Medicine, Science and the Law最新文献

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.

Thrombosis of the deep veins of the legs is a relatively common occurrence initiated by venous stasis, endothelial damage or hypercoagulable states. Prolonged sitting has also been associated with thrombotic events. A case is reported where immobility caused by drug overdose resulted in lethal pulmonary thromboembolism. Case report: A 50-year-old male was found sitting in the driver's seat of his car slumped forward. A suicide note was present. At autopsy finely granular tablet residue was found in the stomach. Deep venous thrombosis was present in both calves with bilateral pulmonary thromboembolism. Toxicological examination of blood revealed elevated levels of amitriptyline (0.92 mg/L), nortriptyline (0.41 mg/L) and oxycodone (0.17 mg/L). Death was due to pulmonary thromboembolism arising from bilateral deep venous thromboses complicating mixed drug toxicity. Prolonged immobility should be considered a possible mechanism for venous thrombosis in drug takers.

To determine the cause of death and sociodemographic predictors of dead-on-arrival cases brought for autopsy, a cross-sectional study was conducted. A total of 422 dead-on-arrival cases brought for an autopsy to a tertiary center in Ethiopia were reviewed. Descriptive and analytic analysis were used, and logistic regression analysis was performed to examine the association between sociodemographic variables and the cause of death. The study found that dead-on-arrival cases accounted for 32.5% of all autopsied cases. The mean age was 38.9 ± 15.6 years and ranged from 15 to 90. Approximately two-thirds of the cases were in the 15 to 44 age range. Male victims accounted for more than two-thirds of the cases, and 82.9% of the victims were urban residents. The cause of death could not be determined in 6.6% of cases. Unnatural deaths were the leading causes, followed by communicable diseases and non-communicable diseases. Pneumonia and coronary artery disease were the leading specific causes of death. Residence and age were found to be associated with unnatural deaths. Urban residents had higher odds of dying due to communicable diseases compared to rural residents. Additionally, younger individuals aged 15-29 years had lower odds of dying due to non-communicable diseases compared to those older than 75 years. In conclusion, the high number of brought-in dead cases in Ethiopia, particularly among the younger population, is a concerning issue that requires immediate attention. Unnatural deaths were predominant, highlighting the need for improved safety measures and emergency medical services.

Child abuse, including physical, sexual, or emotional violence or neglect, is a global problem with serious and long-term consequences for children. Even though child abuse is prohibited in Denmark, the estimated number of physically and sexually abused children is relatively high, whereas the annual number of forensically examined children is low. We present the Danish practice and legal foundation for the clinical forensic medical examination (hereinafter referred to as "forensic examination") in suspected child abuse cases. Forensically documented findings may contribute to the police investigation and legal assessment of child abuse cases, safeguarding the rule of law for both children and suspected perpetrators. The forensic examinations are accredited according to international and European standards, and the Department of Forensic Medicine is regularly assessed for the fulfillment of accreditation. Accreditation, delimitations from medical treatment and police employment, and the fact that the department refers to the University of Copenhagen ensure impartiality from the police and the judicial system. A cross-sectoral intervention project has significantly increased the annual number of forensically examined children at the Danish Children's Advocacy Center (CAC) in Copenhagen, which supports children's legal rights and holds research potential due to systematic and continuous data collection.

Complex Suicide (CS) is defined as an unusual form of suicide in which several harmful methods are used, simultaneously or in succession, whose purpose is to avoid the possible ineffectiveness of one of the methods used to produce a certain fatal outcome. The study of CS is of great interest and plays a fundamental role in characterizing the knowledge of these rare events. We have retrospectively evaluated all CS cases examined at the Institute of Forensic Medicine of Milan from 1993 to 2022 (n = 75) with the aim of characterizing the deceased who have resorted to it. We also compared the sample of 75 CS cases with a sample of paired 115 "simple" suicides (with a single method). Our analysis revealed that the CS cases were carried out by a "typical" subject identified as an adult male, between 41 and 50 years old, suffering from psychiatric disorders and, in particular, major depressive disorder. The most frequent harmful mode was plastic bag suffocation associated with self-poisoning. CS cases used less violent methods than simple suicide controls. The pathological-forensic approach has brought to light elements that can be useful both for forensic professionals (pathologists and psychiatrists) in correctly classifying these unusual and challenging events and for clinicians working on the front line. Some profiles have been outlined that can be used to identify potentially vulnerable individuals who could benefit from increased health surveillance to treat and prevent suicide.

This paper examines the death penalty through a public health framework, analysing its systemic impacts on individual and community well-being. Drawing on recent legislative changes in Malaysia, including the 2023 abolition of mandatory capital punishment, the study identifies three critical pathways through which the death penalty threatens public health: prolonged confinement of death row inmates, miscarriages of justice, and punitive drug policies. The research highlights how capital punishment creates trauma that extends beyond death row prisoners and affects families, prison staff, legal professionals, and communities. It emphasises the death penalty's disproportionate impact on marginalised groups, including women, sexual minorities, and individuals with disabilities, who face compounded discrimination in the judicial system. The paper concludes that abolishing the death penalty is not merely a legal imperative but a public health necessity, recommending a shift toward evidence-based, health-centred approaches that prioritise rehabilitation, harm reduction, and restorative justice.

BackgroundInformed consent (IC) is a legal and ethical cornerstone in clinical research involving humans. While it embodies the principle of decisional autonomy, its implementation faces significant challenges.ObjectivesThis narrative review aims to critically analyse the ethical, legal and regulatory aspects of IC in clinical research, with a specific focus on UK and European Union (EU) jurisdictions. Particular attention is given to medico-legal defensibility, the treatment of vulnerable populations and the emerging forensic implications of consent-related failures.MethodsKey international instruments (Declaration of Helsinki, Council for International Organizations of Medical Sciences Guidelines), UK statutes (Mental Capacity Act 2005, Human Tissue Act 2004) and data protection regulations (Regulation (EU) 2016/679 (EU GDPR) and its post-Brexit counterpart, the UK GDPR) were examined alongside relevant case law. Empirical findings, audit reports and forensic literature were integrated to assess procedural vulnerabilities and regulatory expectations.ResultsThe review identifies major risks associated with invalid or poorly documented consent, including therapeutic misconception, capacity fluctuation and coercion in hierarchical or cross-cultural contexts. It highlights the increasing role of forensic medicine in assessing consent adequacy and outlines innovative models such as dynamic and electronic consent, evaluating their medico-legal relevance.ConclusionsRobust, participant-centred consent frameworks are essential to uphold ethical integrity and legal compliance in clinical research. Regulatory harmonisation, institutional preparedness and forensic awareness are critical to mitigating liability, safeguarding participant rights and maintaining public trust in biomedical science.

Suicide among youth is a major public health issue, and each country has implemented different suicide prevention policies and strategies throughout the years. This study aims to analyse the frequency of suicides and changing of suicide methods among children and young people in Türkiye during the last 15 years. Annual data provided by the Turkish Statistical Institute (TURKSTAT) were utilised retrospectively in this study. Data about suicide rate and methods were analysed by the Joinpoint Regression Program. Over the years between 2009 and 2023, changes in suicide rate and trends in suicide methods were revealed. There were 12,745 suicide deaths among children and young people. These comprised 25.07% of total suicide deaths last 15 years. The age-specific suicide death rates increased with an average annual percent change of 1.46%. Hanging was the most used suicide method in total (n = 5313; 41.69%) and in both sexes (n = 3591, 44.26% in males; n = 1722, 37.18% in females), followed by using firearms in second place and jumping from heights in third, overall. Suicide death rates caused by jumping increased significantly by 6.9% per year. In contrast, suicide deaths by hanging decreased approximately 1.45% annually. Determining the prevalence and trends of suicide methods is crucial for identifying high-risk populations. This knowledge is essential for formulating and executing effective suicide prevention strategies.