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Forensic medicine and the practising doctor 

Forensic medicine and the practising doctor

Forensic medicine and the practising doctor

Anthony Busuttil

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date: 28 April 2017

Doctors have to keep in mind their legal responsibilities and duties from the very first day of their practice. The services of a medical practitioner are often called upon when injuries and other forms of abuse have taken place, and also when death has occurred, particularly if death was sudden and unexpected. As a direct consequence, the doctor may acquire information that suggests a suspicious and potentially criminal event. In such instances, the doctor’s duty of care and bond of confidentiality to the patient must be carefully balanced against their duties as a citizen of a country in which homicide cannot go undetected and crime cannot be condoned.

Duties at a death

When a doctor is called to a person thought to have died, six principal responsibilities have to be considered: (1) to confirm the fact of death and document the event at the time; (2) to exclude on medical grounds, where possible, any suspicions of foul play or negligence in relation to the death; (3) to identify whether there is a requirement to report the death to the appropriate authorities who have a duty to investigate deaths; (4) to issue a medical certificate of the causes of death when in a position to do so; (5) if unable to issue a death certificate, to refer the death to the legal authorities; and (6) if appropriate, and if the medical practitioner is suitably qualified, to issue other certification, which may be required in relation to the death and the disposal of the decedent.

In the recently deceased, formal clinical examination is required to ensure that the pumping action of the heart and breathing have both ceased by (1) auscultation over the chest for a timed period of about 2 min; (2) feeling the tension in the eyes, which decreases quite promptly after death; and (3) looking at the eyes—the pupils assume a mid position and the corneal and light reflexes disappear.

Other matters

This chapter includes sections on (1) particular causes of death—deaths resulting from and in the course of medical care, sudden infant deaths, sudden unexpected nocturnal deaths in adults, sudden death syndrome, cocaine abuse; (2) survivors of violence—including sexual assaults and the medical notes, with particular reference to wounding; (3) intoxication; (4) access to information; and (5) the forensic use of molecular biological techniques.

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