Friday, 21 September 2007

Medicolegal misconceptions

The public is exposed to a wealth of forensic pathology in the media, particularly in TV programmes such as Silent Witness (UK) and CSI. However, these representations are rarely accurate.

Dr Charles Petty identified popular medicolegal misconceptions (the 'devil's dozen') in an article in 1971;

  • that the time of death can be precisely determined by the examination of the body
  • that the autopsy always yields the cause of death
  • that the autopsy can properly be carried out without a 'history'
  • that the autopsy is over when the body leaves the autopsy room
  • that embalming will not obscure the effects of trauma and disease
  • that only true and suspected homicide victims need examination
  • that the cause and manner of death are the only results of the autopsy
  • that any pathologist is qualified
  • that the autopsy must be immediate
  • that the poison is always detected by the toxicologists
  • that all physicians are good death investigators
  • that the medicolegal autopsy is criminally or prosecution oriented
These are still valid misconceptions today, again illustrating the fact that 'nothing is new under the sun', and that forensic practitioners will always be struggling to disabuse the police and others involved in the administration of justice that forensic pathology does not provide all of the answers in any investigation.

Classical mistakes in forensic pathology

Public scrutiny of forensic pathology is frequently intensive, particularly where a 'miscarriage of justice' is perceived, and the case is 'taken on by the media' as a cause celebre. Dr Alan Moritz identified several 'mistakes' to avoid in forensic pathology, in his 'classic paper' of 1956;

  • not being aware of the objective of the medicolegal autopsy
  • performing an incomplete autopsy
  • permitting the body to be embalmed before performing a medicolegal autopsy
  • mistakes resulting from non-recognition or misinterpretation of postmortem changes
  • failure to make an adequate examination and description of external abnormalities
  • confusing the objective with the subjective sections of an autopsy protocol (report)
  • not examining the body at the scene of the crime
  • not making adequate photographs of the evidence
  • not exercising good judgment in the taking or handling of specimens for toxicologic examination
  • permitting the value of the protocol (report) to be jeopardised by minor errors
The recognition of these potential pitfalls are as valid today as they were 50 years ago, and should be learnt by all aspiring forensic practitioners!