An update on the progress of Forensic Medicine practice in India  

Article Type:  Editorial

Published on:  Year: 2024; Volume: 4; Issue: 2; Page No: 1 – 2

 Author:  Dr. Rohit Goel

https://doi.org/10.55349/ijmsnr.20244212

Affiliation:  Assistant Professor, Department of Forensic Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Koodapakkam (Post), Puducherry – 605502. India.  Email ID: rohitgoel008@gmail.com

Article Summary: Submitted:  27-March-2024; Revised:  15-May-2024; Accepted:  10-June-2024; Published:  30-June-2024


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Care for the living, giving voice to the dead

Feeling of contribution- hands, heart, head.

Expertise of medicine, for the purpose of the Law.

Nightmare for wrong doers, we are searching for their flaw.

You may wonder, what it takes, for such amazing deeds;

A man of science, working for, just-what society needs.

 Welcome to the world of Forensic Medicine

Introduction

The two most important principles of any professional practice are: to serve the society; and scientific inquiry for expansion of knowledge.  Forensic medicine as a discipline has evolved with equal allegiance on both the principles in letter and the spirit.

To an outsider, forensic medicine appears striking, but a discipline limited to dead bodies. It has some elements of truth also, as the priorities of 20th century India (a new democracy) needed to- establish health care access, and those of forensic experts were to establish firm grounds of medicolegal practice in the country. This was achieved by taking up the role of Autopsy surgeon (employed in a government service) and/or academician (in academic institution) involved in teaching and research. Yet, we are not limited by where we have been, but where we are headed.

Apart from the recently gained attention of Governments and NHRC (National Human Rights Commission) on upgrading standards of criminal investigative procedures; and that of educational regulators like NMC (National Medical Commission), INC (Indian Nursing Council) emphasizing teaching of Forensic principles to the future healthcare providers- there are other subtle developments in the discipline which will be discussed in this article. [1–3]

In the 21st century India, a professional working at the intersections of medicine and law carries a unique set of personal and professional attributes, that enable us to contribute  to  the society in innumerable

ways. In addition to ever evolving role of autopsy surgeon and academician, the newer disciplines encompassing clinical forensic medicine, medicolegal consultancy and administrative roles in various capacities highlight the career trajectory of Forensic experts today.

Voice to the dead

Autopsy practice in India has remained restricted within the ambit of forensic medicine departments and forensic experts have weighed the scope of autopsy from a medico-legal standpoint only. Pathological autopsies or teaching autopsies never gained grounds in modern medicine of India except for some institutes like PGIMER, Chandigarh. This is likely to change in 21st century as two big challenges gain momentum: firstly, the medical negligence and secondly, patient safety. Autopsy is an indispensable exercise as an audit instrument for antemortem clinical judgment and management. Indeed, there are government orders available for autopsy examination in fatal case of alleged medical negligence. We are likely to witness laws and standards mandating autopsy examination for such cases in the 21st century. To keep-up with the above objectives, the autopsy practice will have to evolve too.

  • Forensic Pathology: Alan Moritz coined the term Forensic pathology in 1944. This specialty has gained new dimension in the developed countries with scope extending from death scene examination at the outset to specialized examinations such as neuropathology, cardio-pathology at the other end. In India, we are witnessing the start of this journey with interested forensic experts visiting the scene of death and academic events focussing on specialized knowledge of forensic histopathology. A super-specialty course in Forensic pathology offered by AIIMS, Jodhpur (for INISS-Jan 2024), is rather a landmark development. [4]
  • Forensic Radiology and virtual autopsy: The department of Forensic Medicine at AIIMS Delhi, envisioned incision less medicolegal autopsies in the country.  The department established a Centre for Advanced Research and Excellence in Virtual Autopsy with support of Indian Council of Medical Research, Delhi. The department took a landmark step further on 21-09-2022, as they used the new autopsy technique (Virtual autopsy) for examination of body of famous comedian Raju Srivastava replacing the conventional autopsy. This step sanctified the procedure and opened-up the way of further development in the discipline. Subsequently, a super-specialty course (DM in Forensic Radiology & Virtual Autopsy) was institutionalised by AIIMS, Rishikesh. [4]
  • Living ForensicsTowards the end of 20th century in USA, issues of ‘living forensic’ gained importance with emphasis on application of forensic science to the examination of living persons. ‘Clinical forensic medicine’ arose as a new discipline; to extend medicolegal care to victims of non-fatal trauma. [5] The momentum generated by efforts of emergency room staff including physicians, nurses & others, led to emergence of Clinical forensic medicine and Forensic Nursing as specialties for physicians and nurses respectively. Carrying a plethora of medicolegal situations under its scope-ranging from fitness of detained, drunkenness examination, injury assessment, age estimation, sexual assault examination to psychiatric care etc. this specialty has given rise to other subdivisions too.In India, we are witnessing the early developments like Clinical forensic medicine units in teaching hospitals and One stop centre at district level hospitals (733 functional and 300 more OSCs to be opened). [6] These developments require professionals trained in medicolegal matters including physicians and nurses like Sexual assault nurse examiner (SANE). [7, 8] Indeed, Forensic Experts have expanded the scope of practice in management of poisoning cases also.Forensic and medical ToxicologyLooking at the curriculum of undergraduate medical education, it is natural for a person to imagine the essential role of Forensic Medicine experts in the diagnosis and treatment of poisoning in emergency setting. However, the want of clinical training of forensic experts, medicolegal awareness of clinician, and timely toxicology analysis- has created a chasm in the management of poisoning cases- a chasm in which patients fall daily. The department of Forensic Medicine, Amrita Institute of Medical sciences, Kochi, Kerala was first to recognise this gap to start toxicological analysis services at emergency department. A need for a super-specialty course was emphasized. [9] The department of Forensic Medicine, AIIMS Raipur took the necessary step ahead and initiated a super-speciality course in clinical and forensic toxicology. [4]Medicolegal ConsultThis role of a forensic medicine specialist is a recent development and we can count the practicing experts on fingertips. A medicolegalconsultant provides insights into the legal suits (criminal and civil law) and ethical dilemmas involving doctors. At one end, these consultants provide service to the institutions, individual professionals (lawyers, doctors) and public- navigating legal recourse for resolving conflicts related to doctor patient relationship. The other extreme helps those in conflict with law with expert guidance throughout the criminal investigation, indirectly strengthening the standard of proof against those convicted.

    Conclusion

    The future of Indian forensic medicine practice looks brighter than ever in 21st century. The developments made in the first quarter of this century act as stepping stones for the future- a future where there is no chasm for patients to fall, unwanted agony is avoided, no innocent is punished and no offender escapes.

    References

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    3. Sharma S, Joseph J. The paradigm of forensic nursing for nursing aspirants in India: Promises, caveats & future directions. J Forensic Leg Med 2022;86:102321. PMID: 35172267
    4. INI-SS: Prospectus Part-A – Institute of National Importance Super-Specialty Entrance Test For DM, M.Ch. & MD Hospital Administration courses 2024:1-42. Available from: https://docs.aiimsexams.ac.in/link/INISS%20Jan%202024/INISS%20Prospectus%20%20Jan-2024%20V5%20correction%20update.pdf
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    8. Patil SS, Deokar RB MD. Study of Feedback of Survivors of Sexual Offences Subjected For Medicolegal Examination in Tertiary Care Municipal Hospital. J Med Sci Law 2022;31(1):16-23.
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