This study examines the mentalities and sensibilities of government that get (re)produced in one programmatic narrative about ‘child abuse’ and child homicide. It shows how a perspective of governance takes shape through the lens and language of risk, and how a discourse of risk can take very different forms even within one governmental programme. Empirically the study examines the major report released from the Public Inquiry into Pediatric Forensic Pathology in Ontario (known after its chairperson as the Goudge Inquiry/Report). The Goudge Inquiry (2008) was commissioned by the Ontario government in the wake of a Chief Coroner’s Review into the problematic practices of Dr. Charles Smith, the province’s most trusted paediatric forensic pathologist for nearly 15 years. The resultant Goudge Report presents a rationalization of Ontario’s paediatric death investigation system and its failures. It presents an ideal-typical narrative that carves out the image of a fully formed and perfected risk management complex for combatting ‘child abuse’. To understand the mentalities and sensibilities of government that shape and get shaped by the Report’s risk management narrative, this study probes what ‘risk’ does in the Goudge Report. Risk discourse in this case proves to be entangled in a ‘volatile and contradictory’ set of ‘superficial’ connections, associations and activities, one that operates at the nexus of ‘common sense’ mentalities and populist sensibilities. That the Report depends for its rhetorical power on the silencing of alternative claims, discourses and rationales is central to this analysis. / Thesis (Master, Sociology) -- Queen's University, 2011-08-31 16:33:55.671

In modern society the medico-legal investigation of death is a prerequisite for the administration of justice and for the betterment of public health. These investigations require a high level of skill, professionalism and ethics and have far reaching effects. South Africa’s high level of unnatural deaths, combined with limited human and fiscal resources, specifically a scarcity in practicing Forensic Medical Practitioners, a lack of adequate training of Forensic Officers and members of the South African Police Service, discrepancies in available statistics and a lack of accreditation and quality control, to name a few, leave the South African medico-legal system overburdened. Death investigation needs to evolve and improve constantly and improvements in death investigation need to occur across a wide spectrum of parameters. In the United States of America, to combat systemic issues such as those experienced in South Africa, Death Investigators have been introduced in a supportive capacity and as an extension of services rendered by Forensic Medical Practitioners. These investigators, who are not medical practitioners but may have some level of training or vocational experience within the medical or investigative field, attend and help to analyse death scenes, collect relevant ante-mortem data, assist during autopsies, expedite special investigations, liaise with other stakeholders and provide testimony if warranted. Multiple benefits are associated with the introduction of these death investigators, with the collection of relevant (pre-autopsy) information which will assist and direct the Forensic Medical Practitioner probably being the most pertinent in the context of this research. The aim of this study was to assess the functionality and value of introducing such Death Investigators into forensic pathology service in South Africa. Specifically, this research focused on the nature and scope of information currently being provided to Forensic Medical Practitioners prior to conducting an autopsy and assessed whether the introduction of these investigators would improve the quality of pre-autopsy information. To determine this, participating Forensic Medical Practitioners were asked to evaluate the quality of information currently provided to them prior to conducting an autopsy and to evaluate the quality of information contained in a Death Investigator worksheet that was completed hypothetically for the same case, as an example of the type of information that would be collected by a Death Investigator. Additionally, the disposition of Forensic Medical Practitioners and external stakeholders to the proposed introduction of Death Investigators was assessed through a questionnaire process. Findings of this research showed that there is a significant deficit in the quality of pre-autopsy information being provided to Forensic Medical Practitioners at present. The current pre-autopsy information received an average information quality score of 21.4%. However, the Death Investigator worksheets received and average information quality score of 84.9% representing a marked improvement. Forensic Medical Practitioners had a favourable disposition to the proposed introduction of Death Investigators and agreed that Death Investigators would provide an improved knowledge and understanding of the circumstances and setting of the death, which in turn would , enhance their ability to strategise a post-mortem approach, to request appropriate special investigations and to better interpret their autopsy findings. Overall, the results of this research suggest that the introduction of Death Investigators would add value, specifically by improving the gathering of appropriate information and would be welcomed by Forensic Medical Practitioners. While this research was conducted in Pretoria, it was done on the premise that the poor-quality pre-autopsy information experienced in Pretoria, is probably, to a greater or lesser extent experienced in other medico-legal laboratories in South Africa. It is recommended, that a multi-centre audit of pre-autopsy information quality is undertaken to verify the results found at the Pretoria Medico-legal Laboratory. Furthermore, to facilitate the introduction of Death Investigators as a new professional category, it is recommended that a working group be convened to further interrogate the added-value potential of this introduction as well as to determine prerequisite educational requirements and acceptable recognised prior learning, and to develop guidelines and scope of practice documents. It is also recommended that should this introduction come to fruition, provision be made to accommodate such Death Investigators on a professional board affiliated with the Health Professions Council of South Africa, to guide training and qualification requirements, advise on best practice and professional standards against which Death Investigators can be held accountable. / Dissertation (MSc (Medical Criminalistic))--University of Pretoria, 2020. / Forensic Medicine / MSc (Medical Criminalistic) / Unrestricted

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Based on interviews and ethnographic fieldwork, this dissertation shows how the Office of the Chief Coroner of Ontario (OCC) – whose object is to speak for the dead to protect the living – is shaped by risk management priorities. It illustrates how the OCC, like many contemporary organizations, has altered its operations and decision making to manage threats to its reputation. The result of these moves has been the privatization of public safety decision making with bereaved families, the general public, and even front line coroners, increasingly excluded from speaking for the dead. This is to say, policy recommendations that shape how life in Ontario is lived tend to be generated in private sessions by OCC managers. While much of this can be attributed to the OCC’s focus on reputational risk management, there are other important factors affecting the privatization of public safety. Drawing on research in the sociology of culture, the dissertation finds that the OCC’s experience of risk management is moderated by other, layered institutional structures. These ‘institutional structures’ are analytic constructs with moral and methodological dimensions that inform the way work in the OCC is carried out. The dissertation demonstrates that the moral priorities and method preferences of doctors, lawyers, managers, families, and modern governments are layered over and under risk management. These layers augment or diminish risk management’s impact on the way death is determined and public safety regimes are developed. In addition to offering a window on death investigators and their work, the dissertation proposes a theoretical toolset for better understanding how contemporary organizations are organized and run.

Based on interviews and ethnographic fieldwork, this dissertation shows how the Office of the Chief Coroner of Ontario (OCC) – whose object is to speak for the dead to protect the living – is shaped by risk management priorities. It illustrates how the OCC, like many contemporary organizations, has altered its operations and decision making to manage threats to its reputation. The result of these moves has been the privatization of public safety decision making with bereaved families, the general public, and even front line coroners, increasingly excluded from speaking for the dead. This is to say, policy recommendations that shape how life in Ontario is lived tend to be generated in private sessions by OCC managers. While much of this can be attributed to the OCC’s focus on reputational risk management, there are other important factors affecting the privatization of public safety. Drawing on research in the sociology of culture, the dissertation finds that the OCC’s experience of risk management is moderated by other, layered institutional structures. These ‘institutional structures’ are analytic constructs with moral and methodological dimensions that inform the way work in the OCC is carried out. The dissertation demonstrates that the moral priorities and method preferences of doctors, lawyers, managers, families, and modern governments are layered over and under risk management. These layers augment or diminish risk management’s impact on the way death is determined and public safety regimes are developed. In addition to offering a window on death investigators and their work, the dissertation proposes a theoretical toolset for better understanding how contemporary organizations are organized and run.

This research study explored the meaning of 'Being' (i.e. Heidegger's four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner's officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England.

Iris recognition is a validated and non-invasive human identification technology currently implemented for the purposes of surveillance and security (i.e. border control, schools, military). Similar to deoxyribonucleic acid (DNA), irises are a highly individualizing component of the human body. Based on a lack of genetic penetrance, irises are unique between an individual’s left and right iris and between identical twins, proving to be more individualizing than DNA. At this time, little to no research has been conducted on the use of postmortem iris scanning as a biometric measurement of identification. The purpose of this pilot study is to explore the use of iris recognition as a tool for postmortem identification. Objectives of the study include determining whether current iris recognition technology can locate and detect iris codes in postmortem globes, and if iris scans collected at different postmortem time intervals can be identified as the same iris initially enrolled. Data from 43 decedents involving 148 subsequent iris scans demonstrated a subsequent match rate of approximately 80%, supporting the theory that iris recognition technology is capable of detecting and identifying an individual’s iris code in a postmortem setting. A chi-square test of independence showed no significant difference between match outcomes and the globe scanned (left vs. right), and gender had no bearing on the match outcome. There was a significant relationship between iris color and match outcome, with blue/gray eyes yielding a lower match rate (59%) compared to brown (82%) or green/hazel eyes (88%), however, the sample size of blue/gray eyes in this study was not large enough to draw a meaningful conclusion. An isolated case involving an antemortem initial scan collected from an individual on life support yielded an accurate identification (match) with a subsequent scan captured at approximately 10 hours postmortem. Falsely rejected subsequent iris scans or "no match" results occurred in about 20% of scans; they were observed at each PMI range and varied from 19-30%. The false reject rate is too high to reliably establish non-identity when used alone and ideally would be significantly lower prior to implementation in a forensic setting; however, a "no match" could be confirmed using another method. Importantly, the data showed a false match rate or false accept rate (FAR) of zero, a result consistent with previous iris recognition studies in living individuals. The preliminary results of this pilot study demonstrate a plausible role for iris recognition in postmortem human identification. Implementation of a universal iris recognition database would benefit the medicolegal death investigation and forensic pathology communities, and has potential applications to other situations such as missing persons and human trafficking cases.

Within the past few decades brain injury, or traumatic brain injury (TBI), has gained widespread attention. Early focus was on more severe forms of TBI; severity typically measured using the Glasgow Coma Scale. In more recent years, however, mild traumatic brain injury (mTBI), most notably concussions, has gained increasing interest due to the high frequency of concussions suffered in athletes of all levels and, recently, in military personnel due to blast injuries. Studies being performed have focused not only on ways to help minimize the incidence of concussion as well as treating concussive symptoms, but also on detecting concussions. Many concussions go unreported due to inadequate knowledge of concussive symptoms amongst the general population. Because many concussions go unnoticed and hence unreported the individual who has sustained a concussion is at risk for a more serious injury in the future. One such injury is Second Impact Syndrome (SIS). Second Impact Syndrome is essentially a synergistic event where the sum of two seemingly mild concussions combine to create an event that is potentially fatal. The findings during the autopsy are that there is insignificant damage to the brain to cause death. The damage that occurs, however, is on a molecular level causing a strain on the metabolic processes of the brain called dysautoregulation. Without an understanding of the changes that have occurred on a molecular level in SIS the assignment of cause and manner of death is difficult for the medical examiner. Currently, in order to diagnose SIS, a thorough scene investigation, along with the documentation of a previous head injury is needed. Without a full understanding of SIS and the pathophysiology changes that take place a medical examiner (ME) could misclassify the cause and manner of death in a death due to SIS. In the future, eliminating the prerequisite of identification and documentation of previous head injuries in order to diagnose SIS is needed. This paper evaluates the literature on the current knowledge of TBI and concussions in an attempt to create a protocol on how a medical examiner should approach a case where autopsy findings are unremarkable.

This research study explored the meaning of ¿Being¿ (i.e. Heidegger¿s four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner¿s officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England.