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The doctor and the law

with the iaw. An obvious exampre is when patient dies' The doctor writes a a death certificate to confirm that the patient is indeed dead, and to state of which disease he died' The death certificate is a legai documlnt.It is a criminal offence to write a death certificate without seeing the dead body. If the body is to be cremated, the doctor must also sign a certificate which says that the patient died of natural causes. @uming the body will destroy the evidence of a suspicious death.) If the doctor suspects that the patient was poisoned by his relatives, for example, he must not sign the cremation cerlificate. A coroner is a doctor who is also a lawyer' He investigates any death where the cause is not obvious' For example, if a student is found dead in bed by his friends one morning, the coroner must perform a post mortem examination to finci or-u why the young ai"o. He might have -un taken an overdose of drugs, either accidentaily or in order to commir suicide. However, the post morfem examination might show that he died from a brain hemorrhage. If a young baby dies after fatling out of his cot' the coroner must perform a post mo.em examination to confirm that the injuries are "consistent with the story". If the baby *u, murd"red, the coroner might find evidence ofprevious vioience, such as heared fractures or oid bruises. Doclors and social workers are discovering more and more cases of violence towards children ("non-accidental injury"). The parents often love their children but they may be mentally disturbed themselves' The husband beats his wife, and the wife then becomes viorent towards the children' The parents may bring the child to the doctor for a different problem (such as minor infection)' when rhe doctor e:ramines the chiid. he sees bruisss or burns on the chiid,s skin. The doctor has a legai and a morai dufv to heip the chiid, but he must first confirm his suspicions. Not :'il bruises are caused by delibeiate vioience. Tire parenis are innocenr until proved guilty. The iioctor must not accuse them of injuring the child. often, the best action is to send the child into a hospitai fot a "generai check-up", where a sneciaiist can examine him and perform X-rays. if the doctor suspects non-accidental injury, he must give medical evidence to the courts. The doctor is then cailed an expert witness. sometimes, it appears that parents are injuring their cnild when they are not' If the chiid has hemophiiia (a disease where he bruises and bieeds easily), brittle bones (which are more likeiy to break), or a skin diseaseo which looks like severe burns, the child's school teacher may suspect non-accidental injury. The child's doctor, as an expert witness in court' could explain the medical reasons for the apparent "injuries.,, occasionally, social workers have taken children away &om their parenrs unnecessarily because they did not know about an unusual medical condition' of course, this had led to dramatic stories in the newspapers. However, these medical conditions are very rare, and non-accidentai injury is common. If the doctor confirms the diagnosis of non-accidental injury, the courts may decide that the parents are not fit to iook after ihe chiid' The legal methods for protecting chiidren fi'om non-accidentai injury are different in ciifferent countries. In Britain, the child often goes to rive with foster parents. Doctors sometimes appear in court as expefi witnesses in compensation claims. one person claims that another person has caused him injury, and seeks compensation for his pain and suffering' This often occurs after road acciclents. For exampie, the doctor might confirm that the patient was healthy until the accident and then developed n."k pain and depression. Another role of the doctor after road accidents is to measure the amount of alcohol in the driver,s urine or blood. This test is simple and does not usuaily need an expert witness in court. But occasio nally, aperson may be involved in a road accident and then drink a large amount of alcohol. if the doctor takes four

A11 doctors occasionally become involved

offive blood tests over several hours, he usually can calculate whether the accused person drank the alcohol before or after the time of the accident. Employees sometimes make compensation claims against their employers. An employer has a legal duty to provide a safe working environment. Work-related injuries range from back strain caused by lifting ioads which are too heavy to severe lung disease from working in coal mines. Compensation claims by empioyees can invoive large amounts of money, especially if an employee is permanently disabled and the court confirms that the employer was to blame. Some empioyees might be tempted to exaggerate their disability. The doctor must be aware of his temptation. In
some cases, he can measure the disability objectively. For exampie, he can assess lung damage very accurately with a spirometer. In other cases, such as back pain, it is impossible to measure how much pain and disabilifv the patient really has. The doctor must use his clinical iudgmenr.

In the past, another leeai duty of the doctor was the resting of u woman's'virginity before marriage. Vlrginiqv testing is stiil common in some countries" particuiarly where lslam is the
dominant religion. However, changing views about sexuai standards ancl women's rights have made ihe test obsoiele in most countries. Doctors are now seldom asked whether a woman has had sexual intercourse. But they are often asked to find out whom she has had intercourse with. This may happen, for exampie, when a woman ciaims that a man has raped her, or when she says that a particular man is the father of her chiid. in most modem countries, fuihers have a legai dufy to pay money for their chiidren's upkeep. If a man doubts that he is the father. he mieht ask a doctor to help him to prove this. Absoiute proof of paternity is not yet possible, but scientists can now estimate the probabili{v that a man is (or is not) the father of a chiid. They use a genetic rechnique cailed DNA fingerprinting. The doctor takes blooci samples from the child, the mother, and the man who might be the lbther. He fnst anaiyzes the mother's chromosomes using restrietion enz'/rnes .,','hich split ihe chromosomes lntc smail fragments. These fragments form a specific pattern when they are piaceci in an eiectric field. He then analyzes the chlid's chromosomes in the same wav. The chiid has inherited rwo copies of each chromosome- one from his mother and one lrom his father. The chromosomes inherited from the mother wiil spiit into fragments with the same partem as the mother's chromosomes. The remaining chromosomes must have been inherited from the father. If the accused man's chromosomes have a completeiy different pattern from these remaining chromosomes, he is not the child's father. DNA fingerprinting is becoming an imponant tool in forensic medicine. Like all powerfui toois, it must be used carefully. For example, DNA fingerprinting of a man accused of rape and of the semen obtained from the "victim" might prove that he had sex with the woman, but it does not prove that he raped her. The doctors and 1aw.r,'ers must use conventional medical and legal methocis to find whether the woman consented to sex. DNA fingerprinring is very accurate on fresh :pecimens, but it becomes inaccurate if the specimens are more than fwenfy-four hours oid or if they are contaminated. The identification of a criminal from a fragment of dirry skin found at the scene of a crime whicir was committed two weeks ago is not yet possibie. Most doctors do not iike appearing in court. A court hearing often takes several days or weeks, and the doctor cannot attend to his other patients during this time. It may involve an unpieasant confrontation between two people, which the doctor does not wish to see. The doctor's iegal dufv to provide evidence is sometimes in conflict with his professionai dufv to care for rhe patient. But whether doctors like it or not, today's society is increasingly "litigation-conscious", and doctors will undoubtedly spend even more of their tirne in the role of expert witness in the future.