Knowledge, Attitude and Practices (KAP) of Medical Professionals on Euthanasia: A Study From a Tertiary Care Centre in India.

INTRODUCTION: Euthanasia or mercy killing has remained as a matter of extensive debate and ethical conflicts in the scientific literature. Discussions on this theme have got legal, religious, political and philosophical ramifications. AIM OF THE STUDY: The present study aimed to assess the knowledge, attitude and practices of medical professionals in a tertiary care hospital. METHODS: After taking prior approval from the institutional ethics committee a structured questionnaire was prepared and distributed among 200 consenting medical professionals in a tertiary care centre in the North-Western region of India. RESULTS: 50% of the respondents said that they were sure of the existing regulation on euthanasia in India. When gender differences were considered a significant difference (p=0.0147) was found between the two sexes regarding the alternate decision maker for deciding euthanasia. It was observed that there was a significant difference(p=0.0055) between those with the age more than 30 years and aged less than 30 years regarding the type of euthanasia that is justifiable. DISCUSSION: In the present study, the percentage of doctors favouring euthanasia is higher than compared in previous studies. The view of euthanasia is highly variable in different studies. Even though passive euthanasia has been legalised recently, there is an apprehension that it might be misused.

Accidental Blast Injuries While Making Indigenous Explosive Chemical Mixture: A Report of Two Incidents.

Apart from terrorist and military bombing, accidental blast injuries are the major source of morbidity and mortality in explosion occurrences. In civilian scenarios, it can happen when unskilled individuals handle explosive materials carelessly, often avoiding legal restrictions. We report two incidents of an accidental explosion in which three victims got injured during the mixing of explosive chemicals which are used in an improvised pipe gun to scare away the animals on the farm. In both incidents, the victims were mixing Gandhak (sulfur) and Potash to make an indigenous fire cracker-type explosive mixture. The victims suffered classical low-order explosion injuries. The chemical reaction between the chemicals, the treatment course of all three victims, and medico-legal implications are also discussed in the article.

Accidental Deaths Due to Toxic Industrial Cyanide Inhalation: An Autopsy Case Report.

Autopsies of accidental deaths in industrial scenarios have always been a challenging job for a forensic pathologist. Industries that employ chemical agents pose a unique risk, especially when safety protocols are ignored. Exposure to cyanide salts creates an additional risk since death may occur quickly. We present one such incident of the accidental deaths of three industrial workers, which could have been prevented if proper safety measures had been followed. Four workers fell unconscious while cleaning the electroplating chamber of the handicraft industry. Three were declared dead on arrival at the emergency department, while one survived. Autopsy of all three victims showed similar findings of pink-colored post-mortem staining and multiple petechial hemorrhages over the heart and lungs. After histopathological and chemical analysis, the cause of death was opined to be due to complications of cyanide poisoning. In accidental industrial deaths, the forensic pathologist should consider the possibility of death due to toxic chemicals, such as cyanide, used in the manufacturing process. The industrial personnel should be educated about the risks involved, and proper use of safety equipment should be encouraged to avoid such hazardous outcomes. Additionally, the people employed in the autopsy of the deaths related to chemical disasters should ensure their personal safety and preventive measures.

COVID-19 pandemic: a reminder to develop forensic radiology facility.

COVID-19 outbreak has resulted in a substantial morbidity and mortality, and has put the health system under tremendous stress. A need for devising and adopting newer methods and techniques is being emphasized in the healthcare facilities to combat the effects of the SARS-CoV-2. Besides patient care, focus needs to be laid on the effective and dignified management of the deceased and medico-legal services provided by the hospitals and medical institutions during the COVID-19 pandemic. Considering the likelihood of forensic experts and autopsy personnel being exposed to SARS-CoV-2 inadvertently during the autopsy, it is recommended to resort to safer and minimally invasive techniques of postmortem examination of the dead. In this regard, employing radiological techniques for postmortem examination appears to be a promising option during the COVID-19 pandemic. An inherent advantage of postmortem radiography over conventional autopsies is the minimization of the risk of transmission of infection to the health care workers. Our correspondence highlights on the possibility of using radiological facilities as an effective replacement of high-risk conventional autopsy procedures during the COVID-19 pandemic.

Metallization at the Exit Wound-An Unusual Finding in Fatal Electrocution.

Electrocution injuries represent a severe occupational hazard. Those at work usually ignore the importance of safety training and safe practices while the electric source is nearby the work area. Death due to electrocution can occur with or without any electric mark on the body. Limbs are the commoner site for electric entry and exit wounds. Various uncommon sites for electric exit wounds have also been reported in the literature. We report a rare case of fatal electrocution, where a 28-year-old male carpenter sustained electric injuries at the worksite. Multiple exit wounds were present over the back of the chest, an uncommon site for the exit wounds, and notably, both entry and exit wounds showed evidence of metallization. The present case emphasizes on the significance of death scene investigations in the reconstruction of events and need for complete autopsy supplemented with chemical and histopathological examination of the electric wounds.

Filicide-suicide: An unusual variant of dyadic death.

Dyadic suicides may be committed simultaneously or one after another by two or more people who may or may not have made a prior pact. The perpetrator is usually male and their victims female, and generally their intimate partners, with children less commonly involved. Another distinct type of homicide-suicide is the killing of children by a parent (filicide-suicide). The terms 'maternal filicide' or 'paternal filicide' are used respectively when the perpetrator is the mother or the father of the victim. We report a rare case of maternal filicide, where the mother drowned her three children and then herself in the same water tank. The case highlights the extreme stress put on a mother of girls in a patriarchal society where there is an overriding expectation and wish for sons. The resulting pressure on this mother for her 'failure' caused her to take her own and her children's lives.

Estimation of stature from sternum - Exploring the quadratic models.

Identification of the dead is significant in examination of unknown, decomposed and mutilated human remains. Establishing the biological profile is the central issue in such a scenario, and stature estimation remains one of the important criteria in this regard. The present study was undertaken to estimate stature from different parts of the sternum. A sample of 100 sterna was obtained from individuals during the medicolegal autopsies. Length of the deceased and various measurements of the sternum were measured. Student's t-test was performed to find the sex differences in stature and sternal measurements included in the study. Correlation between stature and sternal measurements were analysed using Karl Pearson's correlation, and linear and quadratic regression models were derived. All the measurements were found to be significantly larger in males than females. Stature correlated best with the combined length of sternum, among males (R = 0.894), females (R = 0.859), and for the total sample (R = 0.891). The study showed that the models derived for stature estimation from combined length of sternum are likely to give the most accurate estimates of stature in forensic case work when compared to manubrium and mesosternum. Accuracy of stature estimation further increased with quadratic models derived for the mesosternum among males and combined length of sternum among males and females when compared to linear regression models. Future studies in different geographical locations and a larger sample size are proposed to confirm the study observations.

Telemedicine and virtual consultation: The Indian perspective.

Telemedicine was considered futuristic and experimental some years ago, but it is a reality today. It is now emerging as an important tool for convenient as well as specialized healthcare, particularly for patients in remote locations with limited access to standardized healthcare services. However, there are multiple challenges to realizing its full potential. We focus on some key medicolegal and ethical issues such as doctor-patient relationship, informed consent, rights of the patient, malpractice, and principles of confidentiality relevant to the practice of telemedicine and virtual consultation. We explore the global as well as the Indian legal perspective pertaining to the application of telemedicine. The absence of specific laws for registration and practice of telemedicine and virtual consul-tation in India acts as a deterrent for medical practitioners to engage in its potential use. Hence, there is a need for specific legislation.

Unplanned Complex Suicide-A Consideration of Multiple Methods.

Detailed death investigations are mandatory to find out the exact cause and manner in non-natural deaths. In this reference, use of multiple methods in suicide poses a challenge for the investigators especially when the choice of methods to cause death is unplanned. There is an increased likelihood that doubts of homicide are raised in cases of unplanned complex suicides. A case of complex suicide is reported where the victim resorted to multiple methods to end his life, and what appeared to be an unplanned variant based on the death scene investigations. A meticulous crime scene examination, interviews of the victim's relatives and other witnesses, and a thorough autopsy are warranted to conclude on the cause and manner of death in all such cases.