Medicine,Science and the Law

Forensic age estimation is a crucial aspect of the biological profile of unidentified cadavers. The utility of age-related changes of hyoid bone fusion in forensic age estimation has not been explored much in the past. These age-related changes can be visualised in both the living and the dead using conventional radiography. These changes can assist medico-legal professionals and forensic anthropologists in the identification of unknown deceased, especially when the cadaver is mutilated or charred or when the other well-established indicators of skeletal and dental maturity are absent. The aims of this study were to evaluate age-related changes in the hyoid bone and to ascertain whether these changes may be utilised for age estimation in forensic examinations. The hyoid bone was carefully dissected using a standard procedure from 75 cadavers during post-mortem examination. The hyoid bone was radiographed, and the bone was replaced in the body cavity before the post-mortem examination was completed. Hyoid bone fusion was studied by using a standard grading method. Spearman’s correlation coefficient was calculated between the fusion scores and chronological age to assess their relationship. Box and whisker plots of fusion stage-wise age distribution were constructed to demonstrate the gradual linear relationship between hyoid bone fusion and the chronological age of the study participants. The present study concludes that hyoid bone fusion is an indicator of the chronological age of an individual and can be used in conjunction with other methods of age estimation such as the skeletal and dental age.

Forensic mortuaries have always presented a potential threat to workers who come into contact with dead bodies. This research aims to identify hazards faced by forensic mortuary personnel, including forensic pathologists and technicians working in forensic mortuaries in forensic medicine centres throughout Saudi Arabia, to recognise the prevalence of exposure to workplace hazards and to discover the degree of awareness and use of safety practices. A descriptive, cross-sectional study was conducted in a total of 20 forensic medicine centres, using an online questionnaire distributed among forensic mortuary personnel. A total of 113 participants responded to the questionnaire. Just over half (53%) of workplaces always provided personal protective equipment, and 75% of participants always used them. The most common hazards were needle-prick wounds and accidental slips or falls. Almost two thirds (64%) of participants witnessed or experienced a work-related accident in the forensic mortuary. The lack of previous studies concerning hazard exposure among forensic mortuary personnel in Saudi Arabia means that this study provides foundational evidence for future research concerning forensic autopsy-related work accidents in Saudi Arabia.

The coronavirus disease 2019 pandemic has mandated a response from administrative agencies and the health sector globally, however, the number of cases and deaths continue to rise. While management of the living is paramount, the management of the dead is also important. Guidelines for managing the dead have been issued and implemented by various local administrations, in accordance with national and international guidelines. This questionnaire-based research aims to develop an understanding of the knowledge, perceptions and practices of forensic practitioners from India as regards the management of the dead during the coronavirus disease 2019 pandemic. This Pan-India study included 278 forensic medicine experts (249 males and 29 females) working in various hospitals and medical institutions across the country. The questionnaire included various issues involving the management of dead bodies in cases involving coronavirus disease 2019, such as infection control practices, body screening, handling and autopsy, disposal practices, local administrative policies, and available infrastructure and resources. We found that guidelines are mostly being followed across India, barring disparity in issues relating to testing in the dead bodies, the role of local administration in the body disposal, and the use of personal protective equipment while handling bodies and during autopsies. Mortuaries now need to be upgraded, and general infrastructure requires improvement. Periodic training of all stakeholders and assessment of facilities are recommended.

Diabetic ketoacidosis (DKA) is a life-threatening condition arising in individuals with insulin-dependent diabetes mellitus, associated with hyperglycaemia and hyperketonaemia. While drugs such as methadone, cocaine and certain prescription medications may precipitate DKA, the potential effect of methamphetamine is unclear. Analysis of autopsy and toxicology case files at Forensic Science SA, Adelaide, South Australia, was therefore undertaken from 1 January to 31 December 2019 of all cases where methamphetamine was detected in post-mortem blood samples. There were 94 cases with 11 diabetics (n = 6 type 1 and n = 5 type 2). Four of the six decedents with type 1 diabetes had lethal DKA (66.7%; age range 30–54 years; average age 44.6 ± 10.5 years; M:F ratio 1:1). This incidence of DKA was higher than that of the general insulin-dependent diabetic population (6%) and also significantly higher than in medico-legal cases (13%; p < 0.05). The clinical and autopsy assessment of insulin-dependent diabetics presenting with DKA should therefore include specific screening for methamphetamine. The increase in both insulin-dependent diabetes and methamphetamine abuse in the community may lead to increases in such cases in medico-legal and health contexts.

Forensic DNA databases have been established in the vast majority of European countries and represent an essential personal identification instrument in the criminal justice system. The implementation of suitable legislation and accompanying legal practice is an imperative to ensure sensible use of the DNA repository, without interfering with the rights, freedoms and privacy of individuals and their families. Thus, the complex matter of DNA databank effectiveness and intrusiveness is a delicate balancing act, which has resulted in diverse database governing regimes among different countries. In 2018, the National Assembly of the Republic of Serbia passed the first Law on the National DNA Register, which was created by the Ministry of Interior. This short and imprecise regulation was announced without prior consultation with professional stakeholders or the public, resulting in controversy. In this article, we examine essential questions pertinent to launching a forensic DNA database through the lens of the new Law on the National DNA Register in the Republic of Serbia and in comparison to the other European approaches and guidelines to regulating forensic DNA repositories. We further discuss the resulting legal, social and ethical implications and concerns and propose future actions intended to improve the legal framework. We believe that stimulating such discussions throughout the scientific and professional community will result in the advancement of DNA profiling and databasing in a future European Union member state and, more generally, the manner in which biological data are managed in various countries, particularly those that are developing.

The forensic evidence of hanging is based on the autopsy demonstration of the traces left by the noose or the ligature on the neck, as well as on the histological assessment of the hanging mark vitality. However, the specific topography of haemorrhagic infiltration in the context of the cervical damaged tissues involved in hanging is not known. We carried out an extensive microscopic examination to identify if haemorrhagic infiltration in hanging appeared in specific topographic locations that could have been considered as elective. From 102 victims of suicidal hanging, a skin fragment was sampled from the maximum compression area of the sulcus, including the skin portions immediately above and below it. The sampling was also extended to collect the subcutaneous adipose tissue and part of the striated muscle. A standard histological examination was performed on all the samples, and hematoxylin and Eosin, Weigert’s resorcin-fuchsin and Goldner’s Masson trichrome staining were performed. In all the cases assessed, the microscopic examination allowed the detection of haemorrhagic infiltration mainly in the deepest areas under the sulcus and especially in the deep dermis and at the transition point between the dermis and the subcutaneous adipose tissue, as well as in the context of its supporting connective tissue. Such areas could therefore be considered as regions in which the presence of haemorrhagic infiltration is more likely to be demonstrated. Accordingly, we recommend performing sampling similar to ours and focusing the search for haemorrhagic infiltration as suggested.

The feeding of animals on bodies after death – so-called post-mortem animal predation – may complicate autopsy interpretations when there has been removal of significant amounts of skin and tissues. An extreme situation which sometimes arises is the complete evisceration and/or consumption of all major cavity organs. Search of autopsy files at Forensic Science South Australia was undertaken for examples of this phenomenon. Although such a finding at autopsy may suggest the actions of larger animals such as dogs or sharks, it may also occur when groups of smaller animals, such as cats, act in concert. Complete loss of organs may also occur if significant insect activity accompanies decomposition. Empty body cavities may therefore result from of a wide variety of animal activities involving a range of species in quite different environments. A significant problem once organs have been removed or consumed is in identifying or excluding natural diseases or injuries that may have played a role in the lethal episode.

Involuntary psychiatric admission or ‘sectioning’ is a serious event with clear implications for the right to liberty, among other rights. Rates of involuntary admission vary considerably across jurisdictions. The rate of involuntary admission in England is approximately double that in the Republic of Ireland. Why? This paper examines potential explanations for this difference, including the prevalence of mental disorder in the two jurisdictions, factors relating to mental health legislation, differing levels of police involvement in care-pathways, funding and resources, and attitudes to risk among the public and professionals. Overall, it appears that the relatively high rate of involuntary admission in England might be attributable to the role of perceived risk in shaping mental health law in England but not Ireland, the broader definition of ‘mental disorder’ in the Mental Health Act, 1983 in England, broader legal criteria for involuntary admission in the 1983 Act, differences in the operational definitions of ‘voluntary patient’ between the two jurisdictions and, possibly, increased involvement of police in pathways to care in England and differences in relation to different ethnic groups. The relatively higher number of inpatient beds in England could be a cause or a consequence of higher rates of involuntary admission. Future research could usefully focus on other factors that are also likely relevant: issues relating to social care, substance misuse, availability of alternative treatment options in the community and various other factors that are, as yet, unknown. The potential impact of risk aversion among mental health professionals and others merits particular attention.

Basal cell carcinomas are the most common malignancy in Caucasian populations with a very low predisposition to metastatic disease and an excellent prognosis if appropriately treated. Given the rarity of a lethal outcome two cases are reported. Case 1: A 61-year-old reclusive man who had an untreated facial basal cell carcinoma for 10 years died of hypothermia and sepsis complicating the extensively ulcerated and infected tumour. He also had underlying cardiomegaly, ischaemic heart disease and chronic obstructive pulmonary disease. Case 2: A 60-year-old man who had an untreated lower lumbar basal cell carcinoma for 14 years died of sepsis, inanition and pulmonary thromboembolism (due to a right-sided deep venous thrombosis) complicating the deeply ulcerated tumour. Untreated giant basal cell carcinoma may uncommonly present for medicolegal assessment with complex pathophysiological lethal mechanisms. The possibility of Diogenes syndrome should be considered.