Lectures 1-3 Flashcards
Legal Medicine vs Medical Jurisprudence
Legal Medicine is a branch of Medicine, which deals with the application of medical knowledge to the purposes of law and in the administration of justice.
Medical Jurisprudence denotes the knowledge of law in relation to the practice of medicine. It concerns with the study of the rights, duties and obligations of a medical practitioner with particular reference to those arising from a doctor-patient relationshi
Must medico-legal practitioners be lawyers?
No. A common misconception among the public is that medico legal practitioners of necessity must also be lawyers. This is not true because for as long as they are handling cases involving legal duties connected with any aspect of health care, they are doing medicolegal work and therefore, fall under this category
Who is a medical jurist
A physician who specializes or is involved primarily with medico-legal duties is known as a Medical Jurist
Where may medicolegal practitioners practice?
Medicolegal practitioners can either be in the service of the government or in private practice. In government , they are connected with law enforcement agencies such as the police departments or with legitimate investigative bodies such as those with the PNP Crime Laboratory or with the Medicolegal division of the National Bureau of Investigation.
They may also be physicians employed by the government either as Municipal or Provincial Health Officers as they are mandated by law to perform autopsies on medicolegal cases. As private practitioners, they are consultants in private hospitals to whom are referred medicolegal patients. They become part of the Hospital Team that monitors the patient’s condition while confined at the Hospital. When the patient’s case goes to court, the medicolegal practitioner is called to testify on the fact of the injury, the treatment the patient received in the Hospital, his expert opinion as to the cause of the patienty’
Who are authorized to perform autopsies?
- Health Officers
- Medical Officers of Law enforcement agencies
- Members of the Medical Staff of Accredited hospitals
May doctors be compelled to testify against other doctors?
Yes. Code of Medical Ethics of the Medical Profession of the Philippines. Sec. 2. Art. III states:
“However, it is the duty of every physician, when called upon by the judicial authorities, to assist in the administration of justice on matters which are medico-legal in character”.
Ordinary Physicians vs Medical Jurists
OP - Sees an injury or illness on the point of view of treatment sees injury or illness from the
MJ - Point of view of treatment from the point of view of CAUSE
OP - . Purpose is examining patient is to arrive at a definite Diagnosis-Rx Rx
MJ - Purpose is to examine patient is to include those bodily lesions in his report and testify before the court before an investigation body result: justice where justice is due-given.
OP - Minor or trivial ignored -they do not require Rx
MJ - Medical jurists must record all bodily injuries even if they because these injuries may be the cause?
What are these so-called MEDICOLEGAL CASES?
- Injuries or deaths involving persons who have no means of being identified;
- Persons pronounced as “dead on arrival” (DOA).To be classified as being dead on arrival at the emergency room of a Hospital or a DOA is liberally construed to mean also dying within a short period of time from arrival which may be within one hour or as long as 24 hours depending on the circumstances of the case.
- They also involve deaths under the following circumstances:
a. Death occurring within 24 hours of admission when the clinival cause of death is unknown or undeterminable;
b. Unexpected sudden death especially when the deceased is in apparent good health;
c. Death due to natural disease but associated with physical evidence suspicious of foul play;
d. Death as a result of violence, accident, suicide or poisoning;
e. Death due to improper of negligent act of another person;
- They also involve victims of physical injuries caused by the following:
a. physical violence such as gunshot wound, stab wound, mauling, etc.;
b. vehicular accident;
c. asphyxia;
d. electrocution, chemical or thermal insult;
e. accident, attempted Homicide or suicide;
f. poisoning.
- Cases of child abuse, domestic violence, rape, alcoholism and drug addiction;
- Cases involving the mental competency of the patient;
- Iatrogenic causes (relating to illness caused by medical examination or treatment.) brought about by negligent acts or omissions of the hospital staff resulting in violation of rights of patients or leading to his physical and mental incapacitation, physical injury and death.
When is autopsy mandatory?
Under Philippine laws, medicolegal deaths must undergo mandatory autopsy. No consent is required for the autopsy although the next of kin is informed of this requirement and his signed consent obtained as a matter of courtesy. The death certificate cannot be completed without the autopsy.
Major capabilities of a medico-legal officer:
- conducts autopsy
- conducts examination of victims of sexual crimes
- conducts examination of victims of Physical injuries
- Conducts examination of skeletal remains
- Conducts blood and blood stain, seminal fluid/stain-examination of body fluids
- Exhumation of bodies
- Histopathological examinations.
Autopsies shall be performed in the following cases:
- Whenever required by special laws.
- Upon order of a competent court, mayor and a provincial or city fiscal.
- Upon written request by police authorities.
- Whenever the Solicitor General, provincial or city fiscal deem it necessary to dissenter and take possession of the remains for examination to determine cause of death.
- Whenever the nearest kin shall request in writing the authorities concern to ascertain the cause of death.
Evidence defined
Is the means sanctioned by the Rules of Court of ascertaining in a judicial proceeding the truth respecting a matter of fact.
If the means to prove a fact is medical in nature, then it becomes medical evidence.
Object Evidence
Objects as evidence are those addressed to the senses of the court. When an object is relevant to the fact in issue, it may be exhibited to, examined or viewed by the court.
Requisites for admissibility of object evidence:
- It must be relevant
- It must be competent
- It must be authenticated or requires testimonial sponsorship
- Authentication must be made by a competent witness
- It must be formally offered in evidence
Kinds of Object Evidence
Autoptic Evidence
1. Unique objects – those that have readily identifiable marks
2. Objects made unique – Those made readily identifiable
3. Non-unique Objects
Demonstrative Evidence
- Those which represent the actual or physical object
Limitations to presentation of autoptic evidence
- Indecency and Impropriety
- Repulsive objects and those offensive to the sensibilities
Testimonial Evidence in relation to physicians
Physician may be commanded to appear before the court to give his testimony. Physician may be presented in court as an ordinary witness or as an expert witness:
Ordinary witness vs Expert Witnesses - Physicians
-
Ordinary Witness:
A physician who testifies in court on matters he perceived from his patient in the course of physician-patient relationship is considered as an ordinary witness.Sec. 18, Rule 130- Exemption to the ordinary witness rule, privilege of communication between physician and patient- (Sec. 24 (c), Rule 130)
Hearsay information is as a rule not admissible in court (Sec. 30, rule 130)
Exemption to non-admissibility of hearsay evidence-DYING DECLARATION (Sec 37, Rule 130) -
Expert Witness:
A physician on account of his training and experience can give his opinion on a set of medical facts.
Sec. 49, Rule 130, Opinion Rule
Experimental Evidence
Experimentation in evidence, refers to the manipulation of physical objects within or without the courtroom to determine a fact in issue in the case.
a. Example: A doctor may come to court and give lethal injection of poison to a rat to demonstrate its effect on human beings
Physical Evidence and their types
These are articles or materials that are found in connection with the investigation and which aid in establishing the identity of the perpetrator or the circumstances under which the crime was committed, or in general assist in the prosecution of the criminal.
Types:
a. Corpus Delicti Evidence: Objects or substances, which may be part of the body of the crime.
b. Associative Evidence: Physical Evidence which link a suspect to a crime. e.g. broken headlights of a car wearing apparel of offender in the crime scene of rape.
c. Tracing evidence: Physical Evidence that may help the investigator to locate the suspect. e.g. drops of blood going towards the direction where the suspect fled.
Manikin Method
- Manikin Method: In a miniature model of scene or of a human body indicating marks of the various aspects of the things to be preserved. An anatomical model or statuette may be used, and injuries are indicated with their appropriate legends. Although it neither may nor indicated the full detail of the lesion, it is quite impressive to the viewer as to the nature and severity of the trauma.
When may a ploygraph be used
- If ever used, parties must stipulate the ground rules.
- Only admissible if the parties agree on the parameters and there is proiper representation by both parties for the conduct of the test.
Physiological and Psychological Sign and Symptoms of Guilt:
- Sweating-Sweating accompanied by a flushed face indicate anger, embarrassment or extreme nervousness. Sweating with a pallid face may indicate shock or fear. Sweating hands indicate tension.
- Color Change-
-Flushed face: anger, embarrassment and shame
-Pale face: sign of guilt - Dryness of the Mouth- Swallowing and licking of the lips
- Excessive Activity of the Adam’s Apple
- Fidgeting-subject is constantly moving about in the chair, pulling his ears, rubbing his face, picking and tweaking the nose, crossing and uncrossing his legs, rubbing the hair, eyes, eyebrows, beating and snapping fingernails, etc. These are indicative of nervous tension.
- “Peculiar feeling inside”- There is a tension of lightness of the head and the subject is confused. This is the result of his troubled conscience.
- Swearing to the truthfulness of his assertion- Usually a guilty subject frequently utters such expression. “I swear to god I am telling the truth” or “I hope my mother drops dead of a, lying”, ”I swear to God”…etc. Such expressions are made to make forceful and convincing his assertion of innocence.
- Spotless past records-“Religious man”-The subject may assert that it is not nor possible for him to do “anything like that” inasmuch as he is a religious man and that he has a spotless record.
- Inability to look at the investigator-subject does not look into the investigators eyes for the fear that his guilt may be seen in his eyes. He will rather look at the floor or at the ceiling.
- “Not that I remember” expression- the subject will resort to the use of “not that I remember” expression when answering to be evasive or to avoid committing something prejudicial to him.
Emotional Offenders
Persons who commit crimes in the heat of passion, anger or revenge, and also who commit offenses of accidental nature. They usually have a feeling of remorse, mental anguish or compunction as a result of their acts. They have a sense of moral guilt. The most effective interrogation: sympathetic approach
