Dr Wouter Basson’s long fight to prove to the Health Professions Council of South Africa (HPCSA) that he did not breach medical ethics when he manufactured and provided poisonous substances to apartheid security forces has come to an end. He was found guilty of unprofessional conduct today. Basson now risks losing his licence to practise as a doctor in South Africa or anywhere in the world. He could also be fined a hefty sum when he appears for sentencing on February 20 next year. Buyiswa Mjamba-Matshoba, the HPCSA registrar, said this case had been the most difficult and exhausting that had been brought to it. “It took us 13 years to prove that he had breached medical ethics. At the end of it all, I am happy that justice has been served,” she said. In March last year Basson took to the stand and testified that he was not guilty of unprofessional conduct and was merely following orders from his superiors when he manufactured and provided harmful substances for the purpose of using them on “enemies of the state”. He presented nine arguments during his defence. Basson’s arguments were: 1. The alleged unprofessional conduct happened within the context of a specific war and conflict situation. 2. He was under military instruction and supported by senior doctors. 3. He acted as a soldier and not a doctor. 4. He acted as a military doctor and ethics for military doctors are different. 5. The people who received the substances were not his patients, meaning that there was no doctor-patient relationship. 6. He was a young doctor and could not be held responsible for his actions. 7. He was not aware of the codes and conventions that forbade chemical weapons and the use of medicine for non-therapeutic purposes. 8. The medical ethics in 1980 were different from the ethics today. 9. The chemical substances (made for use in cross-border kidnappings) were specifically designed to be non-lethal and to protect life. What the HPCSA tribunal found: 1. That medical ethics are very important in times of war and conflict. Medical doctors have a unique position in society which impels them to stay true to ethical values of the profession. The committee rejected the contention that this factor should be considered in the context of whether the conduct of the respondent was unethical. 2. The committee accepted the fact that the respondent acted on instructions of not only military commanders, but senior doctors. However, the committee’s view was that a medical doctor is responsible as an individual for his/her actions. Medical ethics require independence of thinking by each medical doctor. A doctor cannot simply rely on a military order to escape the consequences of his actions. 3. While the respondent was a soldier at the time of performing the act, under consideration his conduct had to be assessed in light of the fact that he was probably ordered to perform the acts alleged because he was a doctor and the skills and experience in being a qualified doctor played a major role in his activities. The committee was of the opinion that if a doctor decided to use his medical knowledge and skills for actions contrary to medical ethics, then he should deregister from the council. The respondent could not rely on the contention that he acted as a soldier to the charge of breach of medical ethics. 4. Medical ethics are similar inside and outside the military. Doctors in the military in South Africa are bound by the ethical rules generally applicable to doctors. 5. The duties and roles of a doctor include the promotion of health in the general public and not only individual patients. The committee held that the respondent could not rely on the absence of doctor-patient relationship as an answer to the charge of unprofessional conduct. 6. Dr Basson was fully accountable for his actions as he was a registered specialist physician in 1980, and the committee further regarded him not as a young follower, but a mature leader of the chemical warfare programme. 7. It behoves a medical practitioner who ventures in the field of chemical weaponry to acquaint himself adequately on the terms and possible applicability of conventions and ethical rules created thereby. High standards of professional behaviour are required at all times from medical practitioners. 8. Although the discipline of medical ethics was not prominent in the 1980s, the principles of putting the interests of the patient first were accepted and applied universally. No doctor can claim ignorance of the expected professional behaviour of a medical doctor. 9. The committee rejected the contention that ethical principles do not apply to the manufacture and use of these substances.