Ethical issues in the application of verbal autopsies in mortality surveillance systems [editorial]

Age sex and cause of death are registered for only a third of all deaths globally and the vast majority of these deaths occur in developed countries. In rural Africa = 80% of childhood deaths occur at home and are not registered in any routine mortality reporting system. Data on levels and causes of adult deaths in developing countries are extremely deficient in comparison with the information available for children. Increasing investments in controlling acquired immunodeficiency syndrome (AIDS) tuberculosis and malaria and the renewed focus on health indicators by the United Nations Millennium Declaration emphasize the need for new tools and methods to generate robust regional national and sub-national estimates of cause-specific mortality levels and patterns. Verbal autopsy (VA) is a method of ascertaining causes of death from information on illness and circumstances preceding death obtained from bereaved caregivers. VA has the potential to generate cause-specific mortality data and its application in sample or sentinel mortality surveillance systems is proposed as an interim strategy to close the mortality information gap in developing countries. Issues relating to the standardization and validation of VA tools and procedures have been discussed at several international workshops by experts in this field; but surprisingly the ethical dimension has never been raised. We want to increase awareness regarding the sensitive nature of this method of data collection and of the ethical issues that need to be considered to implement VA appropriately within mortality surveillance systems. (excerpt)