Medico-Legal Journal最新文献

Medicine is taught as a science, but in reality, as with other areas that undergo much public scrutiny, it is often more of an art than a science. Particularly when dealing with controversial areas, physicians often attempt to employ the "standard of care" as a guide to practising medicine, and to protect themselves. However, the standard of care itself is often a reactive and temporary construct. A number of practices serve as good examples of accepted patient care that has swung completely from one extreme to another. The history of opiate prescribing in this country exemplifies a complete swing in practice fundamentals among US physicians, where opiates have been repeatedly embraced, and then vilified. Numerous other practices demonstrating this phenomenon can be cited, including the use of electroconvulsive therapy for depression, and hormone replacement for postmenopausal women. Research funding itself has been subject to pendulum swings, such as occurred during the recent pandemic. Currently, there are a number of similar, very active issues of debate, such as marijuana for widespread medical use, and the employment of hallucinogens for addiction and other mental health disorders. Considerable harm has occurred to some patients when extremes of these pendulum swings have impacted their medical care. It is urged that in practising medicine, physicians consider the entire body of medical evidence accumulated during these pendulum swings, and then have the courage and wisdom to represent the best interests of their patients.

We describe two fatal Asian elephant attacks in Rajaji National Park, Uttarakhand. The first victim was a 65-year-old man found dead on a road leading to his village, which passed through a forest. He sustained multiple blunt force traumatic injuries, primarily in the upper part of the body, caused by stomping from an elephant's feet. The second victim was a 28-year-old man found dead along the banks of the River Ganga. In addition to stomping injuries similar to those in the first case, he also had a fatal tusk penetrating wound in the abdomen. In both cases, death was sudden, resulting from shock and haemorrhage due to blunt force and penetrating trauma, respectively. Injuries typical of such attacks often involve blunt force trauma caused by stomping, squeezing or crushing by the elephant's trunk and feet. In rare cases, penetrating wounds from male elephants' tusks may also be observed.

Cade oil is distilled from the branches and wood of Juniperus oxycedrus. It is widely used in traditional medicine in Morocco and is also widely available and promoted on Amazon. It is potentially particularly poisonous to children, the incidence of which is on the rise. Phenol is the most toxic component responsible for most systemic signs. We hereby report the fatal cases of three infants who had cade oil applied topically to treat diarrhoea, vomiting and fever.

Capacity, often linked with the exercise of patient autonomy, was considered again recently by the Court of Appeal in Thirumalesh Chellamal Hemachandran and Another v Sudiksha Thirumalesh (Deceased) (By her litigation friend, The Official Solicitor) and Others ([2024] EWCA Civ 896). This paper reviews that case and comments on it in the light of the two related key themes of capacity and patient autonomy. The paper concludes that only patients with capacity can exercise patient autonomy because a patient who lacks capacity cannot make a decision regarding their medical treatment.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.

Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.

The suitability of an unregistered expert psychologist to give evidence to the Family Court was considered in Re C [2023] EWHC 345 (Fam). An important part of the judgment focused on the need for an expert witness to demonstrate, in a short, concise and relevant CV, why they have the expertise to give opinion evidence in the case. The judgment has important implications for experts in civil litigation, where the same issues arise. The case of Re C is reviewed and recommendations for a new format for part of expert reports provided in civil litigation are discussed.