Strengthening
Forensic Medicine
Stefan Timmermans
UCLA
Macro-view of field of forensic
medicine
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How do changes in the organizational set-up and
professionals affect death investigation?
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Main points:
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Good scientists need to be good politicians.
Continuous need to innovate.
Proactively strengthen professional basis of forensics.
Transition of professional death investigators
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Coroners of early 20th century
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Authority of committing magistrates
Elected or appointed officials
Fee-for-service or salaried
Public inquests
Problem: fraud and corruption
Reorganization: medical examiners
Contemporary set-up
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Stronger scientific basis
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But drop in public involvement
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Expert became judge
No more public viewing
Lack of legislative action
Change in organization and professionals affect
all aspects of death investigation.
Contemporary death investigation
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3 core-elements of forensic authority:
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Valuable public good
Statutory law
Science
Professionalization of death investigation:
challenges and strengths
1. Valuable public good: hope
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Explain suspicious deaths
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Death was not in vain.
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Randomness
More victims?
Knowledge
Justice
Prevention
Who benefits in reality?
Organizational ecology
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Notification
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Physicians-hospitals
Law enforcement
Funeral homes
Information
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Physician-hospitals:
medical records
Law enforcement: police
reports
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Investigation
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Law enforcement
DA
Communication
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Law enforcement
Office of vital records
Next of kin
Other agencies
Courts
Media
Benefits-vulnerabilities of cultural
need
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Law enforcement-courts
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Public health
Relatives
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Further complications
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Glamorization of forensics in media
Organ-tissue donation:
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Gift of life
Transplant games
2. Statutory laws
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Coroner-medical examiner laws:
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Property rights
Cases that fall under jurisdiction
Describes necessary procedures
Trumps interests next-of-kin, other parties
Benefits and vulnerabilities of
statutory laws
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Strong protection on a day-to-day basis
Problem:
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Complacency in professional development
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Compared to clinical medicine: little innovation, need to
lobby, address third-parties
Paradox of too much sheltering
Laws can be changed…
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Organ and tissue interests
Find cheaper labor
3. Science
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NAME description of coroner:
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Coroners are called upon to decide if a death was due to foul
play. Depending upon the jurisdiction and the law defining the
coroner's duties, the coroner may or may not be trained in the
medical sciences. The coroner may employ physicians,
pathologists, or forensic pathologists to perform autopsies when
there appears to be a question or manner of death that autopsy
can elucidate. In some jurisdictions, the coroner is a physician,
but in may localities, the coroner is not required to be a physician
nor be trained in medicine. In the absence of medical expertise,
the non-physician coroner may have difficulty in sorting out
subtle non-violent and violent causes of death.
Forensic pathologist
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The forensic pathologist is specially trained: to perform
autopsies to determine the presence or absence of disease,
injury or poisoning; to evaluate historical and lawenforcement investigative information relating to manner
of death; to collect medical evidence, such as trace
evidence and secretions, to document sexual assault; and
to reconstruct how a person received injuries. Forensic
pathologists are trained in multiple non medical sciences as
well as traditional medicine. Other areas of science that the
forensic pathologist must have a working knowledge of the
applicability of are toxicology, firearms examination
(wound ballistics), trace evidence, forensic serology and
DNA technology.
Benefits and vulnerabilities of
science
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Superior compared to coroners
Context of evidence-based medicine
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Knowledge stratification
Problem mismatch science-manners of
death:
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Suicide
Forensic homicide
Consequence
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Tremendous practice variation
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Questions expertise
Encourages competitors
Especially problematic for
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disaster that crosses geographic boundaries
serial killers
Harold Shipman
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Serial killer
Several forensic
investigations
Governmental inquiry
US medical examiner
Summary
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Great job security
Amazing scientists doing an undervalued job
Still, professional vulnerabilities:
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Too focused on law enforcement
Professional complacency
Practice variation
Risk of marginalization
Risk of external reform
Suggestions
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Reach out at diverse constituencies
Good scientists AND good politicians
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Stronger ties with public health
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Including researchers
Advocate of bereaved
Initiate legislative action: safety
Homeland security ?
Suggestions
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Accelerate professionalization:
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Forensic pathologists and elected officials?
Training programs
Certification
Quality assurance
Research and innovation
Not simply reactive but also proactive.
Suggestions
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Example of interdisciplinary infant fatality
review teams
Greater standardization of autopsy reports
Embrace information technologies
More funding