Medicine, Science and the Law最新文献

Ethanol is the most commonly abused drug worldwide, and excessive alcohol consumption is a major contributing factor in accidents and violent crimes. Methanol is a toxic alcohol and is less commonly detected but holds significant forensic relevance due to its potential for causing fatal poisoning. The study aims to detect the concentrations of ethanol and methanol in postmortem blood, vitreous humor, urine, and cerebrospinal fluid, and to create a database of the involvement of alcohol in postmortem cases. A total of 150 postmortem cases with different causes of death were enrolled for the study. Gas Chromatography-Headspace was employed for the quantitative determination of ethanol and methanol concentrations in the biological specimens. Out of 150 cases, 108 cases (72%) exhibited positive ethanol concentrations. The high prevalence of positive ethanol concentration, particularly in cases of road traffic accidents and hanging, indicated a significant amount of alcohol use prior to death and underscores the role of alcohol consumption in fatal incidents. Methanol was detected in only those cases that had a high ethanol concentration, which may be due to adulteration or contamination of methanol in the alcoholic beverages that the deceased consumed before death. The study highlighted that an alternative/ complementary specimen to the blood should be considered to assess the alcohol concentration and to differentiate antemortem ingestion of alcohol from postmortem formation. The toxicological analysis of alcohol is important in understanding consumption patterns and in developing protocols and policies for preventing such cases.

ObjectiveThis study aimed to develop and validate a sensitive analytical method for detecting and quantifying AB-CHMINACA, and to comprehensively evaluate its pharmacokinetics, metabolic pathways, and acute toxicity in rodent models.MethodologyMale Wistar rats and Swiss albino mice were used for pharmacokinetics, metabolism, and acute toxicity studies. AB-CHMINACA was dissolved in Dimethyl sulfoxide (DMSO; 2%-5%) and diluted in corn oil for oral gavage. Blood and urine samples were collected from rats for pharmacokinetic and metabolite analyses using Gas Chromatography-Tandem Mass Spectrometry (GC-MS/MS) and liquid chromatography-quadrupole time-of-flight mass spectrometry, respectively. Mice were monitored for behavioral toxicity and necropsied for histopathological analysis. Pharmacokinetic parameters were calculated using WinNonlin Phoenix 6.0, and metabolites were identified through mass spectrometry.ResultsMethod validation showed excellent linearity (0.5-1000 ng/mL, r² > .99), with precision (variability 2.3%-7.2%) and accuracy (95%-105%), adhering to FDA guidelines. The method's limit of detection (LOD) and limit of quantification (LOQ) were 0.5 and 1.0 ng/mL, respectively. Pharmacokinetic analysis revealed a biphasic elimination (t½ 13.8 h), Vd of 228.75 L, and Cl of 11.4 L/h. Four major Phase I metabolites were identified, with Met 4 (Di-Hydroxy-AB-CHMINACA) being the most abundant in urine at 8-24 h. Acute toxicity in mice showed dose-dependent symptoms, including lethargy, seizures, and mortality at 50 mg/kg.ConclusionThese results enhance the understanding of AB-CHMINACA's pharmacokinetic behavior and metabolic profile, contributing valuable insights to forensic toxicology and highlighting the dose-dependent nature of its acute toxicity.

Recent decades have been characterized by an exponential increase in medico-legal litigation and an accentuated interest in healthcare responsibility. This study aims to examine cases of alleged medical negligence in Cardiology and Cardiac Surgery in one of the largest hospitals in north-west Italy, over a 11-year period (2013-2023). The primary objective of this study is to conduct a comparative analysis between compensation claims initially advanced by patients (or their legal representatives) in the pre-trial phase and the final outcomes of legal proceedings brought before the court. This article provides an important opportunity for a critical and in-depth analysis of litigation in the fields of cardiology and cardiac surgery, with the aim of improving the efficiency of case management.In the period 2013-2023, San Martino Polyclinic Hospital received a total of 1704 compensation claims, of which 39 (2.29%) were related to alleged cardiological and cardiosurgical professional liabilities. About 64.10% of the compensation claims (25 out of 39) were deemed illegitimate due to the absence of professional responsibility, and were therefore rejected by the Claims Management Committee (CMC). In 38.5% of cases, legal action was pursued, and in four cases, the hospital was ordered to compensate the patient for medical negligence. Conversely, in three cases, the Judge's ruling was in favour of the Hospital. Currently, eight legal actions remain ongoing, and their outcomes are pending.Overall, over the 11-year study period, litigation cases in the cardiology and cardiac surgery fields were relatively infrequent.

The recent introduction in Italy of unsupervised conjugal visits for prisoners is part of a broader trend that has been well-established across numerous European countries. This provision is grounded in the respect for constitutional rights and the principles set out by the European Court of Human Rights (ECHR), which underscores the centrality of private and family life even for incarcerated individuals. This development raises significant bioethical and medico-legal challenges, which have yet to be fully explored, particularly regarding conception during conjugal visits. The present article critically analyses the bioethical implications related to the right to parenthood in prison, state responsibility towards the unborn child, reproductive health challenges, and related medico-legal issues. It highlights a legislative gap that urgently requires attention and proposes operational strategies for addressing these challenges.

The majority of healthcare professionals discharge satisfactorily their civic duty to aid the execution of public justice by assisting courts and tribunals and may have their assistance gratefully acknowledged in a judgment that is on the public record. However, the conduct of a minority causes judicial dissatisfaction and sometimes criticism. The British and Irish Legal Information Institute (BAILII) online resource for the period September 2019 to August 2025 has been used to identify such cases. Examples are given of healthcare expert practice which have repeatedly caused concern: absent, insufficient or unclear reasoning; misuse, or failure to cite, literature; inaccuracy; failure to triangulate self-reported history with other evidence; failure to keep up with evidence; inappropriate language; late introduction of evidence; disregard, omission or misrepresentation of instructions; inadequate treatment of issues; failure to comply with procedural rules and guidance; partisanship; absent or inadequate referencing; incomplete range of opinion; misunderstanding of legal test; ignorance or disregard of procedural rules or guidance; disregard of, or challenge to, previous factual findings; acting outside expertise; omitting evidence that undermines opinion; unwillingness to make reasonable concessions; misuse of, or failure to refer to, relevant clinical guidelines; criticism of other experts; and dishonesty. Expert healthcare witnesses whose conduct results in judicial dissatisfaction or criticism appear to be unaware of, or to misunderstand, the duties of an expert witness or to act in disregard of them.

Electronic monitoring ('tracking') of individuals has been used in the UK criminal justice system for over three decades, and its use is increasing. Electronic monitoring has more recently been implemented in forensic psychiatric services, which has generated considerable debate about the appropriateness of its use in clinical settings, and about legal and ethical concerns. The purpose of this article is to formally address the ethical issues that arise from using electronic monitoring in forensic psychiatry. These issues are considered using the Four Principles approach to medical ethics, namely autonomy, beneficence, non-maleficence, and justice. We conclude that by adopting a patient-centred approach, where informed consent is sought, and the patient's best interests remain central to the decision-making process, electronic monitoring is both ethical and justifiable. More robust studies are required to develop standardised clinical guidelines for the use of EM in forensic psychiatry, and to apply the theory of patient-centred, consent-driven care to practice.

Cultural competence among healthcare professionals and providers is pivotal to providing effective, safe, and quality services. This paper considers the feasibility of using a tool to measure cultural competence within forensic mental health services, adapted from the Cultural Competence and Linguistic Competence Policy Assessment (CLCPA) developed in the United States (US). The adapted tool was piloted at a secure forensic unit in England; this consisted of a two-phase approach to data collection comparing the results from an initial assessment (time 1, n = 50), with those of a follow-up assessment conducted three years later (time 2, n = 100). The aim was to assess the practicability of using the tool to measure perceptions of cultural competence among 150 staff members, as part of a wider quality assurance and improvement process. The results indicate that the tool has utility in measuring perceptions of cultural competence and that the information gathered can be used to plan service improvements. Yet, it is recommended that the tool is modified at site-level as part of a collaborative exercise with staff and patients and according to service need prior to implementation.

People are assumed to have moral responsibility, but the presence of mental disorder may call this into question. Nevertheless, when and how mental disorder affects moral responsibility is unclear. The insanity defence exculpates a defendant and effectively extinguishes their moral responsibility, although the criteria for insanity varies between different jurisdictions. Most successful cases of insanity are due to delusions, although the nature of delusions itself varies considerably. The recent case of Keal in England and Wales demonstrates some of the problems with the insanity defence, and a coherent philosophical basis for the defence is lacking. I argue that a volitional element should be added to the insanity defence in England and Wales such that a person may be exculpated on the basis of a mental disorder which sufficiently causes any of (1) defects of reason; (2) deficits in knowledge; (3) a lack of control; and (4) their ability to form intentions in crimes of intent, although the threshold should remain high. Reasons-responsive accounts of moral responsibility underpin many of these abilities. The extent to which mental disorder, particularly delusions, are considered a type of manipulation, rather than part of the self, is likely to be contributing to intuitions about exculpation although not all delusions will cause impairments or manipulation to the same extent. Amending the insanity defence in this way would be more just, more philosophically coherent and allow a more consistent approach for those with mental disorders who are charged with criminal offences.

Determination of postmortem interval (PMI) is a fundamental aspect of forensic medicine, aiding in the reconstruction of the time of death in medico-legal investigations. The present study aims to compare gender-based postmortem changes and investigates the role of collagen fibers as a potential indicator of PMI in albino rats. Eighteen male and nine female adult albino rats were examined. Three prostates, three uterine horns, and the quadriceps muscle of the hind limb of each animal were collected at six time points (0, 6, 24, 36, 48, and 144 h postmortem) after scarifying rats by neck dislocation. Morphological analysis revealed progressive softening of the organs with darker discoloration with increasing PMI. Histological examination using hematoxylin and eosin staining showed cellular degradation up to 48 h PM. Masson's trichrome staining highlighted the persistence of collagen fibers up to 144 h. Notably, male prostates exhibited greater resistance to postmortem degradation compared to female uteri, suggesting that potential sex identification by gonads is possible up to 48 h PM.

Black oesophagus, or acute necrotising oesophagitis, is characterised by diffuse circumferential black discolouration of the distal oesophagus associated with mucosal necrosis. A consistent feature is a very sharp line of demarcation at the gastro-oesophageal junction. Two cases are reported to demonstrate differences in the lower margin. Case 1: a 63-year-old man who died of gastrointestinal haemorrhage complicating black oesophagus was noted to have an irregular lower border located approximately 5 cm from the gastro-oesophageal junction. This was associated with columnar mucosa typical of Barrett oesophagus. Case 2: a 79-year-old man who aspirated gastric contents following gastrointestinal haemorrhage due to black oesophagus had diffuse black discolouration of the oesophageal mucosa with the more usual sharply demarcated inferior margin at the gastro-oesophageal junction. Sparing of the distal oesophagus in case 1 was most likely due to the protective effect of metaplastic columnar epithelium, a finding that may, therefore, be a potential macroscopic marker for Barrett oesophagus in individuals with black oesophagus.