medical profession. Many of these stem from misrepresentations in the media, motivated by the sensational impact of medical errors and misdiagnosis. These overshadow routine good medical practice.

But there are also other factors which convey a negative image of the profession that, unfortunately, are often of our own making. For instance, the perception that many of us who practice in the private sector are only in it for the money, where the relation between a doctor and patient becomes a simple matter of economic exchange along the model of willing buyer-willing seller. Regrettably such an ethos does exist among many doctors. While it is not unprofessional for a doctor in practice to charge a patient for professional services rendered, overcharging or over servicing is unprofessional. This applies also to the practices of doctors receiving financial and other forms of “kickbacks” from pathology laboratories or pharmaceutical companies. Instances of medical aid fraud by doctors are undoubtedly disgraceful and unfortunately far too common.

Even in the public sector there is much that raises concern. Central to the patient-doctor relationship is patient experience. Public sector doctors are often perceived by the community to be unfriendly, uncooperative and lacking in compassion. Doctors within the public sector have in some instances also failed to keep up with changing societal expectations.

Fortunately for public sector health services, the majority of doctors possess a strong dedication to patient care despite adverse working conditions, and a professional ethic that for many has been the reason for forgoing personal wealth in favor of life of public services and the different, but no less rich, reward that comes from it.

A medical career, however, extends over a period of 30 – 40 years during which a doctor might experience a weakening commitment to professionalism, and need to find ways of sustaining it. As Dhai and McQuoid-Mason suggest, reflection and reappraisal is thus a primary and ongoing aspect of our professional life. And it is crucial that - even as we trade in life and death - we remember our own humanity. We are not gods (even if we sometimes would like to believe otherwise). We are as unique and fragile as the patients we care for and our individual fulfillment is the key to internalising, sustaining and communicating a professional ethic. “To produce happy patients we need happy doctors” (RCP).

As medical professionalism comes under constant and new threats, its strengthening and protection becomes ever more important. This is a combined responsibility. A responsibility of both individual doctors and professional organisations, such as the HPCSA,  SAMA,  medical schools and the Department of Health. Each has a role to play.

For statutory bodies, such as the HPCSA, this role is perhaps best summed up by the supreme court judgement that compelled the former’s apartheid era counterpart to conduct a disciplinary hearing against the doctors involved in the torture of Steve Biko:

“They are the custodians of the honor and rectitude of the profession. It is left to them to say what standards of honor the members of the profession should conform to. The council is truly a statutory  custos morum of the medical profession, the guardian of the prestige, status and dignity of the profession and the public interest in so far as the members of the public are affected by the conduct of the members of the profession”.

The Department of Health, on the other hand, as the major provider of health services, has a specific role in creating an enabling work environment for doctors to perform their responsibilities according to the dictates of professional ethical codes. Attention to additional considerations, such as adequate salaries and benefits, future security, pleasant working conditions, adequate time to attend to professional development and a promising career path, will go a long way to creating a ‘happy doctor’ population in the public sector.

Medical schools also have a critical role to play in developing the future generations of truly professional doctors. Medical schools need to consider selection criteria which would identify students with developed, or the potential to develop, qualities that I have spoken about tonight. Furthermore, the values of professionalism must be integrated into and inculcated throughout a student’s entire medical curriculum. Our Faculty of Health Sciences has for this very reason introduced professional values early into the undergraduate curriculum and attempted to promote a culture of medical professionalism through the creation of institutions like the Steve Biko Centre for Bioethics.

The ethical foundations of our profession are ancient. And, indeed, our profession has come to embody the highest values; a commitment to the well being of others, mastery of a body of knowledge, of a set of skills and self governance. Values that are very close to how the ancients understood ethics itself, that is as the care of the self and others.

A working party of the Royal College of Physicians in the United Kingdom recently defined medical professionalism as:

“[A] set of values, behaviors and relationships that underpins the trust the public has in doctors.”

This trust, which is the very life blood of our profession – and what our patients’ faithfulness to the prescriptions we set rests upon – depends on nothing less than an ethical comportment that, in the words of the Royal College of Physicians, requires “a partnership between patient and doctor…based on mutual respect, individual responsibility and appropriate accountability”.

I would like to end my talk tonight, and what have perhaps been somewhat scattered thoughts on professionalism, with two possible scenarios that John Williams, in a recent publication, lays out for the future of our profession.

In the first, the forces of commercialism, consumerism and bureaucratisation prove overwhelming and health care is largly taken over by corporations and run on business principles. Efficiency becomes the primary value, insofar as it constitutes profits, eclipsing patient well-being. Indeed, in this scenario the patient is nothing more than a customer and physicians serve either as employees, managers or owners of a business whose commodity is health. The ethical centre of the profession has now become the enterprise as the primary object of professional loyalty.

The second scenario is one I prefer and which I believe is worth striving towards:

“Medicine will continue to be a healing profession dedicated to serving humanity. Its cornerstone will contribute to be the relationship of trust between the patient and the physician. It will uphold with integrity the values of respect for persons, compassion, beneficence and justice. It will strive for excellence and incorporate progress in its art and science. It will maintain high standards of ethics, clinical practice and research in order to serve patients. It will encourage the development of healthy communities and of practices and policies that promote the well being of the patient. It will demonstrate its capacity for societal responsibility through self regulation and accountability. It will actively participate in decision making policy regarding health and health care policy. It will guard against forces and events that may compromise its primary commitment to the well being of patients.”

This is the vision and challenge I will have to leave to the new generation of doctor to realise. The future of our profession and the health of our communities depend on them rising to meet it. And it is my fervent wish that they will not fail us and the profession that they now have the privilege of belonging to.

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Presentation to the Ethics Alive Faculty Assembly by Allister Sparks
Wits Medical School

15 March 2010

I am here today to talk to you about a singular moment in our history when the ethics of the journalistic profession intersected with those of the medical profession. A moment when the ethics of both were severely challenged, but out of which the truth ultimately prevailed to present us all today, as fellow practitioners of our respective professions, with a stark lesson -- a classic case study of the enormous importance of ethical behaviour in a civilised society.

It is a lesson, I would say, that is also appropriate to recall at this time, for our society, our brave new South Africa is, I fear, in danger of sliding into a morass of immoral behaviour. I find myself recalling a story that the late, great Helen Suzman once told me of a visit she made in the bad old days to the pass office in Johannesburg to help sort out the difficulties of a black person who had become caught up in a pass-law entanglement. When she protested to the elderly Afrikaner official she was dealing with, and who had been unusually sympathetic, about the immorality of the whole system, the old civil servant looked at her and shook his head. "Mrs Suzman," he said, "the ethics is buggered!"

A pithy observation that bears repeating today.

I am speaking, of course, about the murder in detention of Steve Biko, founder and leader of the Black Consciousness Movement, about the attempts by the security police, by the state doctors who attended Biko in custody and above all by the Minister of Justice, Jimmy Kruger, to cover up the fact of the murder -- and of how the newspaper I was then editing, the Rand Daily Mail, was the first to puncture that cover up and publish the truth of how Biko had actually died, only to find itself reprimanded and punished for what the Press Council of the day declared to be misleading and tendentious reporting.

Guilty, in other words, of telling the public the truth after the Minister himself had lied in Parliament. A finding every bit as egregious as that of the South African Medical and Dental Council's initial finding absolving the so-called "Biko doctors" of any blame for his death.

Thanks to a courageous group of doctors that included Professor Yusuf Variava and Professor Phillip Tobias, a long legal battle was fought that ultimately saw justice prevail in the medical profession with the striking of one of the Biko doctors, Dr Benjamin Tucker, from the medical roll and a severe reprimand for another, Dr Ivor Lang.

Sadly there has been no such formal redressing of the injustice done by the Press Council to the Rand Daily Mail, myself as editor, and the key reporter who handled the breakthrough story, Helen Zille -- now leader of the Democratic Alliance and Premier of Western Cape Province.

So the guilty verdict still stands, theoretically anyway. But that matters little, for the public has long known the truth about this tawdry affair. The cover-up artists had their brief moment of gloating, but I feel sorry for them. There can surely be nothing more painful at the closing of one’s life to find oneself on the wrong side of history.

* * *

Let me say at the outset that I think the murder of Steve Biko was the single most heinous crime of the apartheid era. There were many deaths in detention of course and much covering up of the truth: of the 64 deaths in detention between 1963 and 1988, our most troubled years, inquest courts declared that 30 were "suicide," while police assault and medical negligence never featured in any of the findings.

But Biko's murder was particularly heinous, firstly because he was the most prominent leader in our civil struggle to be killed. There were many deaths in the struggle of course, tens of thousands, but top leaders were never targeted on either side.

Worse still was the manner of Biko’s death, from the brutality of his interrogators who beat him into a state of semi-consciousness, then chained him to a metal grille in a crucifixion position and left him to hang there for hours, to the callousness of his doctors and handlers who ignored his symptoms and then, when they panicked, bundled him into the back of a Land Rover while he was semi-conscious and drove him, naked and shackled, 1,200 km through the night from Port Elizabeth to a prison hospital in Pretoria, where he arrived with no medical report on his condition so that the doctor who saw him there simply set up a drip, gave him a vitamin injection, wheeled him into a cell and left him there to die a few hours later. From all that to Kruger’s statement in Parliament that Biko's death "leaves me cold," constitutes a story that takes some beating for sheer callousness and inhumanity.

* * *

It was September 1977 and I had become editor of the Rand Daily Mail only six months before Steve Biko died. I had never met him, but I was a close friend of Donald Woods, then editor of the Daily Dispatch in East London, who had come to know him very well, had befriended him and had been urging me for months to come to King William's Town and meet this dynamic young leader who was confined there under a banning order. Those of you who have read Donald's autobiography or seen Richard Attenborough's movie, "Cry Freedom," will know that Donald had been completely transformed, both in his person and in his political views, by his friendship with Biko. So although I had not met Biko I knew a lot about him and I knew that his death in detention was an event of seismic importance. So we ran the story big, with huge banner headlines.

Kruger's immediate response to this huge event was to belittle it. He indicated in a statement in Parliament that Biko had died of a hunger strike, adding that the Black Consciousness leader was a dangerous terrorist whose death was of little concern to him and left him cold.

I telephoned Donald immediately. "Kruger’s lying," Donald exploded. "Steve would never have gone in a hunger strike. He’s been in detention several times before and he’s always relished challenging his interrogators because he’s brighter than them. This time the bastards have killed him!"

It was a story crying out for investigation, but there was nowhere to start. All the facts were secreted behind prison walls and impenetrable security legislation. No-one had had access to Biko since his arrest 26 days before his death. The only independent person near him was his friend and fellow activist Peter Jones, who had been arrested at a road block with him, but Jones was still in detention and therefore inaccessible.

So time ticked by until, on the morning of September 29, my phone rang and Dr Jonathan Gluckman, the distinguished pathologist, was on the line. He was a friend so no introductions were necessary. "Please come and see me as soon as you can," he said.

Dr Gluckman, who died in 1993, was one of the backroom heroes of the struggle for justice in this country, a tall, rotund man whose slightly pompous air concealed a passionate humanitarianism that drove him into some of the darkest corners of the apartheid state -- its mortuaries.

He lived graciously, with a liking for fine French wines and good cigars. I once asked him why, with his refined tastes and medical skills, he preferred spending his life cutting up cadavers rather than healing the sick.

"Because," he said simply, "that’s where the truth lies." It was his passion for the truth that had prompted him to phone me.

Gluckman was in a state of agitation when I arrived at his home in Pallinghurst Road, Westcliff. "Come into the garden," he said, "we'd better talk outside" -- which was a common precaution in those days to sidestep the listening devices used by the security police.

So we walked into the garden and spoke in whispers. He pulled out a document and handed it to me. It was a bombshell -- the pathologists’ report on Biko signed by himself and the Chief State Pathologist, Professor J D Loubser. And there in the space for the cause of death were the words: "Brain damage."

"I attended the post-mortem examination on behalf of the family," Gluckman told me. "I'm not supposed to show you this, so please don't mention that I have because then they'll prevent me from testifying at the inquest. But my conscience won't allow me to let Kruger get away with this cover-up about a hunger strike.”

He said Kruger had hinted that there might be no need for an inquest, which meant it was imperative that the truth be published to force the Minister to order one. But I would have to conceal Gluckman's role in doing so.

So I gave Jonathan my pledge of confidentiality. It was a pledge I honoured religiously until after his death 16 years later. Only then did I mention it to anyone outside a small group of need-to-know senior staffers at the Rand Daily Mail and my lawyers.

It was a conundrum. I knew the truth with absolute certainty, and it was obviously in the most profound public interest that I should publish it. But how could I do so when I was bound not to reveal the source of my information?

This isn’t a unique problem in journalism. It happens often. But never before in my career had the conundrum been so tightly drawn -- the need to publish so imperative, yet the difficulty of doing that so great and the implications so dangerous in the prevailing authoritarian climate.

My first decision was that I had to publish, come what may.

We knew the truth, what we needed now was to try to find something to hang it on since we couldn’t disclose our primary source. The only possible source I could think of, other that Biko's interrogators who would obviously give us nothing, were the doctors who had examined him in detention. They were, after all, doctors, not cops, with an ethical commitment to act independently in the interests of their patients -- and Biko had been their patient. So I decided to target them.

My next decision was to call in Helen Zille. She was a young reporter but I already had a high regard for her level of accuracy, backed up by verbatim shorthand and Afrikaans snelskrif. This was before the days of portable tape recorders and we could afford no mistakes or allegations of misquoting. We needed an accurate record of what was said. Also I judged Helen to be determined and smart, with a political savvy that I thought would enable her to think on her feet in what was obviously going to be a helluva tough assignment. Not long afterwards I was to appoint her political correspondent, one of the top jobs on the paper, largely because of her performance on this landmark story and her blanket coverage of the inquest that followed.

So Helen flew to Port Elizabeth and duly confronted the "Biko doctors" -- Dr Ivor Lang, the district surgeon, who was the first to examine Biko after one of the security policemen reported that the detainee was behaving strangely and not responding to questions; Dr Benjamin Tucker, the chief district surgeon, who was called in a day later and found Biko lying on a mat soaked with urine and complaining of pains in his head and back; and, the third one, Dr Colin Hersch, a specialist physician who examined Biko in a prison hospital where he gave him a lumbar puncture which revealed blood in the cerebro-spinal fluid -- a clear indication of possible brain damage.

The first two were worse than non-cooperative. Tucker refused to answer any questions, eventually slamming his door in Helen's face. Lang was simply abusive, cursing Helen and threatening to put his dogs on to her if she didn't leave immediately when she called at his small allotment outside Port Elizabeth where she’s had to knock on the kitchen door to get any response at all.

Hersh was different. He invited Helen into his home, where he was both apologetic and ill at ease. It was a dreadful case, he told her, and he was aware that a very serious situation existed, but unfortunately he had been instructed not to talk about it.

"I had a lot of empathy for him," Helen said afterwards. "It was clear he knew the truth but he had been ordered not to speak about it and he was visibly grappling with his conscience."

Hersch's disclosure that he had been sworn to silence, and his obvious discomfort spoke volumes. Even more significant for our purposes, as we unpacked the information on Helen's return, was that none of the doctors had been willing to confirm Kruger's statement that Biko had died of a hunger strike. They had refused to reply. We took that to amount to a confirmation that there was no such evidence, since if there had been they would surely have said so. There was no possibility that any of them could have got into trouble with the authorities for confirming the Minister's statement.

So Zille and I composed a carefully worded report which began: "An investigation by the Rand Daily Mail -- which included interviews with doctors who examined Steve Biko in detention -- has revealed that the black consciousness leader showed no signs of a hunger strike or dehydration.”

It went on to say that our investigation indicated that Biko had died of brain damage, and that the facts we had unearthed contradicted Kruger's statements. It stated that far from having died of a hunger strike, Biko was in fact slightly overweight when he died. His well-developed body weighed between 85 and 90 kg when it was delivered for burial.

We published the report under a banner headline: "No sign of hunger strike -- Biko doctors." We did not put the phrase in quotes, which we felt covered the fact that the doctors had not actually said this in so many words but had clearly implied it by refusing to confirm that there were such signs, as Kruger had said. And, of course, Gluckman was also a “Biko doctor.”

Kruger went ballistic. He protested that the report was false and demanded an immediate hearing that very day of the Press Council, a body set up by the Newspaper Press Union -- the proprietors' organisation -- in the face of threats by Prime Minister John Vorster to pass a press control law if the newspapers did not "discipline themselves."

(I must emphasise at this point that the Press Council of those apartheid days was fundamentally different from the Press Council we have today, which is headed by Joe Thloloe, a journalist of great experience and impeccable integrity whom I am happy to see with us here today. Unlike the earlier Press Council, which was introduced under duress, under threat from Vorster that he would introduce a law to control the press if it didn’t "discipline itself," today's body is a purely voluntary unit set up by the industry itself to adjudicate matters of journalistic ethics in the public interest and with no official sword of Damocles hanging over it whatsoever.)

I refused Kruger’s demand for an immediate hearing. The rules of the Press Council allowed an editor seven days to prepare a response to a complaint and I didn't want to be bullied by Kruger into abandoning that right. I also felt there was a good chance more facts about Biko’s death would emerge during the week now that we had opened this can of worms, and that this would force Kruger to drop his complaint.

But the president of the National Press Union, members of its executive and eventually my own managing director called on me in a relentless build-up of pressure throughout the day to urge me to accede to Kruger's demand. If I did not, they said, Vorster would cite it as proof that the Press Council was inadequate and he would introduce his legislation.

I would then be seen as responsible for getting us a press control law.

Eventually I yielded. Perhaps I should not have done so. In retrospect I have become convinced that when you face this kind of political blackmail in an authoritarian situation it is better to stand your ground and challenge the authorities to do their worst -- and to be seen doing so by all the world. The prospect of that might make them back off, but even if they don't it is better not to become complicit in their cover-up games. Let the public see what is happening .

But it was the pressure from my own industry, particularly my own proprietors, that tipped the balance and caused me reluctantly to agree. It was my first direct experience of the double whammy of Government pressure and unsympathetic proprietors which had driven my two predecessors from the editorial chair of the Rand Daily Mail, and which was in time to drive me out as well and eventually to shut down that great newspaper altogether just as its moment of vindication was at hand.

So that night I appeared before the Press Council, constituted like a court with a retired Appeal Court judge, Oscar Galgut, presiding. I was represented by Sydney Kentridge, that superb advocate who now practises as a QC in Britain.

Kruger, having lodged his complaint in writing, didn’t bother to attend.

As the hearing got under way it quickly became clear that if a refusal to hold an urgent hearing was considered unacceptable to Vorster, so too would an acquittal. Not being able to call Gluckman as a witness to cite the post-mortem report made our case difficult to present, but even so it was evident that Kentridge's pithiest points were making no impact on Galgut. He had a task to perform on behalf of the NPU.

While Kentridge in an hour-long address stressed that we stood by the facts of our report, that we had confirmation of its accuracy from sources whose identity could not be disclosed because I had given a pledge of confidentially which I was ethically bound to honour, and that in any case the Minister hadn’t contested any of the facts in our report. He had simply claimed that the headline didn’t accurately reflect the body of the report and that the facts published didn’t contradict the points made in his initial statement (which had been about the hunger strike).

But Gangut wasn’t interested in Kenridge's arguments about the essential accuracy of the report. He focused narrowly on the headline, contending that although there were no quotation marks around the words it looked as though it was a direct quote from the doctors and they had not in fact said that in so many words.

This, Kentridge said, was "syntactical trivia" that didn't warrant an urgent late-night hearing and the waiving of the Press Council's rules. It was the accuracy of the facts in the report that mattered and Kruger had not challenged them.

But Galgut wasn't having any of it. He found in favour of Kruger, that the headline was not substantiated by the body of the report and was therefore misleading and "tendentious." He also found, incongruously, that the facts disclosed in the report did not contradict the Minister's initial statement on the issue, which had been about Biko going on a hunger strike.

It was one o’clock in the morning when Galgut delivered his verdict in which he also ordered that it be published on the front page of the next issue of the paper. Which meant we had to stop the presses and do that in the early hours.

Kentridge was furious. I'll never forget Galgut's face as this legendary legal figure told him bluntly that his judgment was "completely unacceptable" and that the paper reserved the right of review on the grounds that no reasonable tribunal could have come to such a conclusion. Galgut reeled back as though he had been physically slapped.

The case didn't go on review. The proprietors, relieved that the Press Council had been able to deliver the scalp to mollify Vorster and Kruger, were happy to let it go at that. So the verdict of misleading and tendentious reporting still stands.

But, as I said earlier, it doesn’t matter. History has vindicated us and I am proud of what we did. Without that the truth of this most obscene of apartheid’s crimes might never have become known, at least not to the extent that it did. Kruger might have succeeded with his attempted cover-up and prevented the holding of an inquest.

As it turned out, the inquest, at which Dr Gluckman was the principal witness, was held, and as the whole story poured out in its hideous detail, Helen Zille and other reporters were there to give massive, almost verbatim coverage, day after day, to tell it all to an appalled public.

Even so the inquest magistrate tried to continue the cover-up with a shameful finding that Biko had died of brain damage but no-one was to blame for it. But the truth was out in the public domain and there was no stopping it. The inquest court records provided the basis for those committed medical professionals who went to court to challenge the Medical and Dental Council's initial exoneration of the Biko doctors, so that justice was eventually seen to be done there. Finally, of course, there was a Truth and Reconciliation Commission hearing at which some of Biko's interrogators revealed more of the truth of what they had done to him -- but not enough, as it turned out, to get them amnesty.

* * *

The abiding lesson in all this is that ethics is not just an ethereal subject for intellectual debate. It is an essential practice in all professions and indeed in all life. It is an organic necessity for the proper functioning of a democratic society. It must be inculcated and practised and constantly safeguarded, for its slippage can quickly take a society down a Gadarene slope.

To illustrate the insidiousness of such slippage, let me finish by quoting from a confession made many years later by one of the Biko doctors, Benjamin Tucker, in an application for reinstatement to the medical register -- an excerpt that I have here thanks to Professor Variava who has continued to follow all the way this most instructive historical saga.

"I came to realise," Tucker wrote, "that over a period of 30 years I had been employed as a district surgeon, I had gradually lost the fearless independence that is required of a medical practitioner when the interests of his patient are threatened. I had become too closely identified with the interest of the organs of the state, especially of the police force, with which I dealt practically on a daily basis."

So there you have it. You can get sucked in. We must never lose our "fearless independence" when our ethical principles are put to the test. The consequences, if I may borrow a John Vorster phrase, can be too ghastly to contemplate.

ENDS

• Living in a healthy and safe environment.
  

• Having access to quality healthcare that you can afford.
  

• Choosing the healthcare services you prefer to use.
  

• Receiving appropriate treatment from a qualified healthcare professional.
  

• Knowing that your personal information is treated confidentially and kept private.
  

• Being fully informed about any illness, diagnostic procedures, proposed treatments and the related costs.
  

• Choosing to accept or refuse treatment.
  

• Obtaining a second opinion, where appropriate.
  

• Receiving ongoing care from your chosen healthcare provider.
  

• You also have the right to complain about healthcare services that either violate your rights to good health or breach ethical standards, to have your complaint investigated and to receive a full response thereafter.