Medicine,Science and the Law

The sources of judicial dissatisfaction with, and criticism of, expert healthcare evidence are traced to unqualified, careless, overworked and unscrupulous experts and a failure on the part of some experts to work collaboratively with their instructing lawyers during the litigation process. The suggested remedies are: adherence to the clear professional standards that already exist, appropriate training for which the foundations should be laid during undergraduate medical education, continuing professional development, credentialing complemented by instructing solicitors and counsel ensuring that the expert is appropriate for the case and aware of their duties, collaborative working between expert and instructing lawyer, peer and institutional support and quality control including peer review of reports and case-based discussion of reports.

In the Eastern Black Sea Region, located in the northeast of Turkey, traditional wooden houses with rich visual and architectural features represent an important aspect of folk building arts. However, fires in these wooden houses, which have a high fire load, pose a significant public health issue, leading to substantial loss of life and property. This study aimed to evaluate deaths caused by wooden house fires over a 10-year-period from a forensic medicine perspective, with the goal of raising social awareness and providing recommendations for prevention and protection. 87.1% of the victims died at the scene. 68.2% of the bodies exhibited fourth-degree (carbonized) burns. 78.8% showed macroscopic soot contamination in the lower respiratory tract. 69.4% had elevated blood carboxyhemoglobin levels, with a mean value of 41.2%. Identification was achieved through DNA comparison analysis in 36.5% of cases. The study determined that 83.6% of the deaths resulted from direct carbon monoxide intoxication, direct burns, or a combination of burns and carbon monoxide intoxication. To accurately determine both the identity of the deceased and the true cause of death in fire victims, a comprehensive investigation is essential. This includes detailed crime scene examination and extended toxicological, pathological, radiological, and molecular genetic analyses alongside autopsy procedures. Strong correlations were identified between blood carboxyhemoglobin levels, soot contamination in the lower respiratory tract (macroscopic and microscopic), and fire-related causes of death. Furthermore, DNA comparison analysis enables 100% accurate identification, even in highly carbonized bodies.

Signature authentication refers to the verification whether the signature is legitimate or forged and is executed by the person who is claiming to have signed it. The main objective of the present research was to customize a deep learning-based convolutional neural network (CNN) model trained on a primary dataset for signature authentication. The model was trained, validated, and tested on the dataset of the 1400 signature images (700 genuine and 700 forged) primarily obtained from the study participants. The signature samples were equally divided into a train (1000 samples comprising 500 forged and 500 genuine signatures) and a test dataset (400 samples comprising 200 forged and 200 genuine signatures) as per the requirements of the model's training and testing procedure. The model's architecture was optimized with different hyperparameters to achieve a higher accuracy rate. The results show that the proposed model attains the training, validation and testing accuracy of 97.32%, 97.92%, and 84.5% respectively. Furthermore, other evaluation matrices were also computed, including precision, recall (sensitivity), F1-score, and specificity with the values of 85%, 84%, 84%, and 90%, respectively. The accuracy matrices provide better performance over the other existing methods. This customized CNN architecture can be trained on larger datasets and directly deployed in the field of forensic science for signature examination. The study has wide-ranging applications in the banking sector, forensic document examination, courtrooms, and beyond.

Following a mass fatality incident, the assessment of survivability and preventability is essential, yet current methodologies remain inconsistent both within the UK and internationally. The 2024 UK Home Office report ‘The Patronising Disposition of Unaccountable Power: Independent Review of Forensic Pathology’ evaluated learning from the Hillsborough disaster and the Manchester Arena bombing inquests, highlighting the urgent need for clearer, standardised processes in determining survivability and preventability. This paper critically reviews existing techniques in use to address the question of survivability and preventability and makes recommendations for a national best practice framework to improve this process for future inquiries.

An amoebic liver abscess (ALA) caused by Entamoeba histolytica remains a significant cause of morbidity and mortality in tropical regions. Although hepatic rupture into adjacent thoracic structures is a recognised but rare complication, it can be fatal if undiagnosed or untreated. Hepatic abscesses can rupture and spread the infection to the thoracic cavity, resulting in the formation of a hepato-thoracic fistula, rarely. We report an autopsy case of a middle-aged female who died suddenly following nonspecific systemic symptoms. Postmortem examination revealed a large ALA that had ruptured through the diaphragm, leading to massive pleural empyema. This autopsy case report underscores the importance of early clinical suspicion, imaging, and surgical management to prevent such catastrophic outcomes.

Ethanol is the most commonly abused drug worldwide, and excessive alcohol consumption is a major contributing factor in accidents and violent crimes. Methanol is a toxic alcohol and is less commonly detected but holds significant forensic relevance due to its potential for causing fatal poisoning. The study aims to detect the concentrations of ethanol and methanol in postmortem blood, vitreous humor, urine, and cerebrospinal fluid, and to create a database of the involvement of alcohol in postmortem cases. A total of 150 postmortem cases with different causes of death were enrolled for the study. Gas Chromatography-Headspace was employed for the quantitative determination of ethanol and methanol concentrations in the biological specimens. Out of 150 cases, 108 cases (72%) exhibited positive ethanol concentrations. The high prevalence of positive ethanol concentration, particularly in cases of road traffic accidents and hanging, indicated a significant amount of alcohol use prior to death and underscores the role of alcohol consumption in fatal incidents. Methanol was detected in only those cases that had a high ethanol concentration, which may be due to adulteration or contamination of methanol in the alcoholic beverages that the deceased consumed before death. The study highlighted that an alternative/ complementary specimen to the blood should be considered to assess the alcohol concentration and to differentiate antemortem ingestion of alcohol from postmortem formation. The toxicological analysis of alcohol is important in understanding consumption patterns and in developing protocols and policies for preventing such cases.

The majority of healthcare professionals discharge satisfactorily their civic duty to aid the execution of public justice by assisting courts and tribunals and may have their assistance gratefully acknowledged in a judgment that is on the public record. However, the conduct of a minority causes judicial dissatisfaction and sometimes criticism. The British and Irish Legal Information Institute (BAILII) online resource for the period September 2019 to August 2025 has been used to identify such cases. Examples are given of healthcare expert practice which have repeatedly caused concern: absent, insufficient or unclear reasoning; misuse, or failure to cite, literature; inaccuracy; failure to triangulate self-reported history with other evidence; failure to keep up with evidence; inappropriate language; late introduction of evidence; disregard, omission or misrepresentation of instructions; inadequate treatment of issues; failure to comply with procedural rules and guidance; partisanship; absent or inadequate referencing; incomplete range of opinion; misunderstanding of legal test; ignorance or disregard of procedural rules or guidance; disregard of, or challenge to, previous factual findings; acting outside expertise; omitting evidence that undermines opinion; unwillingness to make reasonable concessions; misuse of, or failure to refer to, relevant clinical guidelines; criticism of other experts; and dishonesty. Expert healthcare witnesses whose conduct results in judicial dissatisfaction or criticism appear to be unaware of, or to misunderstand, the duties of an expert witness or to act in disregard of them.

Volatile substance abuse (VSA) continues to cause preventable deaths worldwide. In Australia, petrol sniffing has historically been the main form of misuse in remote Indigenous communities. However, coronial and surveillance data suggest an increasing role of gas fuels and aerosol propellants. Twenty-five VSA-related deaths reported to the Northern Territory (NT) coroner over a 21-year period (2002–2022) were reviewed. In the 22 cases where acute volatile substance inhalation was the direct cause of death, the decedents were all male, and predominantly young Aboriginal individuals aged between 12 and 29 years. Furthermore, petrol vapor inhalation was responsible for most fatalities up to 2018, after which no further petrol sniffing-related deaths occurred. Deaths that occurred after 2018 were associated with the use of propane or butane from aerosol cans, such as those used for deodorants. A public health initiative that resulted from this was the keeping of aerosol deodorants in supermarkets within locked cabinets. In conclusion, public health interventions, such as the introduction of Opal fuel in remote communities in the NT, have been effective, with a sharp decrease in petrol sniffing-related fatalities. However, this seemed to have led to a shift towards the use of other inhalants, most commonly butane and/or propane inhaled from aerosol canisters. Forensic practitioners should be alert to non-petrol volatiles, and public health strategies need to broaden beyond petrol substitution to include regulatory and community-level measures addressing gas fuels and aerosols.

Cannabis is a chemically diverse plant with bioactive cannabinoids that exert a wide range of therapeutic and psychoactive effects. This review comprehensively explores the botanical, chemical, pharmacological, and regulatory distinctions between hemp and marijuana, focusing particularly on the contrasting actions of Δ⁹-tetrahydrocannabinol (THC) and cannabidiol (CBD). We examine cannabinoid biosynthesis, structure–activity relationships (SARs) in relation to receptor interactions and activation, and metabolic pathways to highlight the scientific basis for their different effects and clinical applications. Additionally, the paper critically evaluates detection techniques and surveys international legal frameworks, highlighting disparities that often reflect cultural rather than scientific understanding. By integrating emerging clinical data and public policy trends, this review underscores the need for evidence-based reform and education, especially regarding non-intoxicating cannabinoids such as CBD. It also offers a scientific foundation to inform both health professionals and regulators in shaping future cannabis policy.

In child physical abuse cases, a clinical forensic medical examination (CFME) is performed to document medical evidence, such as lesions and scars. In Denmark, however, not all cases are referred by the police to a CFME, and we aimed to study the key characteristics of police reported cases of child physical abuse (N = 136, ages 4–17 years) – case context, the child's disclosure and sociodemographic factors – that could influence the police's selection process. Associations between case characteristics and CFME referrals were studied using univariate and multivariate logistic regression models, which were supported by age- and sex-matched conditional logistic regression models. CFME referrals were found to be less common for cases with children from a low socioeconomic status family or with previously reported concerns (such as a report to the social services), and more common when the violence endured by children involved punching/striking of limbs or left visible marks. Moreover, the number of victims in a sibship seemed to be associated with CFME referrals. Referrals were not influenced by parents’ origin or the suspect–child relationship. A biased referral process may lead to unequal case handling and undermine the rule of law. By identifying the characteristics relevant to this process, we aimed to contribute to a systematic and consistent approach to case management. Future qualitative interview studies with police officers and prosecutors and studies focused on larger populations can offer further valuable insights into the selection process.

This comparative analysis explores the legal frameworks surrounding end-of-life issues in the Scandinavian countries. Despite their shared legal traditions, all four nations exhibit stringent restrictions on end-of-life practices. This paper highlights the specific legal provisions, limitations, and societal attitudes within each country, demonstrating a significant legislative rigidity that contrasts with the more progressive approaches observed in other countries. Notably, while Norway and Denmark maintain a conservative stance lacking substantial public movements advocating for change, Sweden displays elements of dialogue around end-of-life issues, albeit without formal legislation permitting euthanasia. By providing a detailed examination of the current state of laws and ethical considerations in Scandinavian countries, this work underscores the critical divergence between societal desires for autonomy in end-of-life decisions and the legal constraints. The findings suggest the necessity for legislative reflection and potential reform to align legal practices with evolving public sentiment regarding the right to die.

Recent decades have been characterized by an exponential increase in medico-legal litigation and an accentuated interest in healthcare responsibility. This study aims to examine cases of alleged medical negligence in Cardiology and Cardiac Surgery in one of the largest hospitals in north-west Italy, over a 11-year period (2013–2023). The primary objective of this study is to conduct a comparative analysis between compensation claims initially advanced by patients (or their legal representatives) in the pre-trial phase and the final outcomes of legal proceedings brought before the court. This article provides an important opportunity for a critical and in-depth analysis of litigation in the fields of cardiology and cardiac surgery, with the aim of improving the efficiency of case management.

In the period 2013–2023, San Martino Polyclinic Hospital received a total of 1704 compensation claims, of which 39 (2.29%) were related to alleged cardiological and cardiosurgical professional liabilities. About 64.10% of the compensation claims (25 out of 39) were deemed illegitimate due to the absence of professional responsibility, and were therefore rejected by the Claims Management Committee (CMC). In 38.5% of cases, legal action was pursued, and in four cases, the hospital was ordered to compensate the patient for medical negligence. Conversely, in three cases, the Judge's ruling was in favour of the Hospital. Currently, eight legal actions remain ongoing, and their outcomes are pending.

Overall, over the 11-year study period, litigation cases in the cardiology and cardiac surgery fields were relatively infrequent.

Prison environments in Latin America are overpopulated, and current policies restrict more interns’ rights, which in turn leads to high rates of violence and mental health issues. All this goes against social justice in terms of equal rights, equal opportunity, and equal treatment. Following the trend of a more positive criminology, a yoga program was designed for prisoners in a penitentiary center in Valparaiso, Chile. Results of the program were measured before and after the workshop in terms of mental health and aggression. Despite no significant differences being observed in the analysis, a trend was identified in terms of stress, anxiety and aggression reduction. To conclude, longer programs with a gender perspective are suggested for future designs.