Branches of Forensic Medicine

Forensic medicine is a multidisciplinary subject, drawing primarily from medicine, chemistry, and biology, but also from physics, psychology, computer science, geology, and social science. Forensic medicine covers a wide spectrum of professional interests and, in fact, deals with any aspect of medicine which interacts with thelaw. There are many branches in the practice of Forensic Medicine, including forensic pathology, clinical forensic medicine, forensic toxicology, forensic serology, forensic psychiatry, and forensic anthropology.  

1. Forensic Pathology

Forensic pathology deals with the study of the cause and manner of death by examination of a dead body during the medicolegal investigation of criminal lawand civil law cases in some jurisdictions.

Table I.1.1The Categories of Medicolegal Cases

(a) Violent deaths, i.e., unnatural deaths (homicides, suicides, unintentional injuries)

(b) Sudden and unexpected deaths

(c) Deaths with suspicion, i.e., those that may be due to violence 

(d) Death in police custody, in prison, and correctional institutions

(e) Deaths without physician attendance

(f) Deaths related to therapeutic misadventure (medical malpractice)

Table I.1.2 The Objectives of Medicolegal Investigation

(a)To determine the cause of death

(b)To determine the manner of death

(c)To determine the primary, secondary and contributory factors in the cause of death when trauma and disease are present simultaneously

(d)To estimate the time of death and injury

(e)To interpret how the injury occurred and the nature of weapon used (if any) 

(f)To identify the deceased if unknown

(g)To collect evidence from the bodies that can be used in criminal law cases

(h)To provide expert testimony from forensic pathologists in criminal and civil law cases if the case goes to trial

2. Clinical Forensic Medicine

Clinical forensic medicine refers to a branch of forensic medicine that involves an evaluation and interpretation of injuries and illness in living individuals. Clinical forensic medicine is principally concerned with the provision of forensic medical services to the living patients and medical advice particularly in the investigation of crimes. In broad terms, a forensic pathologist generally does not deal with living individuals, and a forensic physician generally does not deal with the deceased. However, there are doctors, worldwide, who are involved in both the clinical and the pathological aspects of forensic medicine. There are many areas where both clinical and pathological aspects of forensic medicine overlap. In the United Kingdom and Australia, clinical forensic medicine is practiced by a group of doctors who are not forensic pathologists. Most of these are general practitioners, although there are now more and more members with other postgraduate qualifications. In continental Europe and China, where doctors in institutes of legal medicine are the clinical forensic practitioners, they often are also forensic pathologists. In the United States, there is no specific group of doctors providing clinical forensic medical service. Instead, forensic nurses provide direct services to individual clients who are in some way involved in the criminal justice system. Forensic nurses deal with patients who have allegedly committed or who have been convicted of a criminal offence, or are victims of an alleged crime.

Table I.1.3Major Tasks of Clinical Forensic Medicine

(a)To conduct medical examination and assessments of victims and assailants of violence, physical abuse, and sexual assault

(b)To provide expert opinion as to the degree of injuries and illness resulted from trauma for possible liability in criminal proceedings and civil compensation

(c)To perform medical examinations and assessments of motorists who may have been driving under the influence of alcohol and/or drugs

(d)To conduct assessments of work ability for the purpose of workers’ compensation

(e)To assess the mental health of victims and assailants for legal and court purposes

(f)To evaluate the adequacy of care and service of detained persons

3. Forensic Toxicology

        Forensic toxicology is an interdisciplinary field applying the methods of analytical chemistry, pharmacology, and toxicology to the analysis and interpretation of drugs and chemicals in biological samples for legal purposes. A forensic toxicologist must work closely with forensic pathologists, considering the context of an investigation. In particular, they must consider any recorded clinical signs and symptoms, any pathological changes caused by poisonings, and any evidence collected at a crime scene that may narrow the search, such as pill bottles, powders, trace residue, and chemicals. Provided with this information and samples with which to work, the forensic toxicologist must determine which toxic substances are present, in what concentrations, and the probable effect of those chemicals on the person. The forensic toxicologist is involved not only in the analysis of body fluids and tissue for drugs and poisons, but also in the interpretation of the resulting information in a judicial context.

4. Forensic Serology

Forensic serology, also known as Science of Forensic Material Evidence or Forensic Physical Evidence, is the application of biology to law enforcement. The forensic biology deals with the study of serological and DNA analyses of bodily (physiological) fluids for the purpose of identification and individualization. The type of material typically examined includes, but is not limited to blood, semen, saliva, and dental pulp from victims and assailants collected at crime scenes and from articles of physical evidence. These types of physiological fluids are frequently generated during the commission of violent crimes such as homicides, rapes, assaults, and hit and run motor vehicle fatalities. The ultimate goal is to identify what type of material is present and then, through the use of DNA analysis, link that material to a specific person. Paternity tests usually are also performed by forensics serologists.

5. Forensic Psychiatry

        Forensic psychiatry involves both psychology and psychiatry science in relation to the law and legal system. It studies, evaluates, and identifies mentally-related illnesses and human behavior to obtain legal evidence.Forensic psychiatrists are frequently required to do behavioral and psychological evaluations of criminals, victims of crime, and individuals involved in major disasters. Forensic psychiatrists consult and testify regarding competency, sentencing recommendations, treatment recommendations, and assessment of future risk of criminals. They may write reports on criminal responsibility, criminal profiles, and exaggerated or faked symptoms of criminals and non-criminals. Forensic psychiatry experts may also testify on criminal evaluations, malingering, feigned symptoms, forensic assessment, personality disorders, settled insanity, mental status, mental capacity, wrongful commitment, and inadequate informed consent.

6. Forensic Anthropology

        Forensic anthropology is the application of the science of physical anthropology and human osteology (the study of the human skeleton) in criminal cases where the victim's remains are decomposed, burned, mutilated, or otherwise unrecognizable. Forensic anthropologists can assist in the recovery of remains, assess age, race, sex, stature, ancestry, and analyze trauma and disease of human remains of crime and natural disasters.  Forensic anthropologists frequently work in conjunction with forensic pathologists, forensic odontologists, and homicide investigators to identify a decedent. They also assist in discovering evidence of trauma and determining the postmortem interval.