Forensic Medicine

Forensic medicine refers to the application of medical facts to legal problems. It includes the medical examination [Page 683]of both the living and the dead in civil or criminal cases, along with the ethical and legal aspects of the behavior and practice of healthcare personnel. The terms forensic medicine, forensic pathology, and legal medicine are often used interchangeably to describe all aspects of forensic work, which nowadays involves the application of a broader range of sciences than those provided by medical knowledge alone.

The antecedents of forensic medicine go back several millennia. The Hippocratic Oath, the basis of medical ethics, dates from the 4th century b.c.e. In ancient Greece and Rome, physicians served as expert witnesses in medical matters, albeit in an ill-defined manner. In 13th-century China, Song Ci first documented how medicine and entomology could be used to solve criminal cases, and described how to distinguish drowning from strangulation. Forensic medicine further developed in 16th-century Europe as the legal system and the state of medical knowledge matured.

During this time, army and university physicians started to collect information on the manner and cause of death. Separate tracts appeared in late-18th-century Italy, France, Germany, and England on what was variously described as police, legal, or forensic medicine. Criminal investigations increasingly adopted forensic science during the 19th century and the first-known chemical confirmation of arsenic poisoning as a cause of death in a murder trial occurred in England in 1836. A number of European universities appointed chairs of Medical Jurisprudence, confirming the emergence of the field. The subject became obligatory for British medical students in 1833, but did not develop into a robust academic discipline.

Forensic pathology is the academic foundation for forensic medicine. It is predominantly made up of death investigation through autopsy and associated procedures, and develops justified explanations. Patient medical histories are obtained, witness statements reviewed, and laboratory tests conducted to recreate the events surrounding a sudden, unexpected death under suspicious circumstances. Crime scenes are investigated directly or indirectly, through testimonies and photographs that may be reproduced for the benefit of a court. An autopsy is performed if the cause of death is not determinable without dissection. Although religious groups may sometimes raise obstacles to conducting autopsies, such objections can often be mitigated through new technologies like laparoscopic examination and computed tomography (CT) scans.

Forensic medicine increasingly calls upon a broader range of sciences to answer legal questions related to crimes or civil actions. For example, a forensic anthropologist may be called to recover and identify skeletal human remains; a forensic toxicologist may be required to identify poisons or drugs and their effects on the human body; a forensic odontologist may be needed to identify a deceased person through dental examination; and a forensic entomologist may help establish the time or location of death through examining insects in, on, or around human remains, and to assess whether a body was moved after death. A forensic engineer may assess injury patterns to evaluate how an injury occurred or how and why a device or structure failed. Forensic psychologists and psychiatrists may be needed to help resolve equivocal suicides or to demonstrate mental illness and thereby incompetency to stand trial, a technique sometimes used in an insanity defense. The need for clinical forensic medicine to devote more attention to the care of living victims of crime or liability-related accidents has driven the development of forensic nursing. Although long established in England, Canada, and Australia, forensic nursing is relatively new in the United States and is just emerging in countries such as India, China, Turkey, Pakistan, Japan, and South Africa. The growing presence and credibility of forensic nursing has expanded the frontiers of forensic medicine.

...