Medico-Legal Journal

Death by hanging is asphyxiation when the body is suspended by means of a ligature. Most deaths by hanging are suicides, though occasionally they are accidental or a homicidal event. The characteristics of the hanging marks depend on the ligature used, the dynamics and on the node position with respect to the neck. When the crime scene is contaminated, the hanging mark must be checked with the type of suspension and ligatures used to establish how the hangings took place. We report on 20 cases (2013–2016) where the bodies were moved at or from the crime scene. We analysed the features of hanging marks, the tools of suspension and the ligatures employed in each case. Judicial inspections and an external examination were also carried out. Analysis of hanging marks enables the pathologist to clarify the manner of death and the type of hanging, and tools used especially where the crime scene has been contaminated and the body has been moved.

The common law's development of the doctrine of informed consent has progressively imposed broader obligations on surgeons to provide patients with information about the surgical and alternative treatment choices available. Prognosis is critical because the patient cannot provide informed consent without information about the likely evolution of the physiological or pathological processes involved in the surgery under consideration. But does the duty of care that a surgeon owes a patient require a precise prognosis to be given in every case? A recent decision of the Court of Appeal considers that question.

Mr Justice Baker delivered the Oxford Shrieval Lecture ‘A Matter of Life and Death’ on 11 October 2016. The lecture created public controversies about who can authorise withdrawal of assisted nutrition and hydration (ANH) in disorders of consciousness (DOC). The law requires court permission in ‘best interests’ decisions before ANH withdrawal only in permanent vegetative state and minimally conscious state. Some clinicians favour abandoning the need for court approval on the basis that clinicians are already empowered to withdraw ANH in other common conditions of DOC (e.g. coma, neurological disorders, etc.) based on their best interests assessment without court oversight. We set out a rationale in support of court oversight of best interests decisions in ANH withdrawal intended to end life in any person with DOC (who will lack relevant decision-making capacity). This ensures the safety of the general public and the protection of vulnerable disabled persons in society.

Cadaveric spasm causes instantaneous rigor without preceding post-mortem flaccidity. The precise pathophysiological basis of this phenomenon is still unknown. We report a case of accidental electrocution where the deceased was found dead with a metallic water supply pipe of a motor booster pump firmly gripped in his hand. In this report, we review the literature and consider the mechanisms that may cause this phenomenon.

All children have the right to complete and integrated physical and psychological protection against abuse. The most important reason and risk factors for child abuse are social causes including poor familial support, poverty, mood disorders in the family, and addiction. Here, we report a case of child abuse of an Afghan child in Iran with a background of mood disturbances who presented with multiple trauma and injury. A nine-year-old Afghan boy was described with multiple injuries on neck, upper and lower extremities, and trunk. On anal examination in knee chest position, a suspected mucosal injury was evident. Interviewing the patient and his sister revealed a report of sexual abuse through the anus by his father.

Forensic pathologists come across many deaths due to natural causes which are sudden. Sudden natural deaths in females who are pregnant warrant thorough investigation and a medico-legal autopsy to rule out any foul play. Here, we report a case of 21-year-old primigravida in her first trimester who suddenly complained of severe chest pain and was brought dead to the hospital with no history suggestive of prior natural disease. At autopsy, the death was attributed to dissection of ascending aorta.