SPECIALIZED CRIME

INVESTIGATION
WITH LEGAL MEDICINE

LESSON TWO: MEDICO-LEGAL Cases

The term “medico-legal” generally refers to something related to both medicine and law. In the field of
law enforcement, medico-legal cases refer to those that involve injuries or ailments in which investigation are
essential to determine the cause and the responsible party. This also means that medico-legal cases involve
medical cases with legal implications for the attending physician, specifically in terms of determining whether
law enforcement authorities must be notified for further investigation. On the other hand, it could also refer to
legal cases or police investigation that may require the expertise of a medical practitioner.
The ff. are examples of cases that usually have medico=legal implications, some of which shall be discussed
in further detail in other chapters.

es

Medico-legal investigations involve the discovery, preservation, documentation and analysis of

evidence, as well as the reconstruction of events leading to the injury or death under investigation.

Legal Medicine and Medical Jurisprudence are terms used interchangeably to refer to branches of
medicine that apply the principles and knowledge of the medical sciences in the field of law. The field of Legal
Medicine is typically associated with death and autopsies, but it also applies in other legal processes, such as
determining whether a violent crimes is a homicide, suicide or accident or whether they constitute negligence,
sexual assaults, physical abuse or domestic violence. Practitioners are sometimes referred to as FORENSIC
PATHOLOGIST or FORENSIC PHYSICIANS.

Forensic Medicine (Legal Medicine) is a branch of medicine that covers both the fields of

o Involves the investigation of unnatural, unexpected, or violent death.

o Changes in the body brought about by death
o Deals with the deceased
CLINICAL FORENSIC MEDICINE
o Involves the interaction between the living person, medicine and legal process.
o Changes in the body due to injuries and diseases
o Deals with living individual

However, the clinical and pathological aspects of forensic medicine tend to overlap, and different
countries have medical doctors who are involved in both the clinical and the pathological aspects of legal
medicine. Each practitioner should be aware of their respective responsibilities, not only to their patient or the
deceased, but to the society as a whole. They should also be able to utilize their medical expertise in the
pursuit of fairness and justice within the framework of legal requirements and ethical values.

FORENSIC PATHOLOGY
The word “PATHOLOGY” literally means “the study of disease”. A PATHOLIGIST is a physician who
determines a patient’s diagnosis from an examination of a tissue sample or cells under microscope.
FORENSIC PATHOLOGY is subspecialty that deals with the investigation of sudden, unexpected, and/or
violent deaths. The main role of most FORENSIC PATHOLOGIST is to undertake forensic death investigation
and perform medico-legal autopsies.

ROLES OF FORENSIC PATHOLOGIST:

1. Executing accurate and complete documentation of finding of autopsies.

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2. Undertakes death certification or the completion of an official death certificate which includes some
personal information of the deceased, as well as the cause of death (the disease or injury that was responsible
for the death) and the manner of death (the means of circumstances by which the cause of death occurred)
3. They are also required to require to provide official testimony in court regarding the deaths they have
investigated.

Forensic Pathologist are concerned with the reason behind the occurrence of death; thus, they must
investigate the context of surrounding events before and after the death of the deceased, especially in
homicidal, accidental and suicidal cases. Needless to say, forensic pathologist are more alert to unnatural
deaths. Their investigation can begin with the determination of the following:
1. Who is the victim? (Identification based on SEX, RACE, AGE and distinguishing characteristics)
2. When did the death and related injuries occur?
3. Where did the death and related injuries occur?
4. What injuries are present? (Identification based on type, distribution, pattern, path, and direction)

Pathologist deals with death and tragedy every day; they can serve important functions by helping to
convict the guilty or exonerate the innocent, by helping families deal with the death of a loved one (once they
know the exact cause and manner of death), by preventing future deaths and injuries from dangers that have
proven to be deadly, and also by alerting and educating the public and the government in an effort to prevent
these hazards from being repeated.

CLINICAL FORENSIC MEDICINE

Over years, practitioners of clinical forensic medicine have been called police surgeons, forensic
medical officers or forensic medical examiners. Nowadays, they are more widely known as forensic physicians.

The Forensic Physician is tasked to undertake a variety of functions:

a. TYPICAL ROLES OF A FORENISC PHYSICIAN
1. Determination of fitness to be detained in custody
2. Determination of fitness to be released
3. Determination of fitness to be charged: competent enough to understand the charge/s
4. Determination of fitness to transfer from one jail facility to another or to the court where the alleged
case is heard and tried

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 5. Determination of fitness to be interviewed by the police or another detaining body
6. Advise that an independent person is required to ensure rights for the vulnerable or mentally
disordered
7. Assessment of alcohol and drug intoxication and withdrawal
8. Comprehensive examination to assess a person's ability to drive a motor vehicle, in general medical
terms and related to alcohol and drug misuse
9. Undertake intimate body searches for drugs
10. Documentation and interpretation of injuries
11. Take forensic samples
12. Assess and treat personnel who are injured while on duty (e.g., police personnel), including needle-
stick injuries
13. Pronounce life as extinct at a scene of death and undertake preliminary advisory role
14. Undertake mental state examinations
15. Examine adult complainants of serious sexual assault and the alleged perpetrators
16. Examine alleged child victims of neglect or physical or sexual abuse
17. Examine victims and assailants in alleged police assaults and alleged perpetrators.

b. ADDITIONAL ROLES OF FORENSIC PHYSICIANS

1. Provide expert opinions in courts and tribunals
2. Certify death in custody investigations
3. Serve as part of pressure group and independent investigators in ethical and moral issues (victims
of torture, war crimes, female genital mutilation)
4. Administer medicine to asylum-seekers (medical and forensic issues)
5. Implement principles of immediate management in biological or chemical incidents.

Clinical Forensic Medicine involves the examination of living patients who have certain rights (e.g. right
of confidentiality) and capabilities (e.g. capacity to give consent). The medical doctor examining prisoners or
victims of abuse must, therefore, consider the boundaries among the conflicting rights of the person examined,
the processes of investigations and the interest of justice.

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 A FORENSIC PHYSICIAN has a dual responsibilities to the patient and the general; public that might
come in conflict, such as when a rape victim request for confidentiality at the expense of the perpetrator
becoming free of criminal charges.

In clinical forensic medicine, most examination have both therapeutic and forensic aspect. The doctor
has the primary responsibility of providing care and actual treatment for giving a referral for further treatment
However, the examination will most likely involve the interpretation evidential content, such as major or minor
injuries that could that could later be the subject of detailed cross-examination in court. While the doctor has
a duty of confidentiality to the person examined, the forensic physician also has an obligation to provide
necessary and appropriate information to the police to facilitate the investigation of a crime.

DEATH INVESTIGATION
One of the most important duties of the forensic pathologist is to investigate the death of an individual
by examining all the medical, scientific, and evidentiary information. Death Investigation usually involve
sudden, unexpected or violent death, even those that may be related to natural deaths. Depending on
jurisdiction, a death jurisdiction may include an initial investigation and the examination of the body, followed
by further investigations.

The ff. are the goals and purpose of death investigations; (Adelman, 2017)
1. To help and serve living
2. To seek the truth objectively, intellectually and without bias or emotional coloration
3. To document guilt and protect the innocent
4. To determine the medical cause of death
5. To determine the manner of death

From a legal perspective, one of the most tasks of the Forensic pathologist is to establish the cause
and manner of death. Based on the objectives enumerated above, the forensic pathologist must also estimate
the time of death, infer the type of weapon used, determine additive effect of trauma or pre-existing conditions,
as well as establish the identity of deceased. By understanding the role of the pathologist and the natural
changes that occur in the body after death, the criminal investigator can gather information that is deemed
useful to everyone involved in the investigation.

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 Death Investigators initially determine which locality has jurisdiction over a reported cases, after which
they will obtained identification information about the deceased, such as:

-to-kin

The Criminal Investigators will also gather other significant information such as

position and conditions of the body

vidence of post-mortem changes

When and where the person was last known to be alive

nd

Definition of DEATH
Death is the cessation of life. In the medical and legal sense, human death has been traditionally
defined as “the complete and irreversible cessation of heart and lung activity”. However, controversies arise
when religious and ethical concerns come into play. For example, a person who has been dead for several
hours can still have functional sperms that can fertilize an egg. A dead person’s cells can also be cultured in
a laboratory to be kept “alive” for decades. To clarify this distinctions, the medical profession considers
separately:
(1) The death of the single cell which is known as cellular death, and
(2) The cessation of the integrated functioning of an individual, known as somatic death

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 CELLULAR DEATH is defined as “the cessation of respiration (the utilization of oxygen) and the normal
metabolic activity in the body tissues and cells,” and is “soon followed by autolysis and decay, which if it affects
the whole body, is indisputable evidence of true death” (Shepherd, 2003).

SOMATIC DEATH occurs when “the individual is irreversibly unconscious and unaware of both the world
and his own existence” (Shepherd, 2007). Unlike during the sleep or under anesthesia or temporary coma,
unconsciousness in somatic death is “irreversible”.

Somatic Death, therefore, refers to the death of the person, while Cellular Death refers to the death of
the cells within the persons. (Adelman, 2007)

The following are the Three Modes of Death;

1. COMA
Death results primarily from the failures of the vital centers of the brain; the person becomes
unconscious and loses all reflexes, after which the heart and lungs.
2. SYNCOPE
Death occurs primarily as a results of heart failure, possibly due to blood loss, power loss of the heart
muscle, or neurogenic shock.
3. ASPHYXIA
Death occurs primarily when the respiratory function of lungs stops as a result of lack oxygen, resulting
in failure of the heart and brain.

TAKE NOTE: If a person dies within 24 hours without suffering from a recognizable cause, such death would
be called a SUDDEN DEATH.