The Rise of Forensic Pathology in Human Medicine

Abstract

The rise of forensic pathology in human medicine has greatly contributed to the administration of justice, public safety and security, and medical knowledge. However, the evolution of human forensic pathology has been challenging. Veterinary forensic pathologists can learn from some of the lessons that have informed the growth and development of human forensic pathology. Three main observations have emerged in the past decade. First, wrongful convictions tell us to use a truth-seeking stance rather than an a priori “think dirty” stance when investigating obscure death. Second, missed homicides and concealed homicides tell us that training and certification are the beginning of reliable forensic pathology. Third, failure of a sustainable institutional arrangement that fosters a combination of service, research, and teaching will lead to stagnation of knowledge. Forensic pathology of humans and animals will flourish, help protect society, and support justice if we embrace a modern biomedical scientific model for our practice. We must build training programs, contribute to the published literature, and forge strong collaborative institutions.

The rise of forensic pathology in human medicine over the latter part of the 20th century and the early part of the 21st century has been a remarkable journey. The systematic development of the medical subspecialty of forensic pathology after training in anatomical or general pathology has changed how science and medicine are used in the justice system and in public safety. Prior to the emergence of forensic pathology, the examination of dead bodies of citizens and victims of crime was performed by pathologists (and other medical practitioners) who lacked basic training in forensic medicine and the interpretation of injuries. However, through the progressive development of institutional and academic infrastructure in forensic pathology, the discipline has evolved to create a highly reliable body of knowledge that can serve the interest of justice. The growth and development of forensic pathology in human medicine can serve as a guide as to how veterinary forensic pathology can become a coherent subspecialty of veterinary pathology. In general, the lessons from human forensic pathology can be distilled into 3 main philosophical or systemic guides.

First, wrongful convictions have provided an important basis to increase the professionalism and reliability of forensic pathology in the justice system. Specifically, the lessons learned from wrongful convictions tell us to use a truth-seeking perspective rather than an a priori “think dirty” stance. In the past, forensic pathologists and other death investigators often used prior assumption that a death was unnatural until proven otherwise, particularly in specific scenarios, such as the deaths of infants and children. As a result, there was an overdiagnosis of apparently homicidal deaths in the context of circumstantial information that tended to bias the investigators. It was only through strengthening forensic pathology as a scientific and medical discipline that this error in thinking became rectified. Specifically, in the past few years, cases have emerged where errors of medical testimony (or testimony that was unbalanced with regard to scientific validity) caused or contributed to the wrongful conviction and incarceration of innocent people. In 2 notable cases in Canada, there was a misinterpretation of postmortem artifacts that resulted in the misdiagnosis of injuries ¹ and an overly specific estimate of time of death based on stomach contents. ² Such cases, as well as others in the United States ³ and the United Kingdom, ⁴ have underscored the need to increase the scientific rigor of forensic medicine.

Second, the historical deficiency in quality of forensic pathology not only led to wrongful convictions; in some cases, the lack of expertise resulted in missed homicides usually due to the failure to detect a concealed homicide. This is the same type of error that gives rise to the problem of wrongful conviction—a gap of knowledge. Our collective experience with missed homicides has underscored the critical value of training and certification as the beginning of reliable forensic pathology. Specifically, the development of formal postgraduate medical education in forensic pathology leading to examination-based certification was a critical factor in ensuring adequate knowledge of human forensic pathologists. It is only through the acquisition of the unique body of knowledge that represents forensic pathology that medicolegal investigation of death can produce reliable results. In human medicine, the model of subspecialty certification has been used to support tertiary and quaternary health care for decades. For example, the differentiation of branches of surgery and internal medicine due to the unique challenges posed by specific organ systems has produced a plethora of subspecialty physicians in human medicine. For example, it is unthinkable that a general surgeon would undertake pediatric neurosurgery in human health care. On this basis, subspecialty training programs in pediatric neurosurgery have been developed to ensure the highest quality of care of infants and children who require such care. Similarly, the application of the subspecialty training model to forensic pathology has increased the rigor and reliability of the work of forensic pathologists in the justice system.

Third, the sustained growth and development of forensic pathology requires strong institutions and collaborations. At the very heart of producing reliable forensic pathology for society is the seamless combination of clinical service, research, and teaching. In the past, isolated solo practicing pathologists, not attached to academic centers and without training, caused difficulties in the justice system. However, the collaboration of pathologists together working in academic and clinical centers while engaged in research and educational activities is a viable and important foundation for the development of forensic pathology. In Ontario, and more specifically at the University of Toronto, the development of postgraduate medical education programs in forensic pathology has been based on combining these academic activities with the provision of clinical service. On this basis, postgraduate trainees and their supervisors form a collaborative partnership in learning, which has reflected benefits for both the learner and teacher. Strong institutional arrangements for veterinary forensic pathology will be key to its growth and development. In human forensic pathology, the development of a unified or cohesive body of literature based on case reports, retrospective case series, prospective series, and experimental model systems has strengthened the evidence base of the literature. The emergence of similar academic development in veterinary forensic pathology will be an important step in the creation of a reliable subspecialty in veterinary forensic pathology.

One of the distinct advantages of veterinary forensic pathology is that it is positioned to learn from the successes and failures of human forensic pathology. The creation of strong institutions, university-based postgraduate training programs with certification, and the commitment to a truth-seeking paradigm will propel veterinary forensic pathology into the future. It will be an exciting journey!