MEDICAL JURISPRUDENCE

the branch of law dealing with various aspects of medicine, including the practices of caregivers and the rights of patients. also called Legal Medicine, science that deals with the relation and application of medical facts to legal problems. Medical persons giving legal evidence may appear before courts of law, administrative tribunals, inquests, licensing agencies, boards of inquiry or certification, or other investigative bodies. Doctors in most countries are legally obligated to certify persons for workers' compensation or other national insurance plans, to certify the occurrence of a birth or the cause of a death, to notify the authorities of any cases of specified infectious diseases, and to determine when mentally disturbed persons need to be detained to protect themselves or others. These routine acts constitute the most frequent tasks of medical jurisprudence. Less frequent but perhaps more significant are the uses of the doctor as a witness. When doctors appear in court merely to relate facts that they have observed, they are governed by the rules applicable to an ordinary witness. If they have to interpret those facts with their medical knowledge, they are known as expert witnesses and are expected to present their opinions fairly and without bias toward the litigant by whom they have been called. Despite this expectation, conflicts of medical opinion in court are common, perhaps because the human body and its ailments are less controlled by rule than is the law. Medicine and the law do not always work in harmony. The most common source of conflict is medical confidentiality. Some doctors claim that any information received from a patient during a medical consultation is subject ethically to absolute confidentiality and can in no circumstances be revealed without the patient's permission. Without such a rule, they believe, patients sometimes would not give doctors all the information needed to treat them. Other doctors (a majority in most countries) believe that occasionally, though very rarely, their obligations to society override their obligations to their patients. Many, but not all, would report to the police a patient with severe epilepsy who, despite a warning from them, persisted in driving a car. This conflict with the law arises because, in most countries, courts, while recognizing legal privilege (the confidentiality of exchanges between lawyers and their clients), do not extend the same recognition to medical consultants. Other conflicts with legal systems arise because doctors have recognized that their responsibility to their patient takes precedence over all others. National and international medical associations have, for instance, advised doctors in countries where torture is legal that they must not be party to it by performing medical examinations to ensure that a prisoner is fit to be tortured. They have also warned doctors against being involved in any police procedure where, without their patient's consent, they could be asked to do something not in their patient's interest. Law and medicine come together more harmoniously in forensic medicine, a medical specialty that assists in the detection of crime. Specialists in forensic medicine also assist courtsincluding the coroner's court in Anglo-Saxon lawto determine the cause of sudden and unexpected deaths. In these cases the main investigation that a forensic specialist employs is a postmortem examination of the body, involving a careful examination of every organ and its contents, with sections of some organs being studied microscopically and subjected to chemical and DNA tests. Forensic medicine encompasses dramatic activities like determining the size and sex of a body by examining just a few bones, identifying a corpse from its dental pattern, or detecting evidence of rape or of unsuspected murder. It more commonly involves estimating the time of a person's death or measuring alcohol level in the blood of a motorist and thus establishing the degree of impaired judgment. Additional reading H. Tristram Engelhardt, Jr., The Foundations of Bioethics (1986), gives an overview of medical ethics. Emily Friedman (ed.), Making Choices: Ethics Issues for Health Care Professionals (1986), is a selection of articles on decision-making in the rationing of health care and in the provision of critical care. United States. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Securing Access to Health Care: A Report on the Ethical Implications of Differences in the Availability of Health Services, 3 vol. (1983), is an authoritative document.Issues accompanying the medical problems of special neonatal care are discussed in Earl E. Shelp, Born to Die?: Deciding the Fate of Critically Ill Newborns (1986); and Sherman Elias and George J. Annas, Reproductive Genetics and the Law (1987). The ethics of general critical care are the subject of Stuart J. Youngner (ed.), Human Values in Critical Care Medicine (1986); and Alonzo L. Plough, Borrowed Time: Artificial Organs and the Politics of Extending Lives (1986). Patients' rights in view of the law of informed consent are explored in George J. Annas, The Rights of Hospital Patients: The Basic ACLU Guide to a Hospital Patient's Rights (1975); Joanne Lynn (ed.), By No Extraordinary Means: The Choice to Forgo Life-Sustaining Food and Water (1986); William J. Winslade and Judith Wilson Ross, Choosing Life or Death: A Guide for Patients, Families, and Professionals (1986); and James Rachels, The End of Life: Euthanasia and Morality (1986).Laws and legislation regulating health care are analyzed in George J. Annas, Leonard H. Glantz, and Barbara F. Katz, The Rights of Doctors, Nurses, and Allied Health Professionals: A Health Law Primer (1981); Samuel C. Ursu (ed.), Symposium on Legal Considerations in Dentistry (1982); Frances H. Miller, Medical Malpractice Litigation: Do the British Have a Better Remedy?, American Journal of Law & Medicine, 11:433463 (1986), a comparison of the systems of medical malpractice litigation in the United States and Britain; Patricia M. Danzon, Medical Malpractice: Theory, Evidence, and Public Policy (1985); Raymond G. DeVries, Regulating Birth: Midwives, Medicine, & the Law (1985); and Robert D. Miller, Problems in Hospital Law, 5th ed. (1986).A summary of the major models of licensing of health-care professionals throughout the world is given in Jan Stepan, Traditional and Alternative Systems of Medicine: A Comparative Review of Legislation, International Digest of Health Legislation, 36:281341 (1985). On professional accreditation and licensing, see Donald G. Langsley (ed.), Legal Aspects of Certification and Accreditation (1983); Clare LaBar, Statutory Requirements for Licensure of Nurses (1985); and Council of State Governments, State Credentialing of the Health Occupations and Professions (1986).Forensic medicine is the subject of R.B.H. Gradwohl, Gradwohl's Legal Medicine, 3rd ed., edited by Francis E. Camps (1976), a comprehensive, fully illustrated text of traditional legal medicine. John Glaister, Glaister's Medical Jurisprudence and Toxicology, 13th ed., edited by Edgar Rentoul and Hamilton Smith (1973), is a comprehensive text on forensic pathology and toxicology. See also Werner U. Spitz and Russell S. Fisher (eds.), Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 2nd ed. (1980); Sir John Jervis, Jervis on the Office and Duties of Coroners, 10th ed., edited by Paul Matthews and J.C. Foreman (1986); and William J. Curran and E. Donald Shapiro, Law, Medicine, and Forensic Science, 3rd ed. (1982).