Judges are often reluctant to interact with medical ethics when deciding cases with an inherently ethical content. They sometimes even transfer decision-making responsibilities to medical ethics groups. At times this unwillingness is based on the presumption that medical ethics will be able to perform an effective regulatory function. The problem is there is a wide range of ethical discourse, both official and unofficial; so much it can cancel itself out. Therefore, as a regulatory tool for the medical profession, medical ethics is insufficient for the job. Judges, on the other hand, could arbitrate between competing ethical conclusions. Indeed, there is a strong argument they \(should\). This thesis addresses this timely and complex issue. Judges need to be willing and able to rely on the soundness of their own moral convictions to recognise and deal appropriately with the inherent ethical content in certain cases. In order to do this, they need a decision-making framework that recognises the ethical nature of judicial decision-making, so as to provide judges with confidence in applying moral principles and medical ethics. This thesis will provide such an integrated framework.

The main aim of this thesis is to advocate a more scientifically informed approach towards epidemiological evidence in disease litigation. It analyses the judicial scepticism about epidemiology in UK tort law, and finds that the myth of scientific certainty lies at the heart of the devaluation of epidemiology as proof of specific causation. It traces misconceptions about epidemiology to broader misconceptions about science as a whole (including medical science and disease), and confused legal approaches to causation. To explain why legal objections to epidemiology are erroneous, the thesis clarifies fundamental aspects of science and disease causation that lawyers need to better grasp. Scientific reasoning is inherently probabilistic. Further, medical research indicates that disease causation is usually multifactorial and stochastic. Rigid and deterministic ‘but for’ questions are thus fundamentally unsuited for assessing disease causation. The mismatch between legal and medical causal models makes courts resort to normative, ‘backwards’ causal reasoning or haphazard exceptional approaches to disease causation, where the most difficult dilemmas around causation arise. This thesis argues that courts need a better test for causation for disease that can take account of probabilistic scientific and epidemiological evidence, and suggests one such principled approach. Epidemiology can be invaluable in such an assessment of disease causation.

Dialectical Behaviour Therapy (DBT) is a type of “talking therapy”, developed from cognitive behavioural therapy; it has been adapted to help people who experience emotions, often females diagnosed with Borderline Personality Disorder (BPD). With its growth in popularity, DBT has been adapted and used with other populations - not just adult females with BPD – to include forensic populations (i.e. people who are in contact with services due to criminal behaviour) and adolescent populations. This thesis contains a systematic literature review investigating the use of DBT in Forensic Services and an empirical study that utilised a qualitative design to explore adolescents and parents’ experiences of DBT.

Forensic science is defined as the application of scientific or technical practices to the recognition, collection, analysis, and interpretation of evidence for criminal and civil law or regulatory issues. A combination of computer science in the field of 3D reconstruction and molecular biology science and techniques were employed in this research aims to document and record a complete picture of the body decomposition process including the changes of the microbiome over the decomposition process. In this thesis, the possibility to reconstruct the crime scene and the decomposition process was investigated. In addition, a 3D model aiming to integrate the biological and thanatological information was generated. The possibility of utilising Autodesk 123D Catch software as a new tool for 3D reconstruction of a crime scene was thoroughly evaluated. First experiments demonstrated that the number of photos required to obtain the best result was specified to be from 20 to 30 photos as a minimum. In addition, significant experiments were performed in different conditions of sizes, locations, and different involved materials. The measurements were obtained from the models using the same software were compared with the real measurements of the tested objects. The result of the correlation between real and estimated measurements showed a very strong agreement ranging from 0.994 to 1.000. With reference to the documentation of the decomposition process, there are different factors, intrinsic and extrinsic, have been reported affecting the decomposition of a carrion/body. These factors mainly interact with the rates of the biological and chemical reaction happening after death. The biological reactions are mainly due to the activity of microorganism and insects. Pigs (Sus scrofa domesticus) were used as a model for human studies and the results obtained have been applied to other mammals without considering the effect of fur on the decomposition process and on the insect and microbial colonisation. In order to investigate this point, rabbits (Oryctolagus cuniculus) with and without fur were used in two sets of experiments at Huddersfield in summer 2014 and in spring 2015. The results obtained in this study showed a similarity of the decomposition stages between animals with and without fur. However, the decomposition process was faster during the summer due to the fast of insect colonisation and activity. In addition, the entomological data collected during the summer and spring experiments were demonstrated that the same taxa nearly were present in both seasons, except Hydrotaea (Diptera, Muscidae), which was presented only in the summer experiment, moreover, only one sample of Lucilia sericata (Calliphoridae) was detected in the spring season. Differences in colonisation time were observed only in spring experiment; animals without fur were colonised two days before animals with fur. The season could have affected the insect’s activity and the spread of the decomposition volatiles. The microbial communities during the decomposition process were investigated using BIOLOG EcoPlateTM and the hypervariable V1-3 region of 16S rRNA gene was used for their molecular identification based on pyrosequencing. Eurofins Genomic Operon using 454-GS Junior pyrosequencing platform (Roche) carried out these analyses. The functional diversity of the bacterial communities on all carcasses samples showed a considerable variability depending on the stage of the decomposition and the sampling region (Oral cavity, skin and interface-sand-carrion) in both seasons. Furthermore, over the molecular analyses of bacterial communities at the phylum level, four main phyla of bacteria were detected among analysed carrion during the decomposition process. These phyla were changed significantly during the stages of the decomposition and between sampling regions. While no difference was observed due to presence or absence of fur. On the other hand, the analysis at the family level was able to highlight differences at the temporal scale but as well as carrion with and without fur. The statistical analysis results showed a significant difference in the bacterial community family distribution among the presence of fur and among the decomposition stages, with significant differences among sampling regions and seasons.

This thesis explores the work carried out by forensic specialists employed by the International Commission on Missing Persons (ICMP). Headquartered in Sarajevo, Bosnia and Herzegovina (BiH), ICMP assists the work of local governments around the world in addressing the issue of missing persons following armed conflict, atrocities, and natural disasters. This thesis focuses on ICMP's efforts to aid the Bosnian government in locating, exhuming, and identifying the remains of the individuals who went missing during the country's recent war (1992-1995). Utilising data obtained via interviews with and observations of ICMP staff members, it primarily represents a study of the management of professional identity in emotionally charged situations, examining the experiences of the forensic specialists who work in the organisation's three mortuary facilities throughout BiH. It explores forensic specialists' work with human remains, their interactions with victims' family members, and their attendance at events in which victims are commemorated and/or buried. Discussion of forensic specialists' experiences with the deceased brings into consideration their varying responses to the remains, emphasising the prevalence and perceived importance of emotional detachment. Situations in which emotional detachment from the remains may prove challenging are considered, as are the varying techniques forensic specialists utilise in managing emotional responses to their work. Examination of forensic specialists' interactions with the living suggests their general dislike of these encounters, although the positive aspects of these interactions are also examined. Exploration of forensic specialists' opinions of attending burials and/or commemorations brings into further consideration the balance between emotional attachment and detachment. While respondents noted the importance of maintaining an emotional connection to their work, they nevertheless emphasised the importance of avoiding such responses while in the mortuary. Commemorations and/or burials become ‘safe spaces' for forensic specialists to express and experience emotional responses to their work that are not overtly professional.

This thesis is concerned with computerised forensic 3-D facial reconstruction as a means of identification and involves the restoration of the face on the skull in an attempt to achieve a close likeness of the individual when alive. The reconstruction process begins with the biological identification of the skeletal remains, (age, sex, ancestry and build). Facial reconstruction is then carried out and essentially works by building the “face” up from the skull using soft tissue thicknesses at specific locations from existing data. However, it is used as a last resort on skeletonised, badly decomposed or mutilated corpses, when no other information is available; even then it is only accepted as corroborative evidence in court. It is performed in the hope that it may stimulate recognition, and consequently narrow the field of identification, allowing other tests to be carried out, such as radiographic and/or dental comparisons, DNA analysis or other means, to establish positive identification. The advantages of the computerised method over the manual clay reconstruction are speed, rapid editing capability, production of images that can be stored and reconstructions repeated at any time if required. Furthermore, in many cases, the original skull instead of a cast or model may be used for reconstruction because the 3-D computerised procedure is rapid and non invasive. However, the most significant advantage of this technique with regard to the aims and objectives of the thesis is that a number of alternative reconstructions may be produced sequentially for the same skull by using different facial templates from the database that meet the anthropological/biological criteria of the skull. The issues addressed by the study and therefore its main aims are: a) evaluation and b) improvement of the reliability of facial reconstruction using 3-D computer graphics. The methodology involved initially digitizing a skull using a low-power laser scanner and a video camera interfaced to a computer. From a database of previously scanned faces, ten facial templates were selected that matched the anthropological criteria of each of the skulls, i.e. age, sex, ancestry and build. Landmarks with their corresponding soft tissue thicknesses were then located and placed on the skull and the equivalent ones on the face. The 3-D computer graphics then reconstructed the face by morphing (warping) the facial template over the skull by matching the corresponding landmarks on the skull and face with the appropriate soft tissue thicknesses at those landmark locations. The soft tissue thicknesses used at their specific landmark locations also matched the anthropological criteria of the skulls, since soft tissue depths are dependent on age, sex, ancestry and build. One of the major problems with any reconstruction which affect its reliability for identification is the uncertainty of the shape of some of the individual characteristics of soft tissue structures such as shape of lips, ears and nose/nasal tip since there is not direct information on the skull regarding the shape of some of these features. In addition, with the laser scanning system, the faces within the database all have closed eyes, because of the potential laser hazard to the eyes. Thus it is necessary to add “opened” eyes, head and facial hair (where appropriate) to give a realistic appearance to the face. The software provides the facility to export a 2-D view in a TIFF or JPEG format from the 3-D reconstructed image. The file can then be imported into a police identi-kit system such as E-FIT™, which allows the addition of features. In this study five skulls of known individuals were used for reconstruction in the manner explained. Ten facial templates which fulfilled the anthropological criteria (age, sex, ancestry and build) for each skull were used for the rebuilding process, thus totalling fifty reconstructions. The study employed a psychological resemblance test (experiment 1) where 20 different assessors, were asked to select in each case study, the best three matches of the ten reconstructions with the ante-mortem photograph of the individual during life. The results from these tests were correlated with a mathematical shape analysis assessment using Procrustes Analysis in which, the skull was compared in turn with each of the ten facial templates of each case study (experiment 2).The ranking of the assessors’ reconstruction choice was correlated with the ranking of the Procrustes Analysis by using Spearman’s Rank Order Correlation. The results indicate that although not statistically significant, it would seem however, that in some of the case studies, the mathematical approach using Procrustes Analysis does seems to capture some perceptual similarity in human observers. Experiment 3, similar to experiment 1, was a further psychological resemblance test, which involved implementing E-Fit features on four of the ten reconstructed images per case study. Assessors were asked to select the closest E-Fit image match with the ante-mortem photograph. Again, results indicated that, although not statistically significant, adding E-Fit feature to the images appears to improve perceptual similarity in human observers, provided, the limitations of adding these characteristics are addressed. Furthermore, there also appears to be good agreement in most of the case studies between the two psychological resemblance tests using the two different sets of assessors in experiment 1 and 3 (reconstruction choice and E-Fit choice, respectively). Further work involving anthropometric comparisons and using two methods of assessment (landmark line matching between images and proportion indices) was also carried out (experiment 4). It was found that matching landmark lines between images appeared to be only of limited value due to the images not being aligned at exactly the same viewpoint and magnification. It should be appreciated that because the thesis was based on recognition and was not an anthropometric study, precise alignment of viewpoints was not a requirement. Hence using the same data from the study, although images were in the frontal view, they were not aligned to the accuracy acceptable for an anthropometric study as there was no requirement to so. It would appear that, although there was some correspondence between the discrepant distances and the first and second ranked reconstructions, no firm conclusions could be drawn from this technique and therefore does not assist in understanding the way observers made their choices. Further tests would need to be carried out (beyond the scope of the thesis) to reach any firm conclusions. Undoubtedly, given the complex nature of the recognition process, it would have been desirable to use reconstructions of persons known to the assessors rather than asking them to assess unfamiliar persons, since it is well established that familiar faces are easier to recognize than those that are unfamiliar to observers. It should be appreciated however, that, although the study was designed in this way for practical and ethical reasons, it nevertheless does not truly reflect the real operational forensic scenario. Furthermore, recognition/matching is a much more complex process and even a reconstructed face which may be generally morphologically similar to the person in life may not capture perceptual similarity in human observers, especially in an unfamiliar scenario. It is not certain that identification will always occur even when the facial reconstruction bears good resemblance to the target individual.

The aim of this study was to document the safeguards inherent in the Mental Health Act (MHA) of 1973, and to examine the extent " to which these are observed in practice. The research was conducted at Lentegeur Hospital in Mitchells Plain, Cape Town. The population consisted of 726 certified patients who were admitted involuntarily (i.e. under sections 9 and 12 of the MHA) from 01 January 1990 to 31 December 1990. Data for each of these patients was collected from the admission register, clinical files, administrative files, and the certified post book. In addition, the official hospital statistics were examined. Measurements obtained included demographic data, the validity of the document contents, the validity of the certification process, and an overall measure of the validity of each of t he certifications taking into account both document contents and observance of the time strictures set out in the MHA. Twenty nine patients (4,0%) were admitted by Urgency (Section 12), and 697 (96,0%) on Reception Order (Section 9). The study focused mainly on the Section 9 patients, because of the small sample size for Urgency admissions. It was found that 609 (87,4%) of the 697 admissions were legally flawed in terms of document contents criteria and the time limits in the certification process. Document content criteria were not fulfilled in: 3,0% of the Applications for Reception Order; 32,1% of Medical Certificates; 20,1% of Reception Orders; and 3,6% of Reports to the Attorney-General. In 40,0% of certifications the Report to the Attorney-General (G2/28) could not be traced. Examination of temporal safeguards revealed that the least satisfactory aspect was the delay in the completion of the post-admission Report to the Attorney-General. It was found that 32,3% of these Reports were not submitted on time. Reasons for the discrepancy ("gap") between legal standards and actual practice are discussed. Recommendations are made which could help minimise or eradicate this "gap". These include suggestions for changes in the document format, for the use of a certification booklet, for stricter control of late and inadequate documentation, and for inservice training of all those involved in the certification process. / Thesis (M.Med.)-University of Natal, Durban, 1993.

In regards to health care, the civil tort system serves to both deter negligent behavior on the part of the provider and compensate victims for losses which must include bodily harm attributable to negligent medical care. Due to the unique malpractice landscape that evolved in the United States, national tort reform has increased over the last several decades and a need for reliable data exists. This paper matches claims from the National Practitioner's Data Bank to an independent state data bank to determine is systematic, nonrandom differences between the observations exist. The paper found that systematic differences existed and their existence was implicitly proven in a paper published in 2013. This calls into question the current state of knowledge surrounding medical malpractice liability reform.

Hollow-fibre liquid-phase microextraction (HF-LPME) was introduced in 1999 as a miniaturised version of liquid-liquid extraction (LLE) in order to reduce the consumption of organic solvents and offer an environmentally-friendly approach to extraction procedures. Since then, several studies have been published in the field of forensic and clinical toxicology applying the technique to a broad range of analytes; however more studies are necessary regarding its applicability to bioanalyses. The principle of HF-LPME is the extraction of analytes across a thin supported liquid membrane within the walls of a hollow fibre from a donor phase (DP) into an acceptor phase (AP). It is an extraction technique that encompasses several parameters that require optimisation for an efficient method; this is most effectively achieved by utilising a design of experiment (DoE) approach rather than the conventional one-factor-at-a-time (OFAT) approach. The main aim of this work is to further investigate the applicability of HF-LPME to the fields of forensic and clinical toxicology by developing and validating methods to extract various drugs from different biological matrices. Complex matrices, such as whole blood, are commonly used in forensic toxicology. Considering that not many studies have been performed on the application of HF-LPME to whole blood (only 10 up to the present day), this is an aspect that requires further investigation. For this, a fast, accurate and precise 3-phase HF-LPME method followed by LC-MS/MS analysis was developed and validated to simultaneously quantify 5 NBOMe drugs in human whole blood. NBOMe drugs are a group of substances part of the so-called “novel psychoactive substances” (NPS); drugs that have been emerging with increasing frequency over the last few years. NBOMes are associated to deaths as the causa mortis, and due to their high potency, these drugs are normally abused in micrograms. For that reason, the HF-LPME method developed had to present high sensitivity (LOD of pg/mL). The aim of the second part of this project was to challenge HF-LPME further by developing and validating methods to assess the potential application of HF-LPME in multi-drug analyses. Urine was selected as biological matrix, and the group of chosen analytes were 14 anti-hypertensive drugs and their metabolites with very different physical-chemical properties. HF-LPME has never been applied to such a broad spectrum of substances in previous bioanalytical studies. These drugs were divided into two groups (acidic and basic/neutral), and a total of four extraction methods (two for each group of analytes) were developed and optimised using chemometrics (DoE) then analysed by LC-MS/MS. Two of these methods were liquid-liquid extraction (LLE) methods that were developed and validated to be used as reference to which the two HF-LPME methods were compared. The LLE methods were sensitive, accurate, precise, and valid for application to real case samples. The HF-LPME methods presented some limitations due to the lack of isotopically-labelled analogues of each specific analyte as internal standards (IS); for non-exhaustive methods the use of these IS should be adopted as standard practise. Real urine samples from genuine patients were extracted using all 4 methods followed by LC-MS/MS analysis. By applying the methods to real case samples, it was possible to define that the HF-LPME methods were suitable for qualitative screening of urine to determine the level of compliance of patients under anti-hypertensive pharmacotherapy. However, for quantification of the drugs applying HF-LPME, further development is required to incorporate the use of isotopically labelled analogues. This study proved that HF-LPME is a potential asset not only for forensic but also for clinical toxicology. It can be a very powerful tool which, mainly due to its green-chemistry approach and pre-concentration capabilities, which allows direct injection into the analytical instrument, could potentially become a more used technique in the future. However, the analyst should be careful when developing HF-LPME methods, to bear in mind its limitations so that methods that are fit-for-purpose can be developed.

Deliberate firesetting causes a significant cost to society in terms of human life and economic loss. However, compared to other areas of offending, firesetting is one area that has received relatively little attention by academics and practitioners in both the psychiatric and psychological literature. Even though a significant proportion of existing research has been conducted with psychiatric populations little is understood about firesetting by mentally disordered offenders, particularly in terms of their characteristics, risk factors, offence process, and treatment. The purpose of this thesis was to extend current knowledge of mentally disordered firesetters by exploring the offence process, treatment needs, and effectiveness of treatment with this population. Four exploratory studies were conducted to address this. Study one examined the characteristics of male and female mentally disordered firesetters in comparison to non-firesetting mentally disordered offenders and also the ability of these characteristics to predict offence status (firesetter or non-firesetter) and repeat firesetting. Studies two and three examined the offence process and the pathways mentally disordered firesetters follow to offending. Finally, study four evaluated the effectiveness of the first standardised treatment programme for male and female mentally disordered firesetters. The studies in this thesis highlighted the importance of fire interest in distinguishing between firesetters and non-firesetters and also for the predicting of repeat firesetting. Further, the development of fire-related risk factors appeared to be important for influencing the offence process for a sub-group of mentally disordered firesetters. The role of mental health in the offence process was also highlighted as being important. Finally, evidence was found to support the need for specialist interventions examining fire related factors with mentally disordered firesetters. The results of all four studies are discussed in terms of the assessment and treatment of mentally disordered firesetters and the clinical implications and utility of the findings are considered.