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OVERVIEW

OF
FORENSIC
MEDICINE
Dato Dr. Bhupinder Singh
Consultant Forensic Pathologist
Hospital Pulau Pinang
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Forensic & Legal Medicine &
Medical Ethics Course.
The course consists of lectures and interactive
discussion in the areas of medical law, clinical
forensic medicine, thanatology and forensic
pathology, prescribing law and toxicology.
Instruction also includes an introduction to
basic concepts in professionalism and medical
ethics with a detailed review of the Code of
Professional Conduct of the Malaysian Medical
Council and of other Codes and Guidelines.
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Thanatology is the scientific study of
death. It investigates the mechanisms
and forensic aspects of death, such
as bodily changes that accompany
death and the post mortem period. In
brief it is the changes after death.

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Relevance to medical practice. Recent changes in Legal Medicine. Course structure. Recommended Texts. Penang Medical College 2015-2016 Forensic/Legal Medicine (including Forensic Pathology). Cross reference to other courses.      Forensic & Legal Medicine. 4 .

Suicide. 5 .Homicide.  3. changes after death. 1. Death. Recognition of violent deaths . incisions. stabbing. Infanticide. lacerations. The doctor’s role at the scene of death. the doctor’s forensic report.  2. establishing the diagnosis. Accident. Forensic autopsies. Wounds: contusions. Brain Death and Somatic Death.  THANATOLOGY AND FORENSIC PATHOLOGY. abrasions.

Physical Injuries: Heat. throttling.  5. Major Disasters. hanging. strangulation. Drowning. Neglect. Road Traffic Accidents. Electrical. Asphyxia. Injuries due to firearms and explosives.  6. Forensic and Medico-Legal Death Investigation and Certification 6 . Cold. 4.  7.

3. 7 .acute and chronic intoxication. Testamentary Capacity. Alcohol . 2. (DAC). Insanity as a defence in Criminal Prosecution. Forensic and Medico-Legal Aspects including Driving Under the Influence of Intoxicants. (DAC). Mental Health Act 2001. Wills.    CLINICAL FORENSIC MEDICINE. Forensic Psychiatry: Mental Health Act 2001. Forensic Psychiatry. Fitness to plead. (SS). 1.

(BS). 5. Victims of Violence. (BS). 8 . 7. Forensic Evidence. Rape and other sexual related crimes. 8. Forensic Paediatrics. Blood groups and DNA Profiling. Sexual Related crimes (Clinical Application). Examination of the victim of sexual assault.     4. Forensic Laboratories. Sudden Infant Death. 6. Child abuse. (DAC). (DAC). (BS ).

The Federal Constitution of Malaysia. (DAC & DG) 2. Registration and the Medical Act l971 (Act 50) and Regulations. MEDICAL LAW.   9 . Malaysian Medical Council (structure and role). (DAC . The legal framework of the doctor-patient relationship. Civil and Criminal divisions of law. the Legal Profession.  1. The Malaysian Legal System and the Courts. Fitness to Practice and Ethics.

Confidentiality. Informed Consent. Medical records. Patients with Mental Disorder. Supervision. Clinical Research. (DAC) 10 . Delegation . Consent of Children. Protection of Medical Data. (DAC)  5. Adequacy. Tortious liability. 3. Medical Negligence. Current trends. The Concept of Consent. Privileged communication. Tort. (DAC)  4.

Discovery of Documents. The Appeal System . 6. The Hearing. Current Trends and Problems. Medico-Legal Litigation (Pre-Action): The Litigation Process and System. Medico-Legal Litigation (The Action): Commencement of Litigation. 11 . Fundaments and Rules of Evidence. Extent and Nature of Liability. (DG)  7. The Role of the Professional and Expert Witness.

( SA). Analgesics. Hypnotics. General Principles of Diagnosis and Treatment of Drug Overdose. 2. Anti-inflammatories.  1. (DAC). Dangerous Drugs Legislation. PRESCRIBING LAW AND TOXICOLOGY.   12 . 3. Prescribing. Malaysian National Poison Centre. Controlled Drugs. Drug Addiction (SA). Poisoning. Cannabis.

 4. (SA). Tranquillisers. Household poisons. Cannabis. Corrosives. Metals (including lead). Poisoning in Children.  5. Narcotics (SA). Irritants. Insecticides. Antidepressants. Barbiturates. 13 .

 3. Professionalism and Medical Ethics 1. Other professional responsibilities. Abuse of privileges and skills. Neglect or disregard of professional responsibilities. Professionalism in Medical Practice. Infamous Conduct. Basic concepts and Ethical Codes. 14 . Malaysian Medical Council Code of Professional Conduct. Standards of medical care. Disciplinary Inquiries.  2.

Conduct derogatory to the reputation of the profession. Good Medical Practice (2000).  5. Advertising. Malaysian Medical Council. 15 . 4. Malaysian Medical Council Codes and Guidelines. Infamous Conduct. Guidebook for House Officers. canvassing and related professional offences.

The advance directive. Health care resource allocation.  16 . 6. Principles in Medical Ethics. Medical care decisions and human life. Euthanasia. Organ donation. Health carer-patient relationship. Confidentiality. Specific medico-ethical issues. Assisted reproduction. Specific medico-ethical issues (conclude). 8. Definition of death.  7.

Overview of Forensic Medicine  Forensic medicine includes medical jurisprudence. the legal aspects of medical practice and many other ethical issues pertaining to medical practice. 17 .

Overview of Forensic Medicine CAUSES OF     DEATH Natural Accidental Suicide Homicide 18 .

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Overview of Forensic Medicine CONSENT: Consent in the practice of medicine concerns the following three situations:    Examination of the living patient for the purpose of diagnosis and subsequent treatment. Examination of the living person for medico-legal purposes. Post-mortem examination and removal of tissues for transplantation 25 .

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Overview of Forensic Medicine Types of consent :    Implied consent Expressed consent – (1) oral (2) written Informed consent Chaperon 27 .

Overview of Forensic Medicine Consent for Post-mortem examination:  Medico-legal Post-mortem referred from police do not need to get consent next of kin are called in to identify the body only  Clinical Post-mortem need consent 28 .

 live donation – tissue taken from a living donor  cadaveric donation .grafting of animal tissue into humans ( in research stage ) 29 .major source of tissue for transplantation  xenographs .Overview of Forensic Medicine  Transplantation of organs and tissues come from several sources :  homologous transplantation – tissue is moved between sites on the same body.

Overview of Forensic Medicine      Blood transfusion is the oldest practical form of tissue transplantation Bone marrow transplant Corneal grafting Kidney Heart 30 .

Overview of Forensic Medicine      Lung Liver Bone Skin Hair 31 .

Overview of Forensic Medicine Sudden Natural Death  Causes- CENTRAL NERVOUS SYSTEM 1) 2) 3) SAH Cerebral Haemorrhage Epilepsy 32 .

2. SYSTEM Coronary artery disease Hypertensive heart disease Aortic stenosis Cardiomyopathies 33 . 3.Overview of Forensic Medicine  CARDIOVASCULAR 1. 4.

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Overview of Forensic Medicine  RESPIRATORY SYSTEM ( LUNGS )  •  • Pulmonary embolism Haemoptysis Asthma Viral Pneumonia 37 .

Overview of Forensic Medicine  GREAT VESSELS Atheromatous aneurysm 2) Dissecting aneurysm 3) Syphilitic aneurysm 1) 38 .

Overview of Forensic Medicine  ABDOMEN (1) (2) (3) (4) Perforated viscus Mesenteric embolism Gastrointestinal Haemorrhage Ruptured ectopic pregnancy 39 .

Overview of Forensic Medicine  INJURY and DEATH FROM PHYSICAL AGENTS     Electrocution Burns Hyperthermia Hypothermia 40 .

Overview of Forensic Medicine  WOUNDS • • • • Abrasions Bruises (contusions) Lacerations Incised wounds 41 .

Overview of Forensic Medicine  HEAD INJURIES Extradural Haemorrhage  Subdural Haemorrhage  Subarachnoid Haemorrhage  42 .

Overview of Forensic Medicine  FIREARM INJURIES   Smooth bore weapons Rifled weapons 43 .

Overview of Forensic Medicine  ROAD TRAFFIC ACCIDENTS  Injuries to the: (1) driver. passengers. (2) Motor cyclist (3) Pedestrian  Seat belt injuries 44 .

sea water Suffocation Manual Strangulation Ligature Strangulation Pressure on the neck 45 .fresh water .Overview of Forensic Medicine       Hanging Drowning .

Overview of Forensic Medicine  SEXUAL ASSAULT   Rape is defined as non-consensual penetration of the vagina. or body parts other than the penis. or anus by the penis. Assault by penetration is non-consensual. intentional insertion of objects such as bottles. 46 . mouth. into the vagina or anus.

Overview of Forensic Medicine  Rape  Indecent assault Indecent exposure Incest Homosexual offences( Sodomy) BESTIALITY     47 .

Overview of Forensic Medicine  INFANT DEATHS Sudden Infant Death Syndrome ( SIDS )  Child Abuse  Infanticide  48 .

Overview of Forensic Medicine  POISONING    SUICIDE ACCIDENTAL HOMICIDE 49 .

Asphyxia .Strangulation 50 .

Brain – Hemorrhages & edema 51 .

Brain – haemorrhages & oedema 52 .

Fat embolism in the lung 53 .

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Drowning: Middle ear haemorrhage haemorrhage of petrous bone in middle ear 55 .

Bullet entry Wound 56 .

Contact wound Cruciate shaped laceration 57 .

Abrasion ring – contact wound impression of weapon seen on the wound 58 .

Powder tattooing unburnt carbon particles which cannot be washed cos embedded in skin. just like tattooing 59 .

Powder tattooing : close range 60 .

Slit like exit wound 61 .

Entry and exit wounds 62 .

gunshot wound from a shot gun . shot gun has small pellets while rifle has single pellet .

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abrasions .

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Burns 68 .

Incised wound.defense wound 69 .

Defense wound 70 .

Incise wound 71 .

72 .Stab wound – hilt mark.

Stab wounds .

(Yellowish green) 74 .Contusion: 1 week.

Blunt Trauma Liver rupture 75 .

Abrasion must know colour to determine how old the wound is 76 .

Laceration 77 .

Atherosclerosis 78 .

Atherosclerosis 79 .

Atherosclerosis 80 .

Aneurysm 81 .

Coronary Thrombosis 82 .

Myocardial Infarction 83 .

I. Coronary Thrombosis Petechial haemorrhages 84 .Coronary Thrombosis M.

Coronary Occlusion occluded vessels due to atheroma 85 .

Haemorrhage in a plaque 86 .

Pulmonary Embolism 87 .

Pulmonary Embolism

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Pulmonary Embolism

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Embolism

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Diabetes Glomerulonephorosis 91 .

Ecchymosis common in elderly ppl / young cos they have fragile tissues can be mistaken as abuse 92 .

Multiple Stab Wounds 93 .

Fat Embolism 94 .

Kidney 95 .Fat Embolism .

Lung 96 .Fat Embolism .

Drowning .Vegetable Matter 97 .

Amniotic Fluid Embolism maternal deaths 98 .

Carbon Monoxide Poisoning nright red discolouration of periphery 99 .

Semi Automatic 100 .

Revolver 101 .

Bullets 102 .

Semi Auto Rifle 103 .

Semi Automatic Pistol normally has a magazine to store bullets 104 .

Slugs with markings 105 .

Contact wound .blood on hands instant rigor .not possible to put gun in the hand of victim after death 106 .

Contact wound 107 .

Retinal Haemorrhages 108 .

Skull 109 .Gunshot .

Haemopericardium one of the causes is due to ruptured myocardial infarct 110 .

Bruising 111 .