Professional Documents
Culture Documents
June 21
Legal medicine (AKA forensic medicine) branch of medicine that deals with
application of knowledge to legal problems and proceedings
- Used in the pursuit of justice in court proceedings and in the protection of the
public from environmental hazards
Pathology branch of medicine that deals with diagnosis of disease and causes
of death by means of laboratory exams of body fluids, cell samples and tissues
from the body.
- if alive = biopsy
- if dead = autopsy; systematic external and internal examination of the
dead
- a subspecialty is forensic pathology: a forensic pathologist examines
persons who died suddenly, unexpectedly, violently or a medically
unattended death, an expert in determining the cause and manner of
death, involved in crime investigation, case coordinator for the medical,
forensic and scientific assessment of a given death (may be the lead
investigator), expert in interpreting the scene of death, assessing the
consistency of witnesses and interpretation of pattern injuries
- SEC. 95 Code of Sanitation: Any medical officer (MHO, RHO, District Health
Officer), medical offices from law enforcement agencies, CHR and
members of the medical staff of accredited hospitals.
- Medico-legal cases: deaths or injuries involving persons who have no
means of being identified, those who are pronounced dead on arrival on
ERs, deaths under the following circumstances [death occurred within 24
hours of admission, clinical cause of death is unknown, unexpected sudden
death especially when the person was of apparent good health, d/t natural
disease but associated with physical evidence of foul play, death as a
result of violence, suicide or poisoning, death d/t negligence of a 3 rd
person, including cases of child abuse, physical and sexual abuse, rape,
drug addiction and iatrogenic causes of injury, disease or death (one
caused by the medical professional such as the doctor/nurse), etc]
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Notes on Legal Medicine
Doctor as a witness:
Child Protection has set qualifications of a doctor who can provide care for the
sexually abused child and these are doctors who can also give expert testimony in
court.
Know the value of the medical literature presented. When it comes to research
the best level of evidence is a blind test that is random.
Protect your witness. Do not allow your witness to be harassed by the other side.
If its a child witness know the rules in examination of a child witness.
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Notes on Legal Medicine
June 28
DEATH
You heart pumps blood throughout the body to circulate oxygenated blood.
These are the two most important systems: your cardiac and circulatory system
and respiratory system that will keep you alive, and the main center for control is
the brain.
Definition of death:
The cessation of life in a previously living organism. It is a process, not a
single event.
The ascertainment of death is a chemical problem. Its the doctor who will
determine when a person has died.
Stages of Death:
1. Clinical or somatic death
2. Brain death
3. Biological death
4. Cellular death
You may end up as a person whos wide awake, continuously breathing, heart
still beating. Or you may end up as a person whos awake, heart beating, but
youre not breathing on your own. Or you may end up as a person whos just
out. You are unconscious and cannot communicate with your environment.
Youre breathing, either on your own with your heart beating on your own, or
your respiration is being assisted, with your heart beating on its own.
Brain death:
If the brain does not receive oxygenated blood within 3-7 minutes, your heart
stops beating. Neurons die if theres no oxygen brought to the brain within 7
minutes.
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3. The last to go is the brain stem. It is in the brain stem where the
cardiac and respiratory centers lie. Its the stem brain thats what will
keep you alive.
Biological death:
Here finally, even the brain stem dies. All components of the brain die, closely
followed by cellular death.
Cellular death:
Think of cells as mini tiny factories. So in cellular death, these factories shut
down one by one. And eventually, they would just break up and decay.
Cellular death itself also does not happen all at once. Cells die slowly. Because
evidence now is showing that, lets say, your skin and bones may remain what
you call metabolically active (still alive for many hours). Thats why after
death, if you need to transplant or use bones or skin, they may be harvested
and cultured up to 12 hours after the heart has ceased beating. Neurons of
course die after 3-7 minutes. The heart and kidney can still be used if theyre
harvested within 8 hours of cessation, after the person is pronounced death.
So its very important, especially when were talking about transplantation.
The person must be pronounced dead by the attending physician.
So death actually takes a long time. It doesnt mean that just because the
person stops breathing and his heart is not beating, hes dead. Its a transfer from
one state of viability to another and may be slow or rapid depending on certain
factors, like your age. The very young and the very old, they die faster. Very
young, because theyre very immature, the very old because of the wear and tear.
They dont have defenses anymore so they can die really fast. If youre very thin,
if youre malnourished, if you have all these diabetes and heart problems, your
death will be faster. Or environmental factors (good thing it doesnt snow here). If
youre sickly and its cold outside, youre not wearing anything, or youre
malnourished, youre going to die fast.
So its the physician who pronounces death when what you call the point of
irreversibility has been breached. And when is that? When does a doctor say that
the point of irreversibility has been breached?
Traditionally, when the doctor doesnt feel a pulse or doesnt hear the heart
beating and the person is no longer breathing, we say the person may have died.
1. Other ways of finding out whether that person is really dead is by putting a
mirror on the face, at the mouth and nose, of the person. If theres no
condensation on that mirror, it means the person is not breathing.
2. What we can do is also look into the eyes, through the pupils. We can see
what we call the fundus where you can see the blood vessels. If the blood
vessels are not pulsating, that means the heart is no longer beating. We
can use EEG (electroencephalogram) test. But in the province, you dont
have EEG. The doctor usually uses what you call the ophthalmoscope to
look into the eye and check if theres still pulsation. Sometimes, they dont
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have a mirror, so doctors bring compacts, like the ladies. So its just a
pulse or listening to the heartbeat.
3. You can also try to monitor response by giving painful stimulation to the
patient. One is pressure on the glabella (N.B. the space between the
eyebrows, unless you have a unibrow!), pressure on the sternum, or pinch
the finger. So if the person is alive, hes going to drive you away because
these are very painful areas. Especially if the person is lying down and
youre standing up, and you put so much pressure, that can be very
painful.
4. The other ones and very importantly, will be the absence of brain stem
reflexes. Meaning the response to pain stimuli in these areas come from
the brain stem. If these are absent, that means the brain stem is dead.
Corneal reflex what we do is get a wisp of cotton and touch the cornea.
You know how painful that is. So a person will blink. If youre dead, you
wont feel anything anyway. So a live person will be in pain.
Shine light into the pupils if youre dead, your pupils are expected to
be dilated. If you shine a light, the pupils should normally constrict. A dead
person will not have that reflex anymore.
Oculovestibular response we inject ice cold water into the ear. And we
normally expect the eyes to move the opposite side. So if the eyes will not
move, then theres no reflex.
Gag reflex when you put a tube, catheter, or tongue depressor and try
to stimulate the back of the throat. Youre going to gag if youre alive.
There are criteria for death. As I said earlier, because of new developments in
medicine, a person may not be declared dead immediately. Of course, the first
thing that came up was your cardiac pulmonary resuscitation (CPR). But we have
other advancements. We have fibrillators. First, when a person suffers from a
heart attack, it has been proven that the heart fibrillates. The person faints
because the heart fibrillates. How does a heart look like when its fibrillating?
Imagine a bag of live worms. You look at the outside. Its just going like that.
Instead of pumping blood out, your heart is just going like that when you suffer
from heart attack. If you put your stethoscope on the chest, youre not going to
hear it so youre going to say hes dead. But applying defibrillators can still revive
the heart. Thats why its very importantif any of you witness a person who may
be undergoing a heart attackto just have to call the emergency medical
services. Here we have ERUF. They have defibrillators just to get your heart to
start pumping immediately.
Theres what you call for a person who needs a heart transplant. They have
what you call assisted devices (not a pacemaker). Its practically there pumping
because the heart muscle itself is not pumping, or inadequately pumping. You
have you ventilators. These are machines that help you breathe.
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Notes on Legal Medicine
If you discontinue ventilation, is it homicide? Because its very hard to keep this
person alive for a long time. It can be physically, emotionally, financially draining.
The care there is every hour, every minute. You turn that person to sides and hes
not even responding to you.
I dont know if you remember this person. This one person was essentially
declared dead. Shes breathing on her own, her heart is beating, she was just
being fed. But the husband, probably tired of taking care of her, went to court and
asked the court to declare her dead, so they just stopped her feeding, and she
died of starvation. To me, she does not fall under the Harvard criteria or the
Uniform Determination of Death.
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So the attending physician may call another consultant; he and the attending
physician can be the ones to declare a person dead.
Sources of organs:
o Fetus contains cells which we call stem cells. They contain cells that
have the potential to become any kind of tissue, provided that tissue is
placed in the right environment. So if you put a tissue in the area of the
heart, that tissue will develop into heart cells. Anencephaly infants are
babies born with only the brain stem intact. They dont have a skull cap,
they dont have the higher brains, but just the tiny brain stem. Thats why
theyre alive, they have all those reflexes, theyre breathing except for that
abnormal head. But when they die, their hearts can be used for
transplanting to babies with congenital heart diseases.
o Artificial animal transplants The problem here is, its not matching. I dont
know how compatible you can be with a pig or a cow. And the problem
there also is, that animal may have some kind of disease which the human
never gets. Whats going to happen is, its passed on to the human being
who received the disease from the pigs heart. So how are you going to
cure that illness?
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But bear in mind the Anti-Trafficking in Persons Act 2003, Sec. 4., wherein
youre not allowed to sell your organs. Now, cadaver donation is actually
the major source of all tissues for transplantation. So your drivers license
may indicate that you want to donate an organ or everything. Most of
organs for transplantation come from dead people but they must be
harvested soon after the patient is declared dead.
o Cloning if you have problems, theyll just give you your clone.
July 5
When everybody dies changes can happen. How do we estimate the time of
death?
When the heart stops and the breathing stops eventually theres a falling blood
pressure, theres no more oxygen and the cell method will stop working and
because of that your nerve cells will die and theres going to be no more
neurological activity.
When blood pressure falls down and theres no more circulation, you would
become pale. There would be pallor personae, there will be eye changes, reflex is
gone, the pupils will not dilate and will not constrict if its shown light, the blood
vessels in the fundus that you see that are actually retina. You wont see any
pulsation and if you touch the eye, its very soft. Muscles will become flaccid. As
soon as there is a loss of the muscle tone it becomes flaccid and this is termed
the primary flaccidity and this may retain any activity and may respond to other
forms of stimuli thats why you might see some twitching of the toes or some
muscle twitching thats reacting to the stimuli. Its not actually dictated by higher
senses. There will also be loss of muscle tone so your anal sphincter will just come
out. Your urinary sphincter, your urine will just come out. Or some semen might
just be emitted but that doesnt mean that he had just had sex before he died.
There will be revegitate of the gastric contents because there is a sphincter in the
esophagus and in the stomach. That will also be relaxed so when the person falls
on his back or even head down stomach opening relaxes, gastric sphincter will
flow backwards this can be confused as if the person died because of asphyxiation
(gastric contents going into the airway). The only way we can say that a person
died because of asphyxiation from aspirating food is from eyewitnesses account.
If food debris can be found down to the smallest part of the lung and then we can
say he asphyrated and that is the cause of his death.
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Difference between a normal metabolic pathway and the anoxic (no oxygen
pathway). A normal metabolic pathway happens within your body, within your
system. An important reproduction of energy in your body, your ATP using oxygen.
So if there is no more oxygen its just glucose that is being used to produce ATP
but then without oxygen it will not go through this process of oxidity >>>> lactic
acid pathway and will produce a lot of lactic acid in the body. With the lack of
oxygen, very little ATP or energy, more of lactic acid what happens is>>>Your
muscles are made up of fibers of cells-acti enmycin fibers. They bind together and
they form a gel and that makes the muscles stiff. Its that lactic acid that will
cause your muscles to gel up thus become stiff. And this can develop fast
especially if theres no blood in the >>>> levels. Especially during exercise or
when the acidic levels are high or when somebody is stressed or during
electrocution when the muscle will be repetitively stimulated, the muscles will
keep flexing and flexing, the oxygen levels can be low, glycogen or glucose levels
can be low, it will become acidic so rigor mortis can be very fast. It may not be
detected in people who have low muscle bulk. Theres not much muscle. So
whats there to harden? It is usually detectable first around the eyes and around
the jaws and fingers and it will develop from the head down, from the smaller
muscle down to the larger muscle groups. In determining the presence or absence
of rigor mortis, it is only estimating the time of death. Rigor mortis is a variable
process because it can be affected by a lot of environmental factors. It is
unreliable to find out the time when the person died. If the person is exposed to a
cold temperature he will develop rigor mortis longer as compared to a person who
is in a warmer temperature which will be of shorter duration. In temperate
conditions its first detected in the face between 1 to 4 hours after death, in the
limbs between 4 to 6 hours after death, the strength of rigor will increase in the
legs 6 to 12 hours. After that, when cellular metabolism or decomposition of the
cells begin, the muscles now will lose its cohesiveness, its gel-like property now
will get lost. In this stage of rigor mortis, the body ends enters the stage of
secondary flaccidity which occurs between 24 to 50 hours after death. Two types
of rigor mortis: primary flaccidity within 24 hours, it becomes stiff; after that the
stiffness is gone and thats called secondary flaccidity.
One can test for rigors. If a joint is flexed at death, apply some pressure. If it jerks
back, that means theres rigidity. If the body feels warm and is flaccid, it may have
been dead for less than 3 hours. If it is warm but stiff, it may have been dead for 3
to 8 hours. When the body is cold and stiff, it may have been dead for 36 hours. If
it is cold and flaccid up to secondary flaccidity, therefore, more than 36 hours.
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skin colors, jaundice or yellowish coloring of the skin. It mostly forms on the back,
buttocks sides, and back of the neck because usually when a person dies hes
lying flat on his back but there are some areas of that persons back that could be
so pressed on a certain part, like on the bed. A person died on his back so the
buttocks probably pressed on the bed will have >>>> called blanching. Meaning,
the blood vessels have been squeezed, so blood vessels could settle in this area.
The part of the butt not in contact with the bed may be found to have a post
mortem hypostasis. You can tell the persons position when he died. When hes
hanging, hypostasis will be on the lower extremities not in the torso. Gravity. If
the body fall head first, the hypostasis will be in the upper part of the body as
compared to the lower part of the body. There may be some changes in the color
after death. If the color changes in a cherry pink color, most likely that person
died of carbon monoxide poisoning; dark red, by poisoning; bronze, infection
caused by an organism called >>>>. If the body was moved and hypostasis is
already happening, there could be layering of that hypostasis.
Algor Mortis. The body will take on the temperature of the environment. It is
useful indicator of the time of death during the first 24 hours post mortem. The
use of body temperature as estimation applies only to cool and temperate
climates not much in tropical areas because the cooling of our body will not be as
much because our environment is warm. Its best measured using core
temperature like rectal temperature taken at examination or on discovery. Using
oral temperature is not advisable.
Examining gastric contents at the time of death will only tell you what he ate the
last time. It is difficult to use this estimation of the time of death. Before, it was
believed that our stomach empty into the intestines within one hour. Thats no
longer correct. It also depends on the kind of food that you eat. Fatty foods remain
longer in the stomach compared to non-fatty food. Another method is looking at
the presence of insects in the body. There are some insects that like to feed on
the human body. Depending on what stage of the insect. You have to get a
forensic entomologist. In other countries, depending on the season, they look at
the animal bites. In the winter season, its just the bears that are there in the
forest. If its summer, its just the squirrels that are there.
Mummification. The body cavities dry up and it usually happens in hot or warm
environment and also in cold dry areas.
Adiposerum. Theres a chemical change in the body fat; the features are retained
apparently no decomposition happens.
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formation if the body is under water. When the body is buried it will decay more
slowly but if the surrounding is wet, very acidic, the body will decompose faster.
Eventually your skin will fall off. Within two years, no more skin tissues, it will then
be all skeletal and what will remain will be your tendons, your ligaments, hair and
nails. Within five years, nothing is left on the bones and all the joints now will be
disarticulated. You can use the bone marrow to get the mytocondreal DNA. Its
one way of identifying a person. But the mytocondreal DNA is only that of the
mother.
Arterial embalming. They inject an embalming fluid into an artery. They inject
one gallon or so of a mixture of formaldehyde and other chemicals with water.
Chemicals are also injected thru syringe into the other parts of the body.
Cavity embalming. The trucar is inserted intto the navel and an instrument is
inserted to puncture organs that contain air. Gases and fluids are withdrawn. Fluid
is put inside the cavity. The anus and vagina are tucked with gauze to prevent
seepage of fluid. Incisions and holes are made in the body, tinatahi, and then the
body is washed again. This is the whole embalming process.
July 12
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was the illness, did he die of a certain disease or injuries, or of poisoning. Its just
within the hospital setting.
2. Medico legal investigation - maybe theres some foul play in the cause of death.
It may be that there is a police investigation going on regarding the death of that
person.
When that natural death occurs, the doctor will sign the death certificate, once
the death certificate is signed then the body can be disposed of the, the death
certificate will include the cause and manner of death. If the death is natural and
no doctor can complete the certificate then that death must be investigated and
the death be classified. Death that cannot be examined by the doctor is examined
by a variety of legal officers-the medico legal officers or the medical examiners.
Herein the country based on the Code of Sanitation, cases where autopsies were
performed are those that are required by special laws upon the orders of a
competent court, a mayor or provincial or city fiscal upon the written request of
police authorities whether the solicitor general or the city or provincial fiscals are
authorized by existing laws shall be when necessary to dis>>> and to take
possession of the remains for examination to determine the cause of death,
whenever the nearest of kins shall request in writing the authorities concerned to
a certain cause of death. In order to be autopsied you have to get the consent of
the relatives and more often than not they will not consent. If there is foul play
you have to run through this people like the city fiscal or the police just to ask for
a request for autopsy. And the police authorities wont even ask for the autopsy
for the medico legal investigation of the death of the person. These are the
problems in our country its very hard to go beyond. It might be that a member of
the family killed that person. If somebody is in the hospital and somebody in the
room killed that patient, the doctor will wonder how he can die suddenly. Sudden
infant deaths. These are the cases that need medico legal investigation.
DOAs, people who died and had not been identified, unexpected sudden death
especially when the deceased was in an apparent good health, death with natural
disease but associated with physical evidence suspicious of foul play, death as a
result of violence, accident, suicide, poisoning, death due to the negligent or
improper act of another person, deaths of persons whose bodies are too burned.
These are deaths that also need medico legal investigation based on the Center
for Disease Control in 1998. It includes death which had occurred in custody,
these are the types of death that ate not listed in our law that are classified as
medico legal cases. A year ago, there were 19 deaths in the BBRC and theres no
autopsy that was done. Deaths of persons whose bodies need to be cremated or
buried at sea because once you cremate the body you have no more body to
exhume. Thats related to disease relating to the employment to or accident on
the job, deaths that are related to the disease that might constitute as threat to
public health. These are the deaths that are not included in our list.
In the US, they have a death investigation team. An author says that death
investigation is composed of a coroner, a medical examiner and a forensic
autopsy technician (theres no such thing daw, its the embalmer). They have to
involve themselves with the people who investigate the scene they also do their
own investigation on the backgrounds, conduct examination in the laboratory,
they also deal with evidence that consult with concerned parties like the all types
of forensic people as well as the police investigators and they must testify in
court. In our country, we have a medical examiner, but most often than not it is
really the embalmer who does the autopsy. Our medico legal officer will just look
at what the embalmer is doing. Doctor Fortun was doing an autopsy on a child
and she found something unusual when she feels the rib of the child, theres may
be a fracture. She tells the medico legal officer who had autopsied that girl and
said feel this out. This is abnormal. The medico legal officer said, he called the
embalmer and say, will you please feel that rib if its abnormal or not. The
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laboratory examinations will have to be done in Manila, the PNP Crime Lab and
the NBI Crime Lab. (I dont know and I dont think they obtain evidence, I dont
think they even consult with concerned parties but they will testify in court. And I
dont know what kind of information they get if theyre only looking at the body.
And Im speaking from experience.)
Aims of a death investigation: the medico legal officer must find out who died,
when that person died, why that person died, and where that person died, and
how that person died. The doctor will have to go to the scene together with the
police officers. Or a trained pathologist is the best person to investigate this
death; he has to get physical and testimonial evidence, photographs and videos
and trace evidence, social history, interview the family and the relatives. Get the
medical history of that person, medical records from the hospital or medical
records from the physician.
The aim is identify the body, estimate the time of death, identify and document
the nature and number of injuries.
Specific objectives: interpret significance and the effects of the injuries, identify
the presence of any natural disease, interpret and identify the significance of the
natural disease present, identify the presence of poisons, interpret the effect of
any medical or surgical treatment. It is not just looking. It is also analyzing what is
seen and has also to see whats not there.
Autopsy will consist of an external examination. Examine the whole body on the
outside. Collect and trace evidence especially under the nails, on the mouth, etc.
After conducting an external examination taking all the necessary pictures and
documentation of the injuries including sizes and location of all those injuries an
internal examination is done where the body is cut up, each internal organ is
removed, weighed and dissected, injuries are looked for, signs of a natural
disease are looked for. Anything thats abnormal there are looked for. Part of the
autopsy is a laboratory examination wherein tissues, fluids, any weapon fragment
bullets or whatever are collected and examined. Autopsy includes gross
observations and microscopic examination of all the tissues. That medico legal
autopsy must determine the cause of death.
Cause of death: It is the disease process or injury responsible for initiating the
train of events whether their brief or prolonged using the fatal end results. Its
that which starts the event.
Manner of death: The fashion or mode in which the cause of death came into
being. It may be natural, accident, suicide, homicide, it can be unclassified
whether if it is due to alcohol or drug. It could be undetermined. In the homicide
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classification of death, this is used to classify the kind of death. It is not used to
imply criminal intents. Criminal intent is left to the police investigators, into the
legal process not in the doctors. It is only used here that the person died because
of a volitional act of somebody. Undetermined cause or manner of death it could
be like there are so many manners of death that could have happened and its
very hard to determine which one weighed more in killing that person. Example: if
youre a person who loves to drink a lot of alcohol, eat a lot especially pork,
smoke so youre prone to have high blood cholesterol level so you will develop a
coronary artery disease. Coronary artery disease can cause two problems in your
heart: electrical disturbance and heart failure. Because of the block in your
coronary artery theres not enough blood supplying the heart, so it could be that
the nerves of your heart or the lethical wires of the heart are not well supplied by
blood. So its not going to pump regularly and rhythmically. Fibrillation or a
fibrillating heart, like a bag of worms, so that heart is not pumping blood at all. Its
not pumping blood out. Every time your heart pumps out of its chamber it will
also supply blood to the heart muscles. A heart failure is caused by poor
oxygenation because of poor blood flow to the heart muscles. If a part of your
heart muscle is weak, its not gonna pump blood. Your hearts gonna have an
ineffective pump so youre gonna have a heart attack. When you die, the manner
of death is classified as natural. When you are stabbed, youll lose a lot of blood,
thats the mechanism. Hanging, suicide, strangulation, the mechanism there is
asphyxia, a lack of oxygen in the system.
The medico legal report must show these three information. Unfortunately, our
system of death, according to Doctor Fortun, is not scientific based and is haggled
by the policy of no aggressive complainant, no case and the practice of relying
mostly on witnesses. If theres no complaint, theres no case.
Here is a case of a girl who died in a Monday morning. She was apparently well 4
days prior to her death. The following day she did not feel well, she complained of
vague abdominal pain. She stayed in bed and ate what was fed to her. Two days
before she died, she refused to eat and continued to complain of abdominal pain.
Her mother noted that her abdomen was becoming distended. She still refused to
eat the next day. And because of that the mothers live in boyfriend beat her with
an electric wire. The child still didnt eat and died the following day. The mothers
live in boyfriend was arrested and was charged with for violating RA 7610, the
Anti-Child Abuse Law. The autopsy report concluded that the child died of
pneumonia. As to the manner of death, there was no report. Based on the request
of the mother this child was exhumed. This is the case where Doctor Fortun felt an
abnormality in the childs rib. The child had bruises. The police were saying that
she died of beating. Doctor Fortun found out that her intestines had telescope
unto itself (the smaller part will enter into the bigger part) there will be intestinal
obstruction. The cause of death is intussusception. The mechanism of death is the
biological and physiological changes in the body; youre not eating, youre
starving, youll have lactic acidosis and your heart is going to stop beating if its in
an acidic medium. The manner of death is homicide because the mothers live in
boyfriend refused to bring the child to the hospital even when the mother pleaded
to bring the child to the hospital. But maybe its unintentional because he
probably just did not know.
July 26
Medical reasons for establishing the identity of a living person and a dead body:
a person is comatose
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infant
for paternity and filiations for proper support, inheritance and parental
authority
You need the help of experts or forensic people like forensic pathologist,
orthodontologist, anthropologist when the dead bodies are severely injured or
severely mutilated, decomposed or skeletized.
METHODS OF IDENTIFICATION:
Picture: get the frontal and the side view shot (more often than not, your
left profile is different from the right profile)
To determine the age: white thing around the eye, teeth only up to age
25 and a range is given, x-ray (oxification centers, bone growth)
Tattoos.
Other marks: Striae, pimples, cleft lip, tribal marks, body piercing.
Write down and describe all the persons individual markings and
personal characteristics
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Fingerprints
Three Types
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Palm prints and sole prints it is believed that people do not have the
same
Ear-shape
Bite mark
Bones: sex, age only up to age 25, height, race, personal identiy:
dependent on ante-mortem data
Tissue and cell samples: blood type, protein complexes, blood enzyme
systems, etc
DNA profiling: used in exclusion and identification thru body fluids, hair
strands; DNA analysis can yield a positive identity
Principles
If the DNA pattern left at the scene of the crime does not match the
suspects DNA pattern, the suspect was never in that scene. If it matches
the suspects DNA pattern, it puts the suspect in the vicinity of the scene
of the crime but does not necessarily mean that he is guilty of the crime.
Ten percent of the molecule is used for genetic coding and the rest are
silent. These silent zones repeat themselves, meaning, there is only 10
percent of the billions of molecules in the body and only a few percent is
specific to you alone but the distribution is unique for each one of us, the
sequencing is different.
The DNA is found in the nucleus and it is a double helix. It is very stable
but the specimen that contains the DNA that is to be analyzed can easily
be contaminated by the collector.
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DNA fingerprinting is the last resort in identifying people. Its used for
healthcare, pharmaceutical research, evolution and forensic.
Types of samples needed for DNA analysis: it must have nucleus (white
blood cells, hair root, spermatozoa). Get a buckle smear from the side of
your mouth, vaginal swabs and anal swabs to determine presence of
semen or Y chromosome within 72 hours placed in a ref right away, blood.
Semen on clothing can stay for a year.
Half of our chromosomes come from our father and the other half from our
mother.
JULY 31 (SATURDAY)
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Independent DNA profiles of the victim (sexually assaulted kid) and the reference
samples are compared. The results are either inconclusive or theres an exclusion
or an inclusion.
1. Inconclusive - DNA testing did not produce info that would include or
exclude the suspect. May result from improper collection, handling or
storage and can occur when quantity of intact DNA is insufficient or sample
contains complex mixture from several individuals (do not contaminate!)
2. Exclusion - if the DNA profile from the sample does not match the profile
of the suspects DNA reference sample. Suspect excluded as a source of
the DNA but does not equate to innocence and does not automatically
absolve suspect of the crime because he may have committed the crime
but did not leave any DNA samples. May indicate involvement of another
person.
3. Inclusion DNA sample from the suspects DNA reference sample
matches the DNA profile of the sample taken from the victim or scene of
the crime. Suspect is included as a potential source of the DNA but does
not automatically determine the suspects guilt. You have to present other
evidences to prove if hes guilty or not.
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How caused?
Important when describing the wound how it looks like, what kind? Demand from
doctor, you have to know whether blunt or sharp force, what are the dimensions,
positions, etc.
Abrasion
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Lacerations
- result of blunt force overstretching the skin and there will be a split of the
full thickness of the skin
- deep and will bleed
- important to look for bridging fibers (remain intact in lacerations and will
not be cut)
- skin can be compressed within the applied force and the underlying bone
- rare in soft fleshy areas of the body
- margins are always ragged
- if caused by thin sharp object, the wound is sharply defined and may be
mistaken for incision but under the microscope there could be abrasions
and contusions on the edges and bridging fibers in the laceration
1. Incised wounds
- also caused by objects with sharp and cutting edge and distinguished from
a stabbed wound by being longer than deep
- Edges will give indication of the sharpness of the object used. Very sharp
objects will not leave bruising on the edges, no bridging fibers.
- rarely life threatening unless it cuts deep into a tissue like your jugular
artery
2. Stab wounds
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Mechanism of Injury
1. accident
2. self-infliction
Bite marks in a child is pathognomonic and the child was definitely abused. To
identify the teeth marks you need a dentist and you need to get an impression of
the suspects teeth and compare. It can also be a source for DNA collection.
DEFENSE WOUNDS
Found in victims who are trying to defend themselves from an attack so it will
depend on the kind of weapon used
Survival:
If theres a lot of bleeding the body has a mechanism to prevent shock called
Compensated shock. But if he will not get any medical attention and body cant
maintain it, body will go to uncompensated shock and will lead to death.
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Aug 2
Violence against women. RA 9262. When do violence against women and their
children occur?
Violence according to the WHO: the intentional use of physical force or power,
threatened or actual against ones self or another person (here were talking
about another person) that results in or has a highlight resulting in injury, death,
psychological harm, mal-development or deprivation. The intentionality is always
associated with the committing of the act itself irrespective of the outcome of the
violence. If somebody hurts another person or threatens to hurt another person
that in itself, the intentionality is there already. There must be a relationship
wherein one person perceives himself or herself as more powerful than the other
person. So this would include threats, intimidation, neglect acts of omission or all
types of physical, sexual and psychological abuse. Such an abuse could also
happen within a marriage. It does not necessarily lead to injury, disability or death
but it will pose substantial burden on individuals, families, communities,
healthcare systems worldwide and this consequences can either be immediate,
latent or can lasts for years after the initial abuse. The consequences such as
psychological harm do not expect it to happen immediately all the time.
Two types of violence: the severe and escalating form of violence and the
moderate form of violence. Traditionally, mans beating is a consequence the
mans right to inflict physical punishment on his wife. There are many cultures
that believe that a wife is a mans property.
What are the events that trigger partner violence? Woman refuses to have sex.
Not preparing the food. Woman asks where the money goes. A lot of men have no
work. It is essentially about power and control. But women still stay in the
relationship.
Cycle of violence. First, tension building. Second, honeymoon stage. Back again to
the tension building.
Excuses of the batterers: I only pushed her; I did not hit her; Its her fault;
Shes hysterical; she bruises easily
Women in a violent relationship try to protect their children. They try to adopt in
such a way that the children will be protected from harm. Witnessing domestic
abuse by children is an abuse in itself.
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Myths about domestic violence: it is not a common occurrence; women are just as
violent as men; men are brought up to be the aggressive person; women are
brought up to be the submissive group; alcohol abuse causes domestic violence
(alcohol inhibits your actions so you are braver to hit the other person); domestic
violence is usually a one-time domestic occurrence; men who batter are often
good fathers.
40 to 70 percent of men who hit their wives abuse their own children either
physically, sexually or psychologically. When there is violence in the family all
members are participating in the dynamics, therefore, all must change to stop the
violence. Battered women are machuchisyic and provoke the abuse they must like
it or they would leave. HITTING IS NOT DISCIPLINING.
When a person is under chronic stress, there will be abnormal secretion of cortisol
and because of that the brain becomes hyper-alert for danger and the woman
now will be focused more on surviving to the point that she will forget about trying
to maintain her healthy cognitive and social skills. Thinking properly becomes
disrupted. Socially, she will not know to relate with her children and she may be
even become abusive to her children, she will not know how to relate to her
neighbors because all that shes trying to do is survive. Because of so much fear
other parts of the brain will wear out. She may either create permanent memories
of what has been happening to her and she may foresee that everything will just
keep happening. There could also be extreme anxiety. Depression. Difficulty
forming attachment to other people. In a way, she isolates herself. She can have
sleep problems. She can be a very impulsive person. They will appear helpless.
Exposure to a remand of earlier trauma to perceive threats or to generalize
reminders will make either respond anxiously, shes gonna start to become panic,
aggressive may even provoke threatening behaviors from others.
There could be a post traumatic stress disorder. Any intrusive recollections of the
traumatic events will create hyper-arousal or hyper-vigilance. Theres avoidance
behavior, emotional longing, disrupted interpersonal relationship, body image
distortion and sexual intimacy issues. When the cycle of violence becomes worse
it may come to a point where she could kill the man when he is asleep or is drunk
because that is the time that she is stronger, or she herself will end up dying.
The medical evidences should include the interview of the woman as to what had
happened. A social workers interview and investigation is also needed. What the
doctor can add to that interview will the physical examination and documentation
of the injuries, the laboratory examination, and psychological or psychiatric
evaluation will also be good if the woman intends to file a case and other
evidence that should include crime scene investigation, accounts from witnesses,
and a social workers investigation also.
Physical abuse. WHO: Child abuse or maltreatment that consists of all forms of
physical, and/or emotional maltreatment, sexual abuse, neglect or negligent
treatment of commercial or other exploitation resulting in the actual or potential
harm to the childs health, survival, development or dignity in the context of the
relationship of responsibility, trust and power. For medical evaluation we have to
include the comprehensive medical history or child-sensitive forensic interview,
physical and laboratory examination. We treat that patient and we do crisis
interventions and referrals. The purpose of our evaluation is to evaluate the
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medical problems, gather evidences, and give the child a therapy by making sure
that the child is safe and protected. In the US, it is the interviewer who tells the
court what the child told her. The child-sensitive interview is done using the
appropriate language depending on the childs age, non-leading questions are
asked initially and when the child starts to disclose everything down to the
specifics thats when we ask specific questions but make sure not to ask yes or no
questions and make sure that the story comes from the childs mouth. Take into
consideration the language development of the child. Children do not keep time.
Children jump from one event to another.
One. The injury is not only inflicted but its non-accidental. (The three mechanisms
of injury: accidental, self-inflicted and action of a third party.) The pattern of
injuries fit a biomechanical model of trauma that is considered. A lot of injuries
have been scientifically studied and there have been conclusions are made
wherein they said that it can only be caused by an abusive act of another person.
The pattern of injuries may correspond to infliction with an instrument in a
manner that would not occur through play or natural environmental interactions.
Shaken baby syndrome. When the baby is shaken he will have subdural
hematoma, thats bleeding within the brain, retinal hemorrhages, without any
evidence of external injuries. The babys head is bigger than that of the body. The
neck muscles are weak. The baby can present sudden seizures, stop breathing,
vomiting, and poor feeding.
Another injury that can happen is rib fractures. Chest compression in CPR does
not cause this kind of fractures. Another problem that can happen is cervical cord
injury wherein the baby stops to breathe. When you shake the babys head, it will
cut the nerve connections in the brainstem (it is where your respiratory and
circulatory centers are, it is what you call the cervical cord), it is known as diffused
axional injury, no time for bleeding to happen. Retinal hemorrhage is a bleeding at
the back of the eye. From a lot of short falls (short falls-falls less than 4 feet),
majority of children do not have serious head injuries because the extremities hit
the ground first. Medical evidences will be the medical history, family and social
history, investigation of the childs environment, physical and laboratory
examination.
When did it happen? Where did the injury occur? Who witnessed at the time of
possible injury? What did the caregiver do after the injury? In formulating our
impression we have to ask these questions. Does the history reasonably explain
the injury? Was there any explanation given as to how the child incurred the
injuries? Is the statement given consistent with the development capabilities of
the child? Is there any delay in seeking medical care? Is the history vague?
Medico legal principles: we can only offer an opinion of the presence of an abuse
because we want to put the child in a safe place after. We cannot give you an
opinion about the guilt of an alleged perpetrator nor can we give you an opinion
of his intents.
August 9
INJURIES FROM FIREARMS
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Projectile any object that is sent through space by the application of force. For
firearms, the projectile is called a bullet or a pellet or a shot which is made of
metal (usually lead). Some projectiles will fragment inside the target while others
do not.
Handgun or pistol the smallest of all firearms, fired from the hand, it has a
riffled barrel. You can have a revolver wherein after the bullet is fired a brass case
which contains the explosive remains in the cylinder unlike an automatic when it
is fired the empty cartridge case falls on the ground.
Riffle - its a long barrel, with a high muzzle velocity, a riffled barrel, and built for
accuracy and long range (1.6 km) and you have to aim to hit your target
Shotgun firearm with a smooth bored barrel designed to fire multiple pellets
that will come out from the barrel and to be fired from the shoulder. It is designed
to quickly hit a moving target. You dont need to aim, just point and shoot
Important to know these things to identify whether the bullet wound is from close
contact or distant contact. If close contact you will not only see the bullet wound
but also some of the gasses, gunpowder residue on the victims body as
compared to distant contact, bullet entry is the only thing evident.
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Microtears- tiny lacerations on the edge of the wound from high velocity center
fire rifle bullet
Graying lubricant or debris of the bullet wiped off the wound edge, smudging or
blackening deposition of soot from partially burned gasses.
Branding or burning from the hot gasses of the muzzle at close range
Muzzle contusion caused by the skin impact against muzzle (close range) (e.g.
muzzle imprint)
Contact range wounds muzzle to target distance: in contact with the body or
only a few centimeters away from the body. Edges of GSW seared by the gasses,
blackened by soot and propellant, and there is concentric blackened zone. Metal
fragments may be found within the wound. Gun placed over bony areas, GSW can
come out in a stellate (x-shape) or lacerated appearance.
Muzzle to target distance is greater than 10 feet all you will see is the GSW entry.
Exit wounds (in rifle wounds) will have inverted flaps because the bullet will go
out. Bigger than an entrance wound. You may not see any stippling or soot.
SHOTGUN WOUNDS
- large contact entrance hole with significant damage to the margins + gun
residue deposits
Close range (less than 5 ft from muzzle to target) can produce single large
defect which will approximate the weapon bore.
Intermediate range (5 to 10 ft) central defect produced by the shot and the
wadding with surrounding wounds because of the tiny pellets. Once ammunition
leaves muzzle, pellets will start to separate. Not only central defect can be seen
but also tiny defects coming from individual pellets.
Long range whole thing breaks out. You still see tiny concentric defects from
individual pellets.
Exit wounds rarely seen if fired in the chest and abdomen. Can be seen if fired
in the head, mouth of huge rugged appearance.
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Bullets are compared and matched to specific firearms. As well as, accurately
determine the distance of the shooting. Bullets will have rifling of the FA that was
used. Rifled FA will leave a mark on bullets. Each FA has a unique rifling pattern. If
no marks on the bullet then gun used has smooth barrel without any rifling.
Sept 6
Two parts:
1. Low explosives exert a throwing effect in a factory or people nearby of any
object
2. High explosives they can explode between 1 thousand to 8, 500 meters per
second causing more shattering and devastating effects in a farther distance
Mechanisms:
Blast caused by tremendous dynamic over pressures generated by
recoillation of a high explosives. Half of the total energy generated will
cause the bomb casing to swell 1.5 times its normal size before it will erupt
into small fragments and that energy will send the fragments flying out in
all directions. The remaining energy is expended in the compression of air
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surrounding the bomb producing the blast effect. Destroys the skin or
muscle even to the point of amputation.
Secondary effects: burns, missile injuries, pepper, all types of injuries from
collapse of a building and destruction of a vehicle
Exchange principle: When any two objects come into contact there is always
transference of material from each object onto the other.
Paraffin test. A test that determines the presence of nitrates and nitrites that
may have come from a gun powder or primer inside the bullet casing that ignites
when a gun is fired.
It has to be warm to open the pores of the skin (because the gun powder is
embedded into the skin) so that the nitrate compounds will go out and will be left
in the paraffin wax.
Presence of nitrite or nitrate in the wax glove (with the use of an acid) produces
specks of violet-blue colors.
ASPHYXIA. Absence of pulse. It describes a range of conditions for which the lack
of oxygen is considered the cause.
Classical Features:
It is not diagnostic. Not definite signs of asphyxia like: facial congestion, facial
edema, facial cyanosis, petechial hemorrhages in the skin and in the eye, star
dose spots
Conditions/causes
1. Suffocation
Lack of oxygen in the inspired air
Example: Putting plastic bags on the head of prisoners
There is quick death and minimal signs of asphyxia except for pallor in the
face
Not struggling to breath; there is low external pressure
2. Smothering
The victim struggles
May experience cyanosis and congestion
Bruises and abrasions on the face, on the lips, or inside the mouth
Non-struggling victims: may not see any of the signs; difficult to diagnose
3. Choking or gagging
Internal obstruction of the upper airway passages by an object or
substance impacted in the pharynx or larynx
Mucus membranes swell or congest if you breathe thru your nose
There will be respiratory distress, can become cyanosis and congested face
and neck up
4. Strangulation or hanging
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Sept 13
3 GROUPS OF VICTIMS
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TRANSPORT INJURIES:
Primary injuries
20-60 km/hr victim may fall on the hood and head may strike windshield
60-100 km/hr victim may fly up in the air and he can fall on the car or
beyond the car.
Secondary injuries
from the contact of other objects or the ground after contact with the
vehicle
Often more serious and potentially lethal than primary injuries (e.g. head
and spinal injuries)
Car occupant
Motorcyle injuries
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Different things
Bodies recovered from water could have died from natural causes before entering
the water. Determine WON victim died of natural causes before entering the water
or while in the water having entered it either voluntarily or accidentally. Did he die
of unnatural causes before entering the water? Did he die from exposure or
hypothermia while in the water? Died of injuries after entering water? Did he die
of submersion or drowning?
Submersion just actually being in the water. A person who drowns can have
signs of being submerged but a person who was submerged in water does not
necessarily mean he drowned. If you died before you were placed in the water you
are submerged.
S/Sx of Submersion:
1. washerwomans fingers/hand
2. macerations and skin will peel off after weeks of immersion
3. decomposition
4. Eventually your body will float. The only time body wont float is when
youre submerged in very cold water.
DROWNING
- you die of suffocation because of water within your lungs and you have to
be immersed in water
- Effect depends whether you drowned in fresh or sea water. Fresh water is
absorbed into our circulatory system resulting to volume overload and
hemodilution, eventually leading to cardiac arrest.
- Sea water more concentrated than blood, so fluid in our blood will go out
into our lungs and theres pulmonary edema or congestion resulting to
hypoxia, respiratory arrest, cardiac failure and cardiac arrest
- Post mortem findings variable and cause of death hard to prove
- 5 stages
a. You struggle, you may find bruises in your chest and shoulders
b. You get tired and you sink
c. You dont want to breathe in water so you stop breathing. Because
we hold our breath carbon dioxide goes up so respiratory centers in
our body say breathe so we breathe in water
d. Cough vomit, loss of consciousness. Convulsions. Involuntary
respiratory movements and we keep inhaling water.
e. Respiratory arrest and cardiac arrest.
- You could drown within 10 minutes
- In 10-20% of the victims laryngospasm can happen and since larynx
remains closed water cannot enter lungs = dry drowning
- The rest theres relaxation of the airway and water enters the lungs
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- There can be blood tinged froth in the mouth and nostrils which is more
common in seawater drowning.
- Sand, silt, seaweed may be found in the lungs sign of life before
immersion
- BUT Finding of foreign material in stomach weighs heavier than finding
them in the lungs because theres a sphincter of some sort in the stomach
which does not relax when youre dead unlike airways which can relax so
water may flow freely.
ALCOHOL
Its a drug and addictive. Makes one prone to accidents and an underlying cause
of misdemeanor, assault and homicide.
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Males cannot say that they could not have raped a girl because they were drunk
because erection can happen in the excitement stage. On the other hand, they
take advantage of girls when the girls get into the incoordination and confusion
stage (Drug facilitated sexual abuse)
1. Romberg test
2. eye movements - place a pen in front of his eyes and theres nystagmus
and place the object on the side of the eyes and theres jerky movements
3. walk and turn test walk in a straight line heel to toe 9 steps then do a
quick turn
4. One leg stand
5. finger to nose test
6. let him pick a small object from the floor without falling off
7. may also be asked to do some tasks like recite the alphabet in a rapid
fashion
BAC Normal below 0.5% (? Maybe Maam meant 0.05), .1-.15 % - impaired
faculties, not fit to drive vehicles, if = 0.15% and non-habitual drinkers intoxicated
to the point of staggering, 0.2% habitual drinkers at the second stage and 0.5%
stage of Coma.
1. weight- the heavier you are, the more water content and since alcohol is
soluble in water, alcohol is easily absorbed in the water content of our
body so a person with more water content does not easily get drunk as a
person with less water content or weight
2. Fatty foods delay alcohol absorption. Alcohol is absorbed in the small
intestine but you can delay absorption if alcohol stays in stomach.
Sept. 20
Child development:
- Continuous process that starts from birth to maturity, and goes to define
stages and phases. Before you can go to the next phase, the child must
master first the previous stage.
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- Now the skills and the complexities as he grows older centers all in the
physical, mental, social, and emotional function of that person. It affects
cognitive development, emotional development, and social development.
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- In court, lawyers should argue objections out of the childs hearing. The child
will think its his fault: My lawyer is shouting at me because I probably did
something wrong.
II. Preschool:
- May signal the start of mental and behavioral problems. The child grows
older, learns new skills, learns to be industrial, etc. If the child doesnt learn
new things, she will learn not to take any initiative at all and not develop self-
esteem.
- Morally, they will do things to please the other people other than the parents.
Now they have a conscience and are aware of social norms.
- A 4-year-old victim will say, Hindi ako magsasabi kahit kanino kasi yan ang
sabi nila. Or Hindi naman ito bad kasi ginawa ni tatay. Hindi naman masakit,
nakakakiliti nga.
- A 9-year-old victim will say, Bastos tong ginagawa ko. Kung magsumbong
ako, kawawa naman si tatay, baka makulong din siya. A 4-year-old is more
inward-looking as compared with a 9-year-old.
III. Adolescence
- The offset of adolescence for girls is at 10-14, boys 13-14. Theyre now
learning how to think abstractly, but their thinking is still egocentric. They
cannot handle hypothetical situations yet.
- They now follow rules and the values of society, but they may not understand
the concept of values and rules. But here, theyre finally learning who they
are.
- Initially, it was thought that the brain develops only in the first 4 years of life,
when all the neural connections are being made. It was found that during the
adolescent stage, a lot of the neuron pathways that were hardly used got
pruned away and new pathways are being created. Another thing that they
learned was that the development of the brain is from the least complex to
the most complex, which is up in front.
- The frontal lobe, where you have what is called the neo-cortex, develops, the
area that regulates our emotions, abstract thinking, and helps us do our
executive functioning. In teenagers, this is the area thats most developed.
The frontal cortex reaches full maturity around 20 years old. Its the area for
planning, reasoning, impulse control, regulation of emotions, learning from
experiences, and weighing risks and rewards. This is the last part of the brain
that develops. Some studies have shown that this is completed at the age of
25 for males, earlier in females.
- The child has preference for physical activity.
- The person has difficulty holding back or controlling emotions. Theres still no
adequate control from the pre-frontal cortex to the amygdala. (Mood swings!
Try to remember your teenage years.)
- Studies show that, although the intellectual activity develops at 16 to 17,
psycho-socially, hes still not mature until hes 25.
- The adolescent brain is a reward-seeking brain, this is where theyre
susceptible to pear-pressure. At the age of 14, they tend to commit crimes.
- So the adolescent is actually still egocentric. They believe that they alone
have difficulties, no one else can understand or sympathize. They believe that
nothing can harm them.
Morality:
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- Ability to differentiate between right and wrong and understand how to make
choices. This is discernment. Again, the childs physical, intellectual,
emotional, and mental skills, as well as his environment will influence the
development of his morality. So you have to look into his background.
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