Introduction

Forensic medicine, forensic pathology, and legal medicine are terms used interchangeably throughout the world. Forensic medicine is now commonly used to describe all aspects of forensic work rather than just forensic pathology, which is the branch of medicine that investigates death. Clinical forensic medicine refers to that branch of medicine that involves an interaction among law, judiciary, and police officials, generally involving living persons. Clinical forensic medicine is a term that has become widely used only in the last two or so decades, although the phrase has been in use at least since 1951 when the Association of Police Surgeons, now known as the Association of Forensic Physicians—a UK-based body—was first established. The practitioners of clinical forensic medicine have been given many different names throughout the years, but the term forensic physician has become more widely accepted. In broad terms, a forensic pathologist generally does not deal with living individuals, and a forensic physician generally does not deal with the deceased. However, worldwide there are doctors who are involved in both the clinical and the pathological aspects of forensic medicine. There are many areas where both clinical and pathological aspects of forensic medicine overlap, and this is reflected in the history and development of the specialty as a whole and its current practice.

From: Clinical Forensic Medicine: A Physician's Guide, 2nd Edition Edited by: M. M. Stark © Humana Press Inc., Totowa, NJ

Table 1

Typical Roles of a Forensic Physician a

• Determination of fitness to be detained in custody

• Determination of fitness to be released

• Determination of fitness to be charged: competent to understand charge

• Determination of fitness to transfer

• Determination of fitness to be interviewed by the police or detaining body

• Advise that an independent person is required to ensure rights for the vulnerable or mentally disordered

• Assessment of alcohol and drug intoxication and withdrawal

• Comprehensive examination to assess a person's ability to drive a motor vehicle, in general medical terms and related to alcohol and drug misuse

• Undertake intimate body searches for drugs

• Documentation and interpretation of injuries

• Take forensic samples

• Assess and treat personnel injured while on duty (e.g., police personnel), including needle-stick injuries

• Pronounce life extinct at a scene of death and undertake preliminary advisory role

• Undertake mental state examinations

• Examine adult complainants of serious sexual assault and the alleged perpetrators

• Examine alleged child victims of neglect or physical or sexual abuse

• Examine victims and assailants in alleged police assaults

Additional roles

• Expert opinion in courts and tribunals

• Death in custody investigation

• Pressure group and independent investigators in ethical and moral issues

■ Victims of torture ■ War crimes ■ Female genital mutilation

• Refugee medicine (medical and forensic issues)

• Asylum-seeker medicine (medical and forensic issues)

• Implement principles of immediate management in biological or chemical incidents

For all these examinations, a forensic physician must accurately document findings and, when needed, produce these as written reports for appropriate civil, criminal, or other agencies and courts. The forensic physician must also present the information orally to a court or other tribunal or forum.

a Expanded and modified from ref. 22. This table illustrates the role of forensic physicians in the United Kingdom; roles vary according to geographic location.

Police surgeon, forensic medical officer, and forensic medical examiner are examples of other names or titles used to describe those who practice in the clinical forensic medicine specialty, but such names refer more to the appointed role than to the work done. Table 1 illustrates the variety of functions a forensic physician may be asked to undertake. Some clinical forensic medical practitioners may perform only some of these roles, whereas others may play a more extended role, depending on geographic location (in terms of country and state), local statute, and judicial systems. Forensic physicians must have a good knowledge of medical jurisprudence, which can be defined as the application of medical science to the law within their own jurisdiction. The extent and range of the role of a forensic physician is variable; many may limit themselves to specific aspects of clinical forensic medicine, for example, sexual assault or child abuse. Currently, the role and scope of the specialty of clinical forensic medicine globally are ill defined, unlike other well-established medical specialties, such as gastroenterology or cardiology. In many cases, doctors who are practicing clinical forensic medicine or medical jurisprudence may only take on these functions as subspecialties within their own general workload. Pediatricians, emergency medicine specialists, primary care physicians, psychiatrists, gynecologists, and genitourinary medicine specialists often have part-time roles as forensic physicians.

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