Practice of clinical forensic medicine in Sri Lanka: Does it need a new era?

Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology. Unlike the practice of forensic pathology, several countries have informal arrangements to deal with forensic patients and there are no international standards of practice or training in this discipline. Besides, this is rarely a topic of discussion. In the adversarial justice system in Sri Lanka, the designated Government Medical Officers practice both clinical forensic medicine and forensic pathology. Practice of clinical forensic medicine, and its teaching and training in Sri Lanka depicts unique features. However, this system has not undergone a significant revision for many decades. In this communication, the existing legal framework, current procedure of practice, examination for drunkenness, investigations, structure of referrals, reports, subsequent legal procedures, undergraduate, in-service, and postgraduate training are discussed with suggestions for reforms.     

Analysis – What is legal medicine?

Legal medicine addresses the interface between medicine and law in health care. The Australian College of Legal Medicine (ACLM) established itself as the peak body in legal and forensic medicine in Australia. It helped establish the Expert Witness Institute of Australia (EWIA), the legal medicine programme at Griffith University and contributes to government enquiries. Public health, disability assessment, competing priorities of privacy verses notification and determination of fitness for a host of pursuits are aspects of legal medicine. Complementing the EWIA, the ACLM runs training programmes emphasising legal medicine skills additional to clinical practice, advocating clinical relevance. Assessment of athletes' fitness and ensuring that prohibited substances are not inadvertently prescribed represent a growing area of legal medicine. Ethical consideration of health care should respect legal medicine principles rather than armchair commentary. International conventions must be respected by legal medicine and dictate physicians' obligations. The NSW courts imposed a duty to provide emergency medical care. Migration and communicable diseases are aspects of legal medicine. Police surgeons provide a face to legal medicine (which incorporates forensic medicine) underpinning its public perception of specialty recognition. Legal medicine deserves its place as a medical specialty in its own right.     

Forensische Veterinärmedizin

Forensic veterinary medicine is covered by different disciplines because there is no independent discipline comparable to legal medicine. A major area of forensic veterinary medicine focuses on offences against animal protection legislation. Other fields of activities include examination of causes of death and identification of species involved in forensic cases. Interdisciplinary collaboration with legal medicine in criminal cases is a further important aspect of forensic veterinary medicine. Findings in cases of cruelty to animals reveal that expansion and intensification of the existing co-operation between forensic veterinarians and forensic pathologists is necessary. A systematic analysis of cases of cruelty to animals and a correlation with subsequent violence to humans is required. This area should be a task for future interdisciplinary research activities.     

Features of the organization and algorithms of actions of forensic experts in emergencies and military conflicts

The article deals with the problem of identification of unidentified dead bodies in emergency situations with mass casualties. The basic principles of forensic identification are regulatory and legal regulation, the types, methods and algorithm implementation. Solving of the problem of identification because of its great social, moral, ethical and political morality is an important public policy issue. It is emphasized the importance of an adequate regulatory framework in relation to objects and subjects of the identification and regulation of algorithms of actions forensic experts.     

Forensische Radiologie

Forensic radiology includes both clinical and postmortem forensic radiology. Clinical forensic radiology deals with imaging of healthy people from a legal point of view, such as for determining age or to prove and document injuries in victims of crime. Postmortem forensic radiology deals with the application of modern radiological methods in order to optimise post-mortem diagnosis. X-ray examination has for decades been routinely used in postmortem diagnosis. Newer developments include the application of postmortem computer tomography and magnetic resonance imaging; these are the methods with the greatest information potential but also with the greatest deviations from diagnostics in living persons. Application of radiological methods for securing evidence in criminal procedures is still in its infancy. Radiologists' technical understanding and forensic doctors' knowledge of postmortem changes in a corpse must be synergised.     

Medical evidence in asylum applications: Medical versus legal approaches

The purpose of this narrative review is to elucidate the ways the clinicians working on forensic medical evaluations can engage with asylum proceedings. We compare the legal and medical perspectives on different aspects of forensic medical evidence, asylum evaluations, and asylum applications. As asylum seekers must demonstrate a well-founded fear of persecution in order to receive asylee status, legal and medical professionals often need to collaborate in asylum cases. Although significant evidence has demonstrated that an objective expert medical opinion can support asylum claims, few studies have analyzed how the medical professional's role complements or is at odds with the goals of the legal system. This review summarizes and compares key aspects of the medical and legal perspectives on trauma, credibility, autobiographical memory, and medical evidence to better comprehend the role that medical professionals can play in writing medical affidavits for asylum applications. We dissect legal misconceptions surrounding trauma and the consequences of such misunderstandings and make recommendations for medical evaluators who are working in a forensic capacity.     

What is legal medicine – Are legal and forensic medicine the same?

Some consider the terms “forensic” and “legal” medicine to be synonymous but this is counter to the title of the Faculty of Forensic and Legal Medicine or the dual strands for progression to fellowship of the Australian College of Legal Medicine. The paper examines a very brief historical background to legal medicine and develops a definition of the strands thereof, namely legal and forensic medicine. It demonstrates that the two are different components of the application of medical knowledge upon the legal system. Legal medicine has greater relevance to civil and tort law, impacting upon patient care, whereas forensic medicine relates to criminal law and damage to, or by, patients.     

Increasing the reach of forensic genetics with massively parallel sequencing

The field of forensic genetics has made great strides in the analysis of biological evidence related to criminal and civil matters. More so, the discipline has set a standard of performance and quality in the forensic sciences. The advent of massively parallel sequencing will allow the field to expand its capabilities substantially. This review describes the salient features of massively parallel sequencing and how it can impact forensic genetics. The features of this technology offer increased number and types of genetic markers that can be analyzed, higher throughput of samples, and the capability of targeting different organisms, all by one unifying methodology. While there are many applications, three are described where massively parallel sequencing will have immediate impact: molecular autopsy, microbial forensics and differentiation of monozygotic twins. The intent of this review is to expose the forensic science community to the potential enhancements that have or are soon to arrive and demonstrate the continued expansion the field of forensic genetics and its service in the investigation of legal matters.     

Medical Negligence - Going Dutch

Forensic DNA profiling combines the dynamic science of molecular genetics with the complexities of the forensic context. As such, throughout its twenty-year history, this field has seen continuous change, remarkable growth and an associated level of public, legal and scientific scrutiny previously unknown in the forensic sciences. Almost ubiquitously, applications of forensic DNA profiling have focused on resolving the identity of the donor of a particular sample of biological evidence. This is typically achieved by targeting non-coding microsatellite (or STR) loci. Recently however, novel techniques have emerged that target different DNA polymorphisms and allow scientists to address additional questions about the evidence, beyond the identification of source. In this short review we introduce an example of this next generation of forensic DNA techniques, single nucleotide polymorphisms (or SNPs). We summarise their molecular and technological basis and the manner in which they may be applied to further advance the capabilities of forensic investigators.     

What do the X and Y chromosomes tell us about sex and gender in forensic case analysis?

Sex determination can be particularly crucial in forensic casework such as rape cases or cases of missing persons. Biological traces have to be genetically typed and the classification of the sex is of great importance for further investigations. Lately, several papers were published on reliability of sex determination by genetic typing of amelogenin gene-specific fragments. Problems may arise not only from false detection (or non-detection) of amelogenin-specific fragments, but also in cases of chimerism (bone marrow transplants) or micro chimerism (pregnant women carrying male fetuses), and from the possible discrepancies between the biological gender and the (forensic relevant) legal gender in the personal identity documents. The phenotype based classification of the legal gender may contradict the genetic sex under several conditions as there are genetic diversity, intersex conditions and transsexualism. The forensic relevance of the possible misinterpretation (sex is not necessarily legal gender) should not be underestimated.     

Crème de la crème in forensic science and legal medicine

The importance and prestige of a scientific journal is increasingly being judged by the number of times the articles it publishes are cited or referenced in articles published in other scientific journals. Citation counting is also used to assess the merits of individual scientists when academic promotion and tenure are decided. With the help of Thomson, Institute for Scientific Information (Thomson ISI) a citation database was created for six leading forensic science and legal medicine journals. This database was used to determine the most highly cited articles, authors, journals and the most prolific authors of articles in the forensic sciences. The forensic science and legal medicine journals evaluated were: Journal of Forensic Sciences (JFS), Forensic Science International (FSI), International Journal of Legal Medicine (IJLM), Medicine, Science and the Law (MSL), American Journal of Forensic Medicine and Pathology (AJFMP), and Science and Justice (S&J). The resulting forensics database contained 14,210 papers published between 1981 and 2003. This in-depth bibliometric analysis has identified the crème de la crème in forensic science and legal medicine in a quantitative and objective way by citation analysis with focus on articles, authors and journals.     

Forensic pathology--de profundis

This review of the literature discusses the evolution of the professional role of the forensic pathologist. This role is defined as that of an expert who mainly assists the legal process of investigating suspicious or unexpected deaths. The forensic pathologist is independent, bringing his expertise to various parts of the judicial process. His role in the development of forensic investigation and promotion of human rights is important.     

The relevance of the Goudge inquiry to the practice of child protection/forensic paediatrics

In 2008 Ontario, Canada the Goudge Inquiry arose following increasing concerns about practices surrounding forensic pathology and the investigation of paediatric deaths. Some of the considerations and recommendations have relevance to child protection/forensic paediatricians, particularly in relation to their responsibilities in opinion formulation and as expert witnesses. By examining the Inquiry recommendations, this paper applies them in relation to child protection/forensic paediatrics by discussing forensic medicine and its legal context, how interpretation of published reports and data should be used in opinion formulation; issues of ‘diagnosis’ versus ‘opinion’; issues specific to child protection paediatrics; quality control; aspects of report writing and terminological considerations. It concludes with an adaptation of key recommendations directly from those of Goudge, applied to the context of paediatric forensic medicine undertaken in child protection assessments.     

Optical coherence tomography in forensic sciences: a review of the literature

Optical coherence tomography (OCT) is an interferometric imaging technique that has revolutionized clinical ophthalmology since the first half of the 1990’s. Despite this approach being successfully employed in ophthalmology and having great potential in forensic cases, its use in different forensic fields appears to be quite limited. In this review we reviewed the scientific literature regarding the application of OCT in forensic science and legal medicine from 1995 to 2019. Our research showed the usefulness of this approach for the study of coronary injuries, postmortem ocular changes, forensic entomology, and several other applications of specific forensic interest (the study of blood stains, fingerprints, and hair bulbs for personal identification, as well as the study of materials found in the crime scene for comparation, or anti-fraud investigation). The creation of specific ‘ad hoc’ devices and a better knowledge of this type of technology by pathologists will be a fundamental step to continue to develop the use of OCT forensic fields.     

Assessment of drug addiction. The experience of the Medico Legal Institute of Oporto

Since 1993 in Portugal, it is possible, by legal enforcement, to request forensic examination to study possible conditions of drug addiction. On the basis of examinations carried out in the Medico Legal Institute of Oporto, we present a study of 494 cases involving the relation to the demographic data of the examined individuals, their family background, legal situation, age at which drug consumption began, consumption profile at the beginning and at time of forensic examination and our conclusions.     

Science,law and the media – the reality of practising forensic science in South Africa

ABSTRACT

The practice of forensic science has changed irrevocably in South Africa in 2017 with the request by the media to live-stream the State vs van Breda court case. The entire trial was broadcast and continues to be accessible on YouTube. Legal professionals are not formally trained with respect to DNA-specific testimony or DNA evidence. Although DNA experts are familiar with presenting DNA evidence to the legal profession and to Court in order to serve justice, the addition of live streaming by the media in the Court environment is a recent development. It is evident that the goals of practitioners of science, law and media are different in a court case. It would be ideal to have informed journalists reporting on the scientific and legal aspects of a case. In the absence of this, the public primarily receives information that is presented for other purposes, rather than for its accuracy. It is thus crucial that forensic scientists in South Africa, and elsewhere, engage in public forums as well as with the media in order to achieve appropriate dissemination of scientific evidence delivered in Court. A concerted effort is required by forensic experts to adapt to this new reality in South Africa.     

Forensic medicine: matters of life and death

Forensic radiology uses medical imaging to answer a variety of legal questions, including questions about suspicious and violent deaths. This article traces the history of forensic medicine and forensic radiology and outlines radiology's role in investigating death. The authors discuss the physical changes that occur after death and the procedures involved in forensic autopsies, including radiography.     

60 Jahre Rechtsmedizin in Mainz

The history of the subject of legal medicine and its institutionalization as an autonomic subject in the faculty of medicine of the Johannes Gutenberg University is closely related to the re-opening of the University in Mainz and the foundation and development of the federal state of Rheinland-Palatine. The institute developed from the first analytical steps and expert opinions, managed in a temporary wooden accommodation in the grounds of the former city hospital, to a potent institution, meeting all requirements of modern forensic science. It is embedded in the main scientific topics at the University hospital, ranked within the first third of national clinical-scientific research institutions. The protagonists of this development were the former heads of the institute Univ. Prof. Dr. Dr. K. Wagner, Univ. Prof. Dr. H. Leithoff, and Univ. Prof. Dr. C. Rittner. The Institute of Legal Medicine in Mainz was the first institute within the community of German-speaking forensic and legal institutes to be accredited and is therefore well prepared for future tasks and challenges.     

The frog and the scorpion: sado-masochistic injury

Interpreting the lesions of victims of sexual violence is one of the most difficult and most controversial areas of forensic medicine. The case we report involves the care of a victim of sado-masochism. It identifies the difficulties of both the forensic and legal management of sexual violence in an unusual context.