Introduction to Legal and Forensic Medicine

General Considerations

• Legal Medicine applies medical and paramedical sciences to interpret legal issues.
• Legal Medicine, Forensic Medicine, and Medical Jurisprudence are synonyms used interchangeably in practice.
• Legal Medicine emphasizes medicine's relevance to the law, while Forensic Medicine focuses on medical knowledge's role in elucidating legal problems.
• William J. Curran defines Legal Medicine as the areas of medicine related to substantive law and legal institutions.
  • Forensic medicine deals with investigating, preparing, preserving and presenting evidence.
• Dr. Henry C. Lee broadens forensic medicine beyond legal issues, including historical, environmental, and socio-political aspects.
• Medical Jurisprudence involves understanding the law in relation to medical practice, including the rights, duties, and obligations of medical practitioners.
• Forensic Medicine encompasses expertise in various medical branches for evidence collection, preservation, and presentation in legal settings.

Scope of Legal Medicine and Wound Production

• Legal Medicine has a broad and encompassing scope.
• Applied knowledge of surgery includes physics, physiology, and pharmacology.
• Physics of Wound Production Formula: Wound = Kinetic Energy x Time x Area x "other factors."
• Kinetic energy relies on mass and velocity; velocity is squared with the formula: Kinetic Energy= MV²/2
  • M=Mass
  • V= Velocity
• Time impacts the likelihood of damage; shorter time increases damage.
• Transferred energy reduces injury.
• Area of contact affects the damage caused.
• Smaller area increases damage from equal force.
• Tissue elasticity influences lacerations.
• Less elastic tissue increases laceration likelihood.
• Fluid-filled tissue under force will transmit the force in all directions and may cause lacerations.

Nature of Study and Medico-Legal Practitioners

• Legal Medicine requires abilities to acquire facts, arrange them logically, draw conclusions, and communicate observations effectively.
• Medico-legal practitioners do not need to be lawyers but handle cases involving legal duties related to healthcare.
• Medico-legal practitioners are not necessarily pathologists.
  • Forensic Pathologists document cause of death via autopsy.
• Medical Jurists are physicians specializing in medico-legal duties, known as Medical Examiners or Medico-legal Experts.
  • Examples are Dr V.V. Villasenor and Dr. Ronaldo Bandonill
• Medicolegal practitioners work in government or private practice.
  • Connected with law enforcement/investigative bodies, or as Municipal/Provincial Health Officers.
• Private practitioners are consultants in hospitals, testifying in court on injuries and treatment.
• Health officers, medical officers of law enforcement, and medical staff of accredited hospitals can perform autopsies.
• All physicians must assist in justice administration on medico-legal matters.

Ordinary Physicians vs. Medical Jurists

• Ordinary Physicians treat injuries/illnesses and focuses on point of view of treatment, arriving to a diagnosis Rx.
• Medical Jurists consider cause, examine thoroughly, and provide proofs for justice, documenting injuries.
• Medical Jurists record every injury.

Medicolegal Cases & Medico-Legal Officer Capabilities

• Medicolegal cases include unidentified injuries/deaths and those "dead on arrival" (DOA).
• Liberally, DOA includes death within 24 hours of admission/ deaths with unknown or undeterminable causes, or unexpected sudden deaths.
• Also: deaths linked to violence, accidents, suicide/poisoning, negligence, physical injuries, child abuse, domestic violence, rape, and issues of the patient's mental competency.
• Medicolegal deaths require mandatory autopsy, with next of kin informed and consent obtained for courtesy.
• Lacking authority to conduct autopsy requires referral to a government body.
• Refusal to cooperate results in "undetermined" cause of death on the certificate.
• Medico-legal officers conduct autopsies, examine victims of sexual/physical crimes, skeletal remains, blood/stain/fluid and perform exhumations/histopathological exams.

Legal Applications and Autopsies

• Legal Medicine applies to Civil Law (paternity, civil status), Criminal Law (criminal liability, crimes against persons/chastity), and Remedial Law (rules of evidence, hospitalization, examinations).
• Autopsies are performed when required by law, by court/official order, by police request, by the Solicitor General, or by request of nearest kin.

Forensic Science Disciplines

• Forensic science includes fields of analysis: hair, fiber, DNA, anthropology, archaeology, glass/paint chips, ballistics, toolmarks, fingerprints, footwear, odontology, document analysis, psychiatry, psychology, and blood splatter.

Medical Evidence

• Medical evidence ascertains truth via court rules; a medical fact becomes this evidence.

Types of Medical Evidence

Autoptic/Real Evidence

• Appeals to court senses, mostly vision.
• Presentation limitations include indecency and offensiveness.

Testimonial Evidence

• Physician testimony in court as ordinary or expert witness.
• Ordinary witness testifies from physician-patient relationship.
• Sec. 18, Rule 130 says that communication between physician and patient is an exception to the ordinary rule (privilege).
• Hearsay information is generally inadmissible; Dying Declaration is an exception
• Expert Witness gives informed opinions.

Experimental Evidence

• Demonstrates medical facts.
• Opinion Rule applies.

Documentary Evidence

• Includes medical certificates, medical reports, autopsy reports, lab reports, exhumation reports, birth/death certificates, medical expert opinions, and depositions.

Physical Evidence

• Materials connected to investigations for perpetrator identification or circumstantial crime facts.
• Corpus Delicti Evidence is objects/substances part of the crime body.
• Associative Evidence links suspect to crime.

Preservation and Good Expert Witness Qualities

• Necessary and vital.

Methods

• Photography
• Sketching (rough, finished)
• Description (verbal)
• Manikin Method (miniature model)
• Witness recollection (disadvantageous)
• Special methods for evidence treatment/preservation to remain unchanged for criminal laboratory examination

Good expert witness qualities

• Reputable professional background (education, formal training, work/experience, office, affiliations)
• Personal integrity and good judgment
• Objective, neutral, independent, and sincere, telling the whole truth
• Convincing and able to communicate clearly in lay terms
• Is a good teacher
• Is not an advocate even if he/she testifies for only one side of the case
• Opinions/conclusions are reached independently of interests of litigants
• Informs the counsel of the party engaging his services of all favorable and unfavorable information
• Must acquaint himself/herself of courtroom procedures, decorum, layout, availability of presentation aids
• Is entitled to funds covering travel and attendance in court, and an expert witness fee
• Must not be compensated on a contingent fee basis
• Is served with a subpoena to indicate he is not a voluntary witness
• Is put on call during the trial
• Must disclose to the lawyer who engages him anything that he thinks might affect the effectiveness of his testimony
• Is willing to disagree with authorities if convinced that they are wrong
• Recognizes that contrary opinions will not necessarily discredit him
• Is most effective if firmly convinced that the theory of liability espoused by counsel is viable and he/she corroborates this

Deception Detection

Essential for justice

• Involves: psycho-physiological responses, drugs, hypnotism, observation, scientific interrogation, and confession.

Measuring Psycho-Physiological Responses

• Records involuntary motor/sensory reactions above threshold.
• Automatic Nervous System controls the response
  • It has sympathetic and parasympathetic branches.
    • Sympathetic branch responds to strain/emotion i.e. fear, anger, excitement, lie detection.
    • Parasympathetic restores normal, calm state.
• Polygraph: called a lie detector; records physiological changes.
• Fear activates automatic/involuntary sympathetic system changes.

Inadmissibility of Polygraph result

• Lacks standardization
• Could potentially give the tiered facts conclusive heights
• Lacks qualified examiner
• Examinee/subject may waive their right against self-incrimination
• Some tests can contain as high as 25% error rate

Word Association Test

• Reads lists stimulus/non-stimulus words: measures response time.
• The answer may be "yes" or "no" subject to be recorded
• Focuses on response time relation to stimulus words.
• Subject cannot be compelled without his consent.

Psychological Stress Evaluator

• Identifies audible & inaudible voice changes due to minute oscillations. Microtremors occur 8–14 cycles/second and controlled by nervous system.
• microtremor gets suppressed when a person is lying/ the degree varies according to psychological stress. PSE detects, measure graphs our voice modulation.

Use of Truth Serum - Misnomer

• The procedure does not make someone tell the truth
• Hyoscine hydrobromide injects needed questioning begins
• The Patient – feels the compulsion to tell the truth, forgets his alibi, has CNS depressant
• Is not admissible as evidence.

Narcoanalysis or Narcosynthesis

• The Drug like sodium amytal/ sodium penthotal causes brain depression the subject talks freely.

Alcohol Intoxication

• In Vino Veritas" reflects revealing real person behind a “mask of sanity”.
• Person is allowed to drink investigator pounds question & recording answers

Hypnosis and Observation

Hyponosis shifts consciousness

• May heighten suggestibility and maintain awareness.
• Compulsive individuals resist it.

Admissibility in Court

• Lacks scientific reliability; could yield fabrication or distorted facts.
• Examiner subjectivity challenges admissibility.
• Confession is inadmissible.
• May yield useful evidence during investigation.

A good criminal investigator is a keen observer/ psychologist.

• Physiological/psychological guilt signs may exist, but are not conclusive or reliable.

Interrogation

By a Scientist

Behavioral Attitude

• Active aggressive offenders act impulsively, or passively with inadequacy
• Rational offenders act intentionally, or irrationally out of touch with reality

Proficiency

• Ordinary needing only limited skill or professional high skill

Psychological Type

• Emotional or non-emotional

Interrogation Techniques

• 1. EMOTIONAL Appeal – The interrogator must create a mood that is conducive to confession. He must be sympathetic and friendly to the subject.
• 2. Mutt and Jeff Technique—There must be at least two investigators, with opposite character
  • 3. Bluff on split-pair technique ---This is applicable when there are several persons who participated in the commission of the crime.
• 4. Stern approach -The questions must be answered clearly and the interrogator uses harsh language. Immediate response from the subject is demanded.
• 5. The subject is given the opportunity to make lengthy, time-consuming narration.

CONFESSION for the Truth

• Is an expressed acknowledgment of guilt by the accused.

kinds

• Extra-Judicial: done by an accused person that must be voluntary
• Judicial: made in open court and used as admissible evidence