Medicine,Science and the Law

The COVID-19 pandemic commenced in March 2020. In May 2019, a new Medical Examiner system was introduced to scrutinise deaths of patients dying within acute National Health Service Trusts. The Coronavirus Act 2020 which came into force in March 2020 modified certification of death requirements. Newly formed Medical Examiner Services were advised they could suspend scrutiny during the pandemic. The Norfolk & Norwich University Hospital Medical Examiner Service (NNUH MES) continued to scrutinise patient deaths throughout. This study summarises the workload of the NNUH MES from 1st June 2020 to 31st May 2021 over which period 2856 deaths were recorded and 2687 scrutinised by the Medical Examiners.

Sex determination is a fundamental step in biological profile estimation from skeletal remains in forensic anthropology. This study proposes deep learning and morphometric technique to perform sex determination from lumbar vertebrae in a Thai population. A total of 1100 lumbar vertebrae (L1-L5) from 220 Thai individuals (110 males and 110 females) were obtained from the Forensic Osteology Research Center, Faculty of Medicine, Chiang Mai University, Thailand. In addition, two linear measurements of superior and inferior endplates from the digital caliper and image analysis were carried out for morphometric technique. Deep learning applied image classification to the superior and inferior endplates of the lumbar vertebral body. All lumbar vertebrae images are included in the dataset to increase the number of images per class. The accuracy determined the performance of each technique. The results showed the accuracies of 82.7%, 90.0%, and 92.5% for digital caliper, image analysis, and deep learning techniques, respectively. The lumbar vertebrae L1-L5 exhibit sexual dimorphism and can be used in sex estimation. Deep learning is more accurate in determining sex than the morphometric method. In addition, the subjectivity and errors in the measurement are decreased. Finally, this study presented an alternative approach to determining sex from lumbar vertebrae when the more traditionally used skeletal elements are incomplete or absent.

Background: Self-immolation is a leading public health challenge with a relatively high mortality, especially in some low- and middle-income countries. This study aimed to investigate epidemiological factors of attempts and completed suicide by self-immolation during 2011–2019 in Fars province (Iran). Materials and methods: This retrospective cross-sectional study included 506 cases of attempted self-immolation suicide during 2011–2019 in Fars province (Iran). Demographic characteristics and suicide information were collected from the Fars Suicide Surveillance System. The first fatality rate and age-standardized mortality rates were calculated. Then, chi-square tests were performed to evaluate suicide trends and examine differences between qualitative variables and outcomes. Logistic regression was used to identify factors associated with self-immolation death. Result: The mean age of study participants was 32.11 ± 14.04 years. The highest age-standardized rates of attempt and completed self-immolation suicide were seen in the age group 25–34 years. The fatality rate of suicide by self-immolation was 61.89%, and the risk of death was around three times higher in people with a history of suicide attempts compared to those who had no history of suicide attempts. However, a family history of suicide attempts was shown to be a protective factor against completed self-immolation suicide. Conclusion: The rate of self-immolation is higher in women and young adults. The results of our study can assist health policy-makers to design comprehensive plans and determine the necessary strategies aimed at identifying vulnerable people, then preventing self-immolation suicide.

Age estimation is one of the essential criteria in the identification process. The method of age estimation employed depends on the availability of skeletal material brought for forensic examination. McKern and Stewart's method constitutes one of the principal approaches towards pubic symphyseal age estimation. The method entails evaluating morphological changes within the pubic symphysis and subsequently allotting a specific score corresponding to the observed changes. Based on the obtained scores, an age range is then assigned to the remains presenting for examination. The present systematic review was undertaken to ascertain the applicability of the McKern-Stewart method for age estimation. Studies pertaining to the use of the McKern-Stewart method for age estimation in skeletal remains were retrieved by keying in a combination of MeSH terms and other free terms from four databases. The retrieved articles were subjected to a stringent inclusion and exclusion criteria, following which the risk of bias was assessed and the overall quality of evidence was established. Once the final tally of relevant articles was obtained, data specific to the mean age corresponding to each score was extracted. Non-parametric tests and boxplots were employed to compare the mean ages reported across multiple studies. The present systematic review concludes that the McKern-Stewart method can be applied for the purpose of age estimation in skeletal remains. Broader age cohorts for higher scores, as well as, overlapping values for age ranges in relation to the cumulative scores, however, can be considered a limitation for its applicability in forensic case work.

Mental health courts offer access to community-based care for defendants with psychiatric disorders, including posttraumatic stress disorder (PTSD). However, limited information is available on how judges make treatment decisions about evidence-based practices. In this qualitative study, we interviewed mental health court judges to evaluate: (1) perspectives toward the role of PTSD in criminal behavior; (2) knowledge about evidence-based practice for PTSD; (3) treatment decisions for defendants with PTSD; and (4) treatment decisions for defendants at risk for suicide, a common comorbidity with PTSD. We hypothesized that mental health court judges would report low familiarity with evidence-based practices for PTSD despite wide recognition of the impact of trauma on criminal behavior. Methods: Mental health court judges (N = 11, 60% women, 60% between 50–59 years) were recruited from 7 states in the US and completed a demographics questionnaire and semi-structured qualitative interview that was transcribed and double-coded. Results: Judges in mental health court unanimously agreed that PTSD is highly prevalent among their defendants, but that they had not having received formal education about evidence-based practices for PTSD. They reported relying on their team members to provide recommendations for treatment planning and viewed their role as the enforcer of the treatment teams’ suggestions. Finally, judges also reported that suicide prevention is an important consideration and that there is a need for universal suicide risk assessments. Conclusions: These findings have implications for continuing education among judges in mental health court, and we recommend mandated training to increase awareness of evidence-based practices for PTSD and suicide prevention.

Objective: Opioid substitution treatment (OST) is a common treatment for individuals who use opioids; however, empirical evidence on the effects of OST during incarceration is scarce. Our aim was to conduct a meta-analysis on the effects of incarceration-based OST on substance use, treatment engagement post-release and re-incarceration. Method: We searched for studies on individuals who were incarcerated and treated with OST, compared to a comparison group. Studies were only included if they reported data post-release. Results: N = 15 studies met the inclusion criteria. We found less opioid use, less other drug use, higher treatment engagement post-release and less re-incarceration among treated individuals compared to the comparison group. Moderator analyses showed some influence of length of follow-up period and study quality. Conclusions: Incarceration-based OST reduces drug use, re-incarceration and leads to higher treatment engagement after release. More research is needed on the effects of incarceration-based OST on secondary outcomes (e.g. health and social integration) and on factors that moderate these effects.

The extensive use of smart technology (smartphones and wearables) and the vast amount of information they contain have positioned remote devices and technology as a massive database resource. Harnessing these big data into the clinical and research fields has introduced a new horizon of possibilities along with significant privacy issues. A significant evolution in this respect has been the introduction of the new European Union (EU) General Data Protection Regulation (GDPR). The GDPR acknowledges that information related to individuals (i.e. personal data), as well as data flow, and thus databases, are of high political, clinical, and economic value. Hence, the Regulation aims to protect personal data and, consequentially, privacy. Nevertheless, the GDPR is a legal document with legal language. The purpose of this paper is to serve as a – practical guidance as well as a theoretical framework – for clinicians (and non-clinicians) who integrates digital tools in their clinical and research work.

It is hard to say at what point someone with dementia has changed so dramatically that the self that existed before the dementia manifested itself cannot be said to exist (anymore). This issue raises important existential questions and may call into question the validity of a living will, in particular that of an advance euthanasia directive. The idea that the request expressed in such a directive should always be respected, regardless of conflicting expressions by the severely demented individual, may conflict with the interests of that individual. Balancing the various interests is the difficult task undertaken in this paper.

When the issue of donor assisted conception arises, two bioethical and legal issues have to be answered. Firstly, when can a donor be considered as a legal parent of a child who claims to have been born through his genetic material? Secondly, should anonymous sperm donation be allowed? In this article, these questions are answered according to Greek Law. Also, the author provides integrated solutions to legal problems.

On 17 March 2022, the Italian Council of Ministers, by means of Press Release No. 67, sanctioned the extension of the vaccine obligation against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for health workers until 31 December 2022. Healthcare workers who do not demonstrate that they have adequate vaccination coverage will be suspended from work and will not be paid. Recently, the Council of Administrative Justice of Sicily has identified possible contrasts between the vaccine obligation of health professionals and numerous constitutional principles, paving the way for an interesting bioethical-legal debate on the subject. The aim of this article is to examine the possible profiles of unconstitutionality of the measure of the Italian Government and to identify medico-legal and bioethical issues potentially related to the vaccine obligation for health professionals in a context of resolution of the emergency phase related to the coronavirus disease 2019 (COVID-19) pandemic.