Introduction

Written by Dr. D. Rao

 

 

THERE ARE TWO DISTINCT ASPECTS OF LAW MEDICINE RELATIONSHIP: 1. FORENSIC MEDICINE, AND 2. MEDICAL JURISPRUDENCE. THEY ARE ESSENTIALLY DIFFERENT SUBJECTS BUT ARE CLOSELY RELATED.

Forensic pr Legal medicine (Forensic-of or used in Courts of Law) deals with the application of medical knowledge to aid in the administration of justice. It is used by the legal authorities for the solution of legal problems. Some examples are applying the medical knowledge in deciding cases of injuries, hanging, sexual offences, infant deaths, poisoning, etc. In short, it deals with medical aspects of law.

Medical Jurisprudence (juris-law;Prudentia-knowledge) deals with legal responsibilities of the physician with particular reference to those arising from physician-patient relationship, such as medical negligence cases, consent, rights and duties of doctors, serious professional misconduct, medical ethics, etc. Inshort, it deals with legal aspects of practice of medicine.

Forensic Pathology deals with the study and application of the effects of violence or unnatural disease in its various forms in or on the human body, in determining the cause and manner of death in case of violence, suspicious, unexplained, unexpected, suden and medically unattended dearhs.

Forensic Medicine deals almost entirely with crimes against the persons, in which medical examination and evidence are required. Forensic Medicine is mostly an exersice of commonsence, combined with the application of knowledge and experience, alrealdy acquired in the study of other branches of medicine, surgery, obstertrics, etc. Its aim is to find out the truth. Its particular field of activity is judicial investigation, both civil and criminal. In all cases of crime involving the person, e. g. homicide, suicide, assault, sexual offences, traffic accidents, poisoning. etc. . the help of the medical practioner is sought by the police. n all such cases, the Pathologist will be required to appear as an expert witness in a court of Law. In cases of sudden death, the authorities will depend mostly or compleltely on medical evidence (Past and Present Medical History besides Postmortem Evidence) in establishing the cause of death, and in case of accident to determine blame.

 

The Forensic Pathologist
All forensic medicine science expert witness must strive to achieve respect, understanding and credibility in Court. They must give the appearence, the aura of being independent, non-partisan scientists. The appearence and projected image of neutrality, impartiality and objectivity are as important as the authentic characteristics. A Pathologist should not become partisan. Once a theory is embraced, it is only human nature to eagerly search for facts which support that theory, and rejects those which indicate some other theory. Brouardel, the French medicolegal authority wrote"if the law has made you (the physician) witness, remain a man of science;you have no victim to avenge, no guilty person to convict, and innocent person to save. You must bear testimony within the limits of science". The attitude of a scientific witness should be the same wheather he is called by the prosecution or by the defence. The doctor really testifies neither for, nor against the prosecution or by the defence. The doctor's expertise is in the application of science to a legal controversy and the proper interpretation of scientific findings. His sole obligation is to present the truth as he sees it, adding nothing, witholding nothing and distorting nothing.  He should not concern himself with the previous character of the accused or with other evidence in the case. He should not be influnced in any way by emotional consideration, such as sympathy or antipathy. The doctor must be honest, for confidence is inspired by honesty and sucess depends upon confidence.

It is advisable that the doctor should learn to look from the medico-legal standpoint upon such of his cases as are likely to become the subject matter of judicial investigation. He should acquire the habit of making a careful note of all the facts observed by him. The medico-legal aspects of any case must always be secondary to life saving treatment of the patient. Vagueness and theory have no place in forensic medicine. He should examine the facts which come to this knowledge in his special capacity, draw his consideration of the pros and cons of the case, and indicate to the court that interpretation, along with the grounds on which it is based. Presumption is not proof, and conjecture is not evidence. The Court has no special medical knowledge. It relies on his witness for an opinion and expects him to assist it with his special knowledge and experience. The burden of presenting medical facts and medical opinions in the best possible way rests on the pathologists. Forensic Pathologist testifies on so called"fact issues", such as cause and manner of death, rather than"ultimate issue"of guilt or innocence, so that opinion based upon reasonable medical ceriainty is adequate to support the testimony of the forensic pathologist. The medical evidence does not itself prove the case of prosecution. Other things being equal, the better the presentation of medical evidence, the better is the administration of justice.  Demeanour, appearence, professional manner and general behaviour of the expert witness are almost equal in importance to forensic ability talking too much, talking too soon, and talking to the wrong persons. Prejudicial and sensational statements should not be made prior to trial. The pathologist should never overlook an oppurtunity to remain silent. The pathologist must be guarded in what he says and how he says it.

The medico-legal expert is not a detective. He may use his knowledge and intelligence to help police to solve a crime. His role should be to furnish the police to solve a crime.  His role should be to furnish the police with specific information on matters of which he was specialised knowledge. Because of his special knowledge, a non-medical clue may have a signinficance to him, which even an experienced police officer has not grasped. The medical expert should be very careful when he is examining living people. He should not encourage an accused person to talk about the events that led to his arrest. If, during a medical examination, a person says anything that might incriminated himself, it should be neither recorded nor repeated. However, occasions may arise when a doctor may use an admission to direct the police to certain lines of inquiry and action without actually disclosing what has been said.

Three things are needed for sucess 1. the power of observation 2. a wide range of exact knowledge, 3. the power of deduction. The power of constructive imagination is also essential when there are no more facts to be observed, and no further inferences to be drawn. There is no substitute for basic intellegence and clinical competence. Experience, coomonsense, and willingness to consider other possibilities are as essential in the practice of forensic medicine as wide range of theoretical knowledge. The attributes of the physician are 1. caution, 2. foresight, and 3. wisdom.

 

The Forensic Pathologist
should deliver a fair understanding, satisfactory appraisal and high index of awareness of the medical, philosophical and legal problems related to the determination of the manner of death.

He should be thoroughly familiar with the problems of causality and manner of death.

He should realize that total complications of extraneous injuries do not change the manner of death from unnatural to natural, e. g. the victim of homicidal attack, dying with peritonitis following abdominal injuries and surgery should be certified as homicide victim and not as surgical complications.

A good command of language, clear presentation, and ability in expressing a relatively firm opinion are necessary for the success of the forensic pathologist.

The forensic pathologist must be alert to where evidence should be looked for, and how it should be interpreted.

Medicine is a biological science with the variability inherent in biological science with the variability inherent in biological matters. One thing that makes medicine so difficult is that there is no such thing as the average man. . We can only say the reading is “within the range of normal”. Forensic Medicine is not a exact science. Unexpected results are produced due to biological variations. In every case, there is an element of uncertainity, and absolute proof is a rarity in any medical problem. The most extraordinary event occur in medico-legal practice, and a careful evalution must always be made to ensure that dogmatic statements by medical witnesses do not mislead the investigating officers. No possibility is wholly excluded in medical experience. Doctors should bear in mind the essential difference between probability and proof. The medical witness should not be dogmatic about his opinion, and also lawyers should not expect him to do so.  They should be reasonable in their opinions and should not overstate the likelihood of a relationship between cause and effect.  The doctor should be ready to defend every finding and conclusion on the report on clinical and scientific grounds. He should be aware of professional and scientific viewpoints which might differ from his , and should be familiar with the latest scientific literature in relation to the subject involved. For the purpose of illustrating and clarifying his testimony, the medical expert may employ photographs, mps, diagrams, charts, X-rays, skeletons, models, etc… when they are properly verified.

Forensic medicine can be mastered only by an extensive practical experience acquired by an application and study of medico legal problems Forensic pathologists have an ethical obligation to contribute to further knowledge, research and education in their field. He should avoid special efforts to “cover up” medical negligence or intentional wrong doing.

 

Medical Evidence
Evidence means and includes: 1. All statements which the court permits or requires to be made before it by witness, in relation to matters of fact under inquiry, 2. all documents produced for inspection of the court. For the evidence to be accepted by the courts, it must be properly identified as to what it is, and where it was found. The evidence of eyewitness is positive. The evidence of doctor or an expert is only an opinion which is corroborative.

Chain of Custody: It is a method to verify the actual possession of an object from the time it was first identified until it is offered as evidence in the court. Each specimen when obtained, should be labeled with the victim’s name, the time and date, the nature of the specimen, identification number, and signed by the doctor. If the material is handled by another person, that person must give receipt for the material and be included in the chain of custody. The evidence must not be damaged, contaminated, or altered in any significant way. The shorter the chain the better.

 

Photographical Evidence:
They should show 1. General relations of the scene of body to its surroundings. 2. Special relationships between the deceased and weapon or blood stains, overturned furniture, etc. 3. Means of possible entrance to and exit from the scene. 4. Position and posture of the victim.

Take a scaled photograph of the scene as it was first viewed. A second scaled photograph should be taken, locating in the field of camera with suitable markers any small objects, such as fired cartiridge case, bullet holes in walls, ets. A scaled drawing of the room or the area of intrest in the investigation should be made. The dead body should be phtotographed from different angles.

Photographs of all injuries, major and minor, are essential including ruler to provide a scale. To indicate important features, markets or pointers can be inserted. If the powder residues are on the clothing, the clothing be preserved by wrapping in clean paper. If they are on the victim’s skin, a scaled photograph should be made, including the entire area over which the powder residues exist. Photographs help the investigating officer and the doctor to refresh their memories for giving evidence in the Court. They also convey essential facts to the Court.