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PubMed1977

Psychiatry and the dangerous sexual offender.

A study of Dangerous Sexual Offenders, undertaken for the Canadian Law Reform Commission, reveals that about one-third of DSOs seriously threatened or actually endangered the life of the victim. One-third were moderately assaultive. The remainder, mostly homosexual pedophiles, were offensive but not physically violent. The role of psychiatrists, employed by the Crown in the process of securing an indeterminate sentence, is described. Most of them did not declare their role as "double-agents". Their expert testimony before the Courts also revealed a failure to discriminate between fact and opinion. Individual prejudice was, not infrequently, presented as the wisdom of the psychiatric profession. The life of DSOs in Canadian penitentiaries, is likely to be exceedingly brutal. Four of them have been murdured while in custody. Others have killed themselves or made determined attempts to do so. Since it is obviously unethical for psychiatrists to participate in any procedure which is likely to result in harm or the death of an individual, the author urges the Canadian Psychiatric Association to support the Law Reform Commissions' condemnation of the DSO legislation. As an interim measure psychiatrists should be urged not to collaborate in DSO cases.

Adolescent↗
PubMed1995

[Requests for compensation for immaterial damage: child and adolescent psychiatric legal assessment in conjunction with the revised legislation].

Child and adolescent psychiatry is concerned with many forensic questions. Among these, expert testimony about immaterial injury (pain, suffering) in conjunction with claims for compensation is being requested with increasing frequency. Until recently German law took the position that in cases of severe brain damage compensation (smart money) had to be granted only as a symbolic payment because the loss of cognition and lack of suffering excluded a feeling of satisfaction resulting from compensation. The highest court in Germany has now revised its position by introducing a new category of immaterial injury. This additional category refers to cases of severe brain damage where the "loss of personal quality" in itself creates the basis for a claim for compensation. As a result, related medical examinations and evaluations require as careful a description as possible and the use of scales to assess quality of life.

Adolescent↗
PubMed1995

The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. American College of Physicians.

The prevention of torture and the treatment of survivors are issues that concern an increasing number of physicians in their daily work. Every day, thousands of men, women, and children are subjected to violence and are forced to flee their homelands. There are more than 18 million refugees in the world and hundreds of thousands of persons seeking asylum, many of them in the United States. Physicians are often the first to interview these victims of abuse. Torture has serious and long-lasting health consequences. Thus, physicians can play a key role in documenting and preventing many forms of abuse and in treating survivors. In some areas, physicians may become the targets of arrest because of their work as clinicians or as influential members of their communities. They may also face disturbing ethical dilemmas as they witness torture or its results. As members of the medical profession, physicians have an obligation to their peers around the world. This report reviews the current state of physicians' involvement in the prevention of international torture and in the treatment of its victims. We propose ways in which physicians can become involved by caring for survivors of torture and by providing expert testimony on behalf of victims who seek asylum. We discuss how the medical profession complements the efforts of individual physicians by providing an infrastructure to support and guide their work. Medical organizations can adopt and disseminate ethical principles that specifically address human rights and their violation. They can coordinate letter-writing networks for human rights, organize or sponsor fact-finding missions, and develop continuing medical education courses on topics such as the identification and treatment of victims of torture. We conclude that physicians can make a difference, both as clinicians and as advocates for the health of the public and the protection of the human rights. The American College of Physicians will continue to advocate for the rights of persons and communities to live in dignity and peace, free of the fear of unjust imprisonment or torture.

Adult↗
PubMed1960

Heart disease under workmen's compensation.

In expert testimony before the Industrial Accident Commission, all physicians are taken as equally competent. The value of their testimony depends upon the validity of their data and the reasons for the conclusions drawn. In case of conflicting opinion, the referees, who are laymen, must decide on the basis of the testimony. Therefore physicians preparing reports must see that data are complete, that all routine investigative procedures are not only applied but reported, and that the reasons for claiming connection of injury with employment are fully stated. Moreover, other recognized causes of the patient's condition should be considered and ruled out for reasons given. The increasing number of claims for workmen's compensation in heart disease, and the increasing tendency of insurers to settle rather than contest claims, may actually be harmful to the welfare of persons with heart disease, for it deters employers from hiring them and thus risking higher insurance costs. Physicians concerned with compensation claims must develop more widely acceptable standards that properly separate the inherent risk of heart disease from that incurred through employment for which the employer may reasonably be considered liable.

Accidents, Occupational↗
PubMedDate not supplied

[Undesirable treatment results from the viewpoint of an expert witness on medical liability problems--an analysis of 142 cases].

Causes of proven medical misconduct were analyzed on the basis of 142 expert testimonies prepared for an advisory committee on medical liability. The principal causes of misconduct identified were: 1. an incorrect indication for surgery; 2. Unsatisfactory surgical technique; 3. Inadequate preoperative patient enlightenment. In many of the cases in which an incorrect indication for therapy or a technical error could not be proved, the patients or their lawyers attempted to assert their claims by declaring that they had been insufficiently informed. The majority of the claims for recourse concerned: a) problems associated with implantation of total hip replacements; b) sequelae of revisional osteotomies of the lower extremity; c) infiltration therapy with a topical anesthetic; d) sequelae of lumbar disc surgery. These four therapeutic categories accounted for almost two-thirds of all proven errors of therapy and in informing patients. A total of 16.26% of the claims were resolved in the plaintiff's favor. Several examples are presented to illustrate the problem of incorrect indication and unsatisfactory surgical technique as a cause of proven therapeutic error.

Adult↗
PubMed2005

Predictions of future dangerousness in capital murder trials: is it time to "disinvent the wheel"?

Although recent U.S. Supreme Court decisions regarding the death penalty (e.g., Atkins v. Virginia, 2002) have renewed interest in mental health issues, one topic that has not received much attention recently is the ongoing use of expert testimony to support claims that defendants represent a "continuing threat to society." In this article, we (a) review prior research relevant to determining the accuracy of clinical predictions that capital defendants will commit future acts of criminal violence; (b) summarize new data from current and former death row inmates in Texas that bolster the claim that such predictions are gross overestimates of risk; and (c) review extant research addressing the potential utility of various risk assessment instruments that increasingly are being used to reinforce clinical predictions in capital trials. Despite significant recent advances in the field of risk assessment, clinical assertions that a defendant is likely to commit future violent acts appear to be highly inaccurate and ethically questionable at best. Moreover, available research offers little support for the claim that the accuracy of these predictions will be appreciably improved by relying on more structured risk assessment measures that have some demonstrated predictive validity in other contexts.

Adolescent↗
PubMed2005

Evidence-based medicine and tort law.

Recent statutes and legal decisions have been aimed at bettering the quality of tort-law decisions by substantively improving "expert" testimony. However, in analogy to the experience of physicians attempting to upgrade medical practice using the principles of evidence-based medicine, lawyers and the courts have found it much easier to describe ideal science than to actualize it. This is particularly so in a system (the Law) that has traditionally not been very discerning about scientific rigor, and which has established procedural priorities that are often incompatible with strict scientific standards. This overview will examine the American tort system from an evidence-based perspective. We include a discussion of standards that could be used for "outcomes analysis" in the Law; recognition and classification of errors made by the courts themselves; the relationship between medical errors, "negligence," and standard of care; and the problem of reconciling the rights of plaintiffs with medical-scientific facts. We also consider selected impediments to developing a legal system that is capable of consistently reaching evidence-based decisions concerning complex scientific information, including pathologic interpretation of tissue specimens.

Decision Making↗
PubMed1996

Forensic significance of the limbic psychotic trigger reaction.

During the "decade of the brain," competent expert testimony should encompass widely neglected, even novel, neurophysiologically plausible explanations for otherwise unexplainable acts. In the case presented here, a sudden, out-of-character, motiveless, unplanned homicidal attack was committed by a patient who demonstrated flat affect, preserved consciousness, and memory of the episode. Transient autonomic hyperactivation and psychosis were suddenly experienced when the victim happened to move his mouth while eating. Following a sudden memory revival of repetitive but moderate bodily stresses, the patient suffered visceral hallucinations of his entire body being cut into pieces with the delusional belief that he was about to be "cannibalized." The patient's sudden and very transient symptomatology is characteristic of 13 interrelated symptoms and signs (including autonomic, e.g., visceral, hyperactivation and psychosis) proposed as a new subtype of a partial seizure, called "limbic psychotic trigger reaction," which has been consistently delineated thus far in 18 white social loners (14 homicidal men, 3 fire setters, and 1 bank robber), who ruminated about past, moderately painful, but repeated events. This rendered them liable to seizure kindling, particularly of the limbic system. Apparently a post-ictal transient frontal lobe deficiency is secondary to the limbic storm. The forensic impact of seizures on cognition (appreciation of the quality of the act) and on volition is discussed.

Adult↗
PubMed1986

Prohibiting psychiatric diagnosis in insanity trials. With special reference to John W. Hinckley, Jr.

Over 12 different diagnoses were offered in expert testimony during the Hinckley insanity trial. This multitude of diagnoses, many of them overlapping, served to focus attention on the labels themselves rather than on the psychological processes of the defendant. As a result, differences in opinion among the experts were exaggerated; more important, the testimony confused the jury. I believe that stating--or even explaining--a diagnosis is not only unnecessary but also misleading in courtroom testimony. In an application of Roy Schafer's "action language" approach (1976; Miller 1979, 1983) and consistent with the law, I recommend that diagnoses be excluded from insanity trials.

Adult↗
PubMed2002

Witnesses of the body: medico-legal cases in seventeenth-century Rome.

Studying early modern medico-legal testimonies can enrich our understanding of witnessing, the focus of much research in the history of science. Expert testimonies were well established in the Roman Cannon law, but the sphere of competence of expert witnesses - one of the grounds on which seventeenth-century physicians claimed social and intellectual authority- troubled contemporary jurists. By reconstructing these debates in Counter Reformation Rome, and by placing in them the testimonies given by Poalo Zacchia, one of the founding fathers of legal medicine, this article discusses the epistemological and social issues surrounding the definition of expertise about the body in court. It shows how a high-ranking expert witness would define his competence versus the legal authority on the one hand, lower-status expert witnesses on the other. But it also explores the interactions between specific legal constraints, for example about eye witnessing, and the ways in which different kinds of witnesses would use the body as a source of evidence for testimony. While engaging with medico-legal issues including the ambiguous signs of childbirth and the (in)visibility of pain, the article examines their meanings within Counter Reformation social controversies, including control over sexuality, imposition of discipline and the social status of physicians.

Catholicism↗
PubMed2003

Avoiding ipse dixit mislabeling: post-Daubert approaches to expert clinical opinions.

Recent Supreme Court decisions emphasize the need to regulate the admissibility of expert testimony by means of standards that require opinions to go beyond ipse dixit--that is, that are based on more than the fact that the expert said it. The authors discuss subtextual themes underlying this issue and suggest approaches to attaining expert clinical opinions that reduce the likelihood of being mislabeled as ipse dixit contributions. The approach involves providing substantiation of testimony by offering a reliable methodologic basis for communicating the relevant opinion in a thoughtful and intellectually rigorous manner. A model is offered, emphasizing a process approach to opinion formulation and reformulation prior to deposition and trial. This approach addresses not only the Supreme Court's current focus on moving expert opinion beyond ipse dixit, but also such concerns as possible distortions of an expert opinion in the adversarial process. Since judicial determinations may vary depending on many factors, however, even the most careful process of opinion formulation cannot guarantee admissibility. The article assumes a general familiarity among forensic readers with the Federal Rules of Evidence and the recent series of Supreme Court decisions in this area.

Expert Testimony↗
PubMed1999

Practitioners and saints: medical men in canonization processes in the thirteenth to fifteenth centuries.

This article shows that recourse to expert medical judgement for authenticating miracles has medieval roots which lead to the thirteenth century. It provides a survey of those cases in the printed versions of canonization processes from c. 1200 to c. 1500 where medical men actively appeared as witnesses. It shows how, from the second half of the thirteenth century, many canonization processes (overwhelmingly in southern Europe) included at least one medical man who witnessed or gave expert testimony as a supplier of medicine. The physicians who appeared as expert witnesses were expected to rule out the possibility that there was a natural explanation for the wonderous cure. To acquire medical confirmation that a certain cure was miraculous seemed highly desirable to those wishing to substantiate claims of sanctity. Physician witnesses were often called upon to evaluate cases of which they had personal knowledge because of the medical know-how they possessed: however, medical science was not considered so universal that any physician could review the case (as is theoretically the case today in the medical council at the Vatican). Thus, to the therapeutic function of physicians and surgeons in southern Europe from the second half of the thirteenth century, a hitherto neglected duty should be added: whenever necessary, the community as well as the local ecclesiastical authorities expected the suppliers of medical services to contribute to the formal recognition of an apparent saint.

Catholicism↗
PubMed1989

Spontaneous hypnosis in the forensic context.

"Hypnosis" denotes either specific phenomena (altered volition, perception, cognition, and recall) or interpersonal transactions that often elicit them. Basic research leads to paradox: hypnosis is validated, and shown to be dissociative in essence, at the same time that neither its phenomena nor transactions can be separated from those of everyday living without logical absurdity. This paradox can be resolved by assuming that consciousness and volition are complex, occurring simultaneously at many levels in the same waking individual. Hypnotic-like phenomena and transactions occur spontaneously, in either covert or overt forms. The former are pervasive, whereas the latter are often associated with psychological trauma. Forensic implications are twofold: for criminal responsibility, and the reliability of eyewitness testimony. Hypnotic-like states and transactions are rarely affirmed as an insanity defense because at some level these subjects are aware of what they are doing and why. Diminished capacity and mitigation of sentence are more appropriate defense strategies. Several conflicted traditions of case law have evolved to protect eyewitness testimony from hypnotic-like distortions in cognition, perception, and memory that can occur either during or outside of formal hypnotic procedures. These include the admissibility of posthypnotic testimony, due process safeguards at eyewitness identification procedures, and the admissibility of expert testimony on the findings of eyewitness research. These areas are inseparable from one another and demand a systematic coordinated approach.

Forensic Psychiatry↗
PubMed2006

Ecstasy (MDMA), methamphetamine, and date rape (drug-facilitated sexual assault): a consideration of the issues.

The term "date rape drug" has traditionally been applied by the media to powerful sedatives, such as gamma hydroxybutyrate (GHB) and flunitrazepam (Rohypnol), which can render a person unconscious and hence unable to resist and/or recall an assault. However, some law enforcement agents and others have recently obtained convictions by arguing that the empathy-generating and sensual effects of MDMA, and an occasional increase in disinhibition and sexual desire linked with methamphetamine use, remove a person's ability to give a reasoned consent, turning the person into "a helpless slave" to their own sexual desires and those of the alleged perpetrator. The argument holds that the victim becomes part of the assault because they may appear to be cooperating and colluding with activity which they would not have consented to without taking these drugs. This interpretation of the term "date rape" has been fed by data that sometimes finds MDMA and amphetamines in samples taken from sexual assault victims, and hence these prosecutions sometimes rely on expert testimony from toxicologists, pathologists and police officers rather than psychologists and psychiatrists who are expert in the human effects of these drugs. Some of those in the latter group have dismissed claims that MDMA is an aphrodisiac or a date rape drug as myths propagated by the media. In this article, these arguments and their respective strengths and weaknesses will be examined to assist professionals and others who may become involved in these cases.

Coma↗