Aspectos éticos de las periciales en la valoración de la praxis médica / Ethical aspects of the experts in the evaluation of medical praxis

Los médicos que realizan actividades médico-periciales deben o debemos detenernos a reflexionar sobre nuestra propia tarea, sobre los valores que desarrollamos, sobre el servicio que aportamos a la sociedad, sobre los fines que perseguimos, las consecuencias que podemos llegar a soportar, etc., y cómo orientar nuestra práctica hacia la calidad y la excelencia. En el entorno de la medicina pericial se hace necesaria esta reflexión, para tratar de evitar que determinados criterios o cuestiones sustituyan en buena medida al compromiso responsable con nuestra actitud médica, y que podamos llegar a dejar de lado los elementos que legitiman nuestra acción, en pro de un beneficio o de una labor de intercambio de servicios que es al menos digna de ser analizada en nuestro ámbito

Physicians who carry out medical-expert activities must pause to reflect on our work, on the values we develop, on the service we provide to society, on the goals we pursue, the consequences we can endure, etc., and how to guide our practice towards quality and excellence. In the area of expert medicine, this reflection is necessary, to prevent certain criteria or questions largely replacing responsible commitment with our medical attitude, and get rid of the elements that legitimize our action, in favour of a benefit or exchange of services that is at least worthy of being analysed in our field

Medico-Legal Aspects of Pulmonary Thromboembolism.

Pulmonary ThromboEmolism (PTE) is an important disease for legal medicine. Because of their sudden lethal onset, generally medicolegal autopsies show few clinical information when PTE is the cause of death. During medicolegal autopsies, the autopsy operator must answer to important questions. For example, autopsy operator can need to assess the casual relationship between PTE and recent accident, such as trauma or long air travel. Furthermore, the autopsy operator needs to investigate the pathology of PTE as a cause of sudden cardiovascular death. It is relatively simple to confirm a fatal massive thromboembolus in the initial stage of thoracic investigations, but sometimes it might be difficult to distinguish this from postmortem clot. In such cases histopathological examination can help in the differentiation. Histological examination is also required for observation of chronological changes of the thrombi. Chronological evaluation is an important factor especially to determine whether the death coincides with the date of a specific accident/event or instead there is an earlier onset of PTE. In addition, histological sections sometimes show additional information, such as tumor fragments in cases of malignancy or small fragments of bone marrow in cases of active resuscitation, that can be useful in a medicolegal scenario. Furthermore, new diagnostic tools are arising, which they can be very helpful in the individuation of this frequently underdiagnosed disease. The goal of our work is to investigate these aspects through the review of the recent literature.

RELIGION AND DISASTER VICTIM IDENTIFICATION.

Disaster Victim Identification (DVI) is a triangle, the components of which are secular law, religious law and custom and professional methods. In cases of single non-criminal deaths, identification often rests with a hospital or a medical authority. When dealing with criminal or mass death incidents, the law, in many jurisdictions, assigns identification to the coroner/medical examiner, who typically uses professional methods and only answers the religious requirements of the deceased's next-of-kin according to his personal judgment. This article discusses religious considerations regarding scientific methods and their limitations, as well as the ethical issues involved in the government coroner/medical examiner's becoming involved in clarifying and answering the next-of-kin's religious requirements.

Expert witnesses in dentistry: a comparison between Italy and Croatia.

A dentist is frequently required to translate dental trauma into monetary value, for example after car accidents and/or work-related injuries. When called to act in this capacity a dentist should combine his/her biological and technical knowledge with a quality medico-legal knowledge. Calculation of economic (pecuniary) damages and non-economic (non-pecuniary) damages requires specific training in medico-legal matters and awareness of the inherent pitfalls. Expert Witnesses registered in Court are usually asked to perform this duty. Nevertheless, European countries have differences regarding dental damage evaluations as well as significant differences in the conditions required for registration as an Expert Witness in Court. A dental Expert Witness has precise responsibilities and is subject to civil or criminal proceedings (depending on the judicial system) if found wanting. In forensic/legal dentistry a medico-legal doctor should not work in isolation from a dentist in dental cases nor is it wise for a dentist to work in the courts without having had specific training regarding judicial disciplines relating to dental damages. In this preliminary work the authors investigate the principal differences in the judicial systems regarding the appointment of Expert Witnesses in both Italian and Croatian courts. The next step will expand this investigation through to European countries in order to marshal knowledge towards harmonization, best practice and a common ground for dental evaluation and claim compensations (in accordance with the Council of Europe Resolution 75 ­ 7 Compensation for physical injury or death).

Research participation experiences of informants of suicide and control cases: taken from a case-control psychological autopsy study of people who died by suicide.

BACKGROUND: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. AIMS: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners' court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. METHODS: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. RESULTS: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. LIMITATIONS: The acceptance rate for our original psychological autopsy study was modest. CONCLUSIONS: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

[Professional confidentiality and forensic medicine]. / Het beroepsgeheim en de forensische geneeskunde.

Medical confidentiality is a complex subject. The legal position of a physician depends on his or her role (medical advisor, attending physician, official, or medical examiner) as well as the physician's task and commission. In common with all physicians, the forensic physician has a duty to provide confidentiality. As a medical examiner, he or she has a limited professional confidentiality: there is an oath of secrecy, but not a right of refusal to testify with respect to the information obtained in carrying out the commission. When the forensic physician assumes the role of the attending physician, the professional confidentiality applies in full.