Contemporary Clinical Forensic Medicine

The following working definition has been suggested: "Clinical forensic medicine includes all medical [healthcare] fields which may relate to legal, judicial, and police systems" (17). Even though medicine and law interact more frequently in cases of living individuals, forensic pathology has long been established as the academic basis for forensic medicine. It is only in the last two decades that research and academic interest in clinical forensic medicine have become an area of more focused research.

The recent growth in awareness of abuses of human rights and civil liberties has directed attention to the conditions of detention of prisoners and to the application of justice to both victim and suspect. Examples of injustice and failure to observe basic human rights or rights enshrined in statute in which the input of medical professionals may be considered at least of poor quality and at worst criminally negligent have occurred and continue to occur worldwide. The death of Steve Biko in South Africa, the conviction of Carole Richardson in England, and the deaths of native Australians in prison are widely publicized instances of such problems. Reports from the European Committee for the Prevention of Torture and Inhuman and Degrading Treatment in the early 1990s drew attention to the problem of lack of independence of some police doctors. The conflicting needs and duties of those involved in the judicial system are clear, and it is sometimes believed that recognition of such conflicts is comparatively recent, which would be naive and wrong. In England and Wales, the Human Rights Act 1998, whose purpose is to make it unlawful for any public authority to act in a manner incompatible with a right defined by the European Convention of Human Rights, reinforces the need for doctors to be aware of those human rights issues that touch on prisoners and that doctors can influence. It is worth noting that this law was enacted almost 50 years after publication of the European Convention of Human Rights and Fundamental Freedoms. The future role of the forensic physician within bodies, such as the recently established International Criminal Court, is likely to expand.

The forensic physician has several roles that may interplay when assessing a prisoner or someone detained by the state or other statutory body. Three medical care facets that may conflict have been identified: first, the role of medicolegal expert for a law enforcement agency; second, the role of a treating doctor; and third, the examination and treatment of detainees who allege that they have been mistreated by the police during their arrest, interrogation, or the various stages of police custody (18). This conflict is well-recognized and not new for forensic physicians. Grant (19), a police surgeon appointed to the Metropolitan Police in the East End of London just more than a century ago, records the following incident: "One night I was called to Shadwell [police] station to see a man charged with being drunk and disorderly, who had a number of wounds on the top of his head.. .I dressed them.. .and when I finished he whispered 'Doctor, you might come with me to the cell door'.. .I went with him. We were just passing the door of an empty cell, when a police constable with a mop slipped out and struck the man a blow over the head.. .Boiling over with indignation I hurried to the Inspector's Office [and] told him what had occurred." Dr. Grant records that the offender was dealt with immediately. Dr. Grant rightly recognized that he had moral, ethical, and medical duties to his patient, the prisoner. Dr. Grant was one of the earliest "police surgeons" in England, the first Superintending Surgeon having been appointed to the Metropolitan Police Force on April 30, 1830. The Metropolitan Police Surgeons Association was formed in 1888 with 156 members. In 1951, the association was reconstituted as a national body under the leadership of Ralph Summers, so that improvements in the education and training for clinical forensic medicine could be made. The Association of Forensic Physicians, formerly the Association of Police Surgeons, remains the leading professional body of forensic physicians worldwide, with more 1000 members.

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