Evidence-based medicine and medicine-based evidence: the expert witness in cases of factitious disorder by proxy

The UK media has recently devoted much attention to the role of expert witnesses in child protection cases. One or two particular pediatricians who have given expert testimony have been the subject of personal vilification and professional investigation. These cases raise questions about the use of medical expert testimony when there is real uncertainty in the scientific community and the emotional stakes are high. Do doctors use scientific evidence to make diagnoses in the same way that the courts use evidence to make judgments? The cases also raise questions about the personal credibility and trustworthiness of experts: should we allow ourselves to be seen as personally powerful witnesses? Are we responsible for how we are seen by the jury? In this article, these questions are addressed, with the conclusion that distress and anxiety about child maltreatment influences all the players in the justice process and may interfere with the process of justice.     

Treatment of adolescent psychoses with olanzapine: A preliminary report

Background: The empirical and theoretical literature on children's autobiographical statements about child sexual abuse and other forms of maltreatment should be of potential importance to all professionals who regularly interview children as part of their professional duties. Aims: To present an introduction to this field. Methods: Narrative review. Results: Preschool children appear to be capable of providing reliable testimony on highly salient personal experiences such as sexual abuse, though a substantial proportion of children may choose not to. However, suggestive interviewing practises, particularly when used with younger children, may elicit false allegations. There is little evidence to suggest that experiences from the preverbal period of life can later be meaningfully reconstructed by means of statements or clinical signs. Conclusions: Use of children as witnesses and informants requires special considerations, knowledge and skills.     

The expert witness in forensic psychiatry.

Forensic psychiatry operates at the interface of the Justice and Health systems and has been defined as: "That branch of psychiatry which requires special knowledge and training in the law as it relates to the mental state of the offender, or alleged offender" [1]. As a consequence of working in this area, psychiatrists are often called into court to give evidence as "expert witnesses". This article examines some of the professional and legal issues involved in providing expert testimony. Secondly, it aims to outline some practical guidelines for giving evidence in the court-room. The predominant focus is on criminal, rather than civil, proceedings in which the forensic psychiatrist gives expert testimony; however much of the information is also relevant to other psychiatrists and psychologists undertaking this role in the legal arena.     

The treating physician as expert witness: ethical and pragmatic considerations

OBJECTIVE: The objective of this analysis is to apprise pain physicians of the ethical concerns and practical considerations that arise when a treating physician is called upon to testify as an expert witness in a legal proceeding involving his or her own patient. The provision of expert testimony in medico-legal proceedings has come under heightened scrutiny in recent years. When a physician testifies as an expert witness, such testimony is considered to be the practice of medicine, and hence subject to the same ethical and professional obligations as patient care. Increasingly, medical professional organizations have promulgated guidelines for such activities, and even implemented oversight mechanisms to review complaints concerning expert testimony by their members. Additional issues are raised when the expert witness is also the treating physician for the patient who is a party to the legal proceeding in which the expert testimony is offered. CONCLUSIONS: While it is not categorically unethical or inadvisable for a physician to testify as an expert witness in a medico-legal proceeding involving his or her own patient, such activity raises special issues and concerns. Prospective expert witnesses in such situations should be cognizant of these issues and insure that they have been adequately addressed before and during the testimony.     

Continuous mental disorder as a prerequisite for the loss of legal capacity

German civil law differentiates between continuous and temporary mental disorder. Loss of legal capacity can only be ascertained if a continuous mental disorder is evident. Considering the far-reaching consequences of the loss of legal capacity, careful distinction between these two groups of disorders is necessary, but clear legal guidelines and unequivocal psychiatric statements are still lacking. The solution given here can assure the quality of expert testimony by taking into account the current diagnostic conventions of ICD-10 research criteria as well as relevant knowledge about clinical course and therapy of psychiatric disorders.     

How Child Maltreatment Enduringly Impacts Aggression: A Perspective Based on Personality Solidification

It has been shown that early experiences of maltreatment can stably influence an individual’s internal and external aggressive behavior in adulthood. And on what mechanisms do this stability arise? From the perspective of personality solidification theory, this study sample of 1951 primary and secondary school students was used to explore the relationship between child maltreatment, Big Five personality and internalized and externalized aggression, as well as the different mechanisms of differentiation of personality components in child maltreatment on two different natures of aggression, using four scales: The Childhood Trauma Questionnaire (CTQ), Revised NEO Personality Inventory (NEO-PI-R), None-suicidal Self-Injury Scale and Aggression Questionnaire. The findings suggest that (1) neuroticism plays the same mediating mechanism in the effect of child maltreatment on the persistence of internalized and externalized aggression; and (2) conscientiousness plays a different mechanism in effect of child maltreatment on both internalized and externalized aggression. Therefore, child maltreatment should be discouraged and the development of a sound personality should be guided, thus reducing future aggressive behavior and promoting child development and social harmony.     

Lies,damned lies,and medical experts: the abrogation of responsibility by specialty organizations and a call for action

The festering problem of medical expert witnesses proffering false testimony in court remains. A review of the many proposed reforms to resolve this chronic and outrageous practice has indicated little progress despite a resolution by the American Medical Association enunciating that medical expert witness testimony is effectively the practice of medicine. A questionnaire was sent to 36 specialty organizations to determine whether they had established guidelines, position statements, policies, or bylaws that govern the disciplinary management of their members who testify falsely. Responses were obtained from all 36 specialty organizations and showed that over 80% had no definitive disciplinary policies to deal with this egregious practice. This finding is all the more surprising given repeated judicial and other exhortations to professional organizations to "police themselves." To address the abrogation of responsibility by specialty organizations, new stringent disciplinary steps are proposed to exorcise the despicable practice of false expert witness testimony from the practice of medicine.     

A neuropsychological perspective on perinatal complications and the law

The increasing reliance upon neuropsychological data and testimony, as part of the evidence in obstetric malpractice cases, requires an informed community of professional and research-oriented neuropsychologists. This paper addresses a number of issues relevant to perinatal complications and their impact on neuropsychological development. Theoretical and empirical evidence is discussed which points to possible causal mechanisms that operate interactively to produce neuropsychological symptoms during early development. Recent research based on neuropathological findings suggests the implausibility of certain developmental outcomes related to perinatal trauma. This evidence should find its way into the expert testimony of clinical neuropsychologists in personal injury litigation. A theoretical formulation and model of perinatal insult is provided in order to serve as a basis for conceptualizing clinical cases where such insults are involved. The current paper extends the forum of opinion about obstetric malpractice and reviews the role of the clinical neuropsychologist in this context.     

The Effects of Evidence,Coherence and Credentials on Jury Decision-Making in Child Sexual Abuse Trials

Expert testimony is being used increasingly in child sexual assault cases. This study extended a prior study that examined factors related to expert testimony (evidence strength, coherence and credentials of the expert) on ratings of guilt and overall verdict. Specifically, we replicated our prior study but with two modifications: we used community samples as opposed to university students, and participants made their decisions in groups of 12 (as in the case of juries where one decision represents the overall group) rather than having participants decide and submit their verdicts and guilt ratings individually. Consistent with the prior (less ecologically valid) study, credentials of the expert had negligible impact. Evidence that was high in strength elicited a relatively high guilt rating even when the testimony was low in coherence. Further, it appears that when participants deliberate in a group (as in the case of juries) they are more conservative in their judgements (i.e., they are less likely to give a guilty verdict) compared to individual jurors who make their decisions alone. These findings suggest that caution must be exercised when drawing conclusions about the generalisability of prior research findings where participants did not engage in group deliberation.