Global Clinical Forensic Medicine

Table 3 is a summary of responses to a questionnaire on various aspects of clinical forensic medicine sent in early 2003 to specialists in different countries. The selection of countries was intended to be broad and nonselec-tive. It shows how clinical forensic medicine operates in a variety of countries and jurisdictions and also addresses key questions regarding how important aspects of such work, including forensic assessment of victims and investigations of police complaints and deaths in custody, are undertaken. The questionnaire responses were all from individuals who were familiar with the forensic medical issues within their own country or state, and the responses reflect practices of that time. The sample is small, but numerous key points emerge, which are compared to the responses from an earlier similar study in 1997 (20). In the previous edition of this book, the following comments were made about clinical forensic medicine, the italicized comments represent apparent changes since that last survey.

• No clear repeatable patterns of clinical forensic medicine practice may be seen on an international basis—but there appears to be an increase in recognition of the need to have appropriate personnel to undertake the roles required.

• Several countries have informal/ad hoc arrangements to deal with medical and forensic care of detainees and victims—this still remains the case—often with large centers having physicians specially trained or appointed while rural or outlying areas are reliant on nonspecialists.

• The emphasis in several countries appears to be on the alleged victim rather than the alleged suspect—this remains the case, although there are suggestions that this approach is being modified.

• The standard of medical care of detainees in police custody is variable—there appears to be more recognition of the human rights aspects of care of those in police custody.

• There are no international standards of practice or training—international standards are still lacking—but more countries appear to be developing national standards.

• There are apparent gaps in the investigation of police complaints in some coun-tries—this remains the case.

• Death-in-custody statistics are not always in the public domain—this remains the case—and the investigation of deaths in police custody may still not be independently undertaken.

There appears to be wider recognition of the interrelationship of the roles of forensic physician and forensic pathology, and, indeed, in many jurisdictions, both clinical and pathological aspects of forensic medicine are undertaken by the same individual. The use of general practitioners (primary care physicians) with a special interest in clinical forensic medicine is common; England, Wales, Northern Ireland, Scotland, Australasia, and the Netherlands all remain heavily dependent on such professionals.

Academic appointments are being created, but these are often honorary, and until governments and states recognize the importance of the work by fully funding full-time academic posts and support these with funds for research, then the growth of the discipline will be slow. In the United Kingdom and Europe much effort has gone into trying to establish a monospecialty of legal medicine, but the process has many obstacles, laborious, and, as yet, unsuccessful. The Diplomas of Medical Jurisprudence and the Diploma of Forensic Medicine (Society of Apothecaries, London, England) are internationally recognized qualifications with centers being developed worldwide to teach and examine them. The Mastership of Medical Jurisprudence represents the highest qualification in the subject in the United Kingdom. Further diploma and degree courses are being established and developed in the United Kingdom but have not yet had first graduates. Monash University in Victoria, Australia, introduced a course leading to a Graduate Diploma in Forensic Medicine, and the Department of Forensic Medicine has also pioneered a distance-learning Internet-based continuing-education program that previously has been serialized in the international peer-reviewed Journal of Clinical Forensic Medicine.

Many forensic physicians undertake higher training in law or medical ethics in addition to their basic medical qualifications. In addition to medical professionals, other healthcare professionals may have a direct involvement in matters of a clinical forensic medical nature, particularly when the number of medical professionals with a specific interest is limited. Undoubtedly, the multiprofessional approach can, as in all areas of medicine, have some benefits.

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