Medicine,Science and the Law

There has been limited study to date into the specific patient factors that influence decisions about an individual's need for high-security psychiatric care. Admission to high-security services requires careful assessment and consideration to ensure patients receive the least restrictive care justified, and those who are most likely to benefit from it are admitted. This retrospective case-control study describes the demographic, clinical and risk characteristics of referrals made to the State Hospital in Scotland during a 12-month period, and delineates differences between referrals that were accepted and rejected for admission. It updates the methods of a previous study undertaken at the State Hospital. Six variables differentiated rejected and accepted referrals in univariate analyses. Multivariate logistic regression found that a model with only the individual's age, whether they were prescribed antipsychotic medication at the time of referral, and whether they had a history of violent convictions, best predicted referral outcome. The findings support the conclusion that it is not only an individual's risk of violence or the severity of their mental illness in isolation, but the combination of these factors that is deemed to necessitate high-security care within a stratified forensic mental health system.

The incidence of fatal staircase accidents in Japanese households has remained consistent for several decades, with staircase dimension regulations seeing minimal revisions since their inception. Studies concurrently investigating the influence of staircase factors and user factors on staircase accidents, particularly in terms of severity, are lacking. This study examined how these factors influence the severity of accidents by means of an Internet-based questionnaire survey. A private company was tasked with conducting the survey, and logistic regression analysis, encompassing both staircase and user factors, was performed on 165 individuals in the mild injury group and 129 in the severe injury group from a pool of 6945 responses. The odds ratio (OR) of the severe injury group to the mild injury group was assessed. For staircase factors, the OR of severe injury was 2.16 (95% confidence interval (CI): 1.23-3.79) for straight stairs, with increased OR observed with a higher number of steps and wider staircases. Regarding user factors, the OR was 3.80 (95% CI: 1.29-11.14) for individuals with visual disturbance, with the OR escalating with age. This study suggests that in Japan, among the legally defined factors for stairways, limiting the installation of straight stairways and setting limits on stairway width can reduce the impact on the severity of accidents. And, of course, it is crucial to promote the use of alternatives, especially among high-risk users.

People living in prisons have higher mortality rates compared to the general population. We undertook a retrospective analysis of deaths recorded between 2010 and 2018 at the sole prison hospital in Greece (Korydallos Prison Special Health Centre for men) to assess the causes of death overall and by type of offence (drug-related or other), sociodemographic characteristics by cause of death, and mortality trends over time. Permission to access forensic reports and criminal files was obtained from the relevant authorities. Deaths were categorized as either non-natural (drug overdose, suicide, and homicide) or natural (cardiovascular disease, cancer, and others). Between 2010 and 2018, 236 deaths were reported; 80.9% were natural deaths, and 19.1% were non-natural deaths. The primary causes of death were circulatory disease (34.7%), cancer (17.8%), suicide (10.2%), respiratory disease (8.9%), and overdose (6.4%). Suicide and overdose accounted for 53.3% and 33.3% of non-natural deaths, respectively. The mean (SD) age at death was 52.4 (16.2) years, with individuals experiencing non-natural deaths being significantly younger than those experiencing natural deaths [39.1 (10.5) vs. 55.5 (15.7), p < 0.001]. Among individuals incarcerated for drug-related offences, 23.8% died from non-natural causes, with drug overdose accounting for 60% of non-natural deaths. A significant peak in mortality was observed in 2013. This study emphasizes the need to closely monitor mortality rates, including drug-related fatalities, to implement suicide prevention training as well as measures to prevent deaths by overdose, including comprehensive harm reduction strategies, overdose education, and naloxone training.

The possession and trafficking of drug substances is one of the major public health problems. When examining court records of drug offenses, it is often found that the dealer may claim to be a user in order to avoid punishment. Of course, it is essential to determine whether the crime is drug trafficking or personal possession.

The role of the courts in determining the purpose of possession is quite complex, as it requires an understanding of the offender's intent. This situation shows us that two articles in Turkish law (TPC No. 5237, Articles 188 and 191) could not be drawn with clear lines. Although there are many factors that cause this unclarity, the most complex one is the amount of substance recovered, i.e., the threshold value. This threshold terminology is a situation of great importance, given the increase in the types of illegal substances in today's world. In this study, we examined the verdicts (805 files) on the four main classical illicit substances commonly found in Turkish courts between 2016 and 2023 to determine the conditions that play an important role in determining the intention to supply drugs based on judicial principles.

Independent mental health homicide inquiries in England are required to comment on predictability and preventability and attribute causation. National commissioning bodies do not provide definitions. This study examines how predictability and preventability were determined, and causality attributed, by independent mental health homicide inquiries published in England between 2010 and 2023. The conceptual underpinnings of predictability and preventability in other specialities of medicine, and in suicide and homicide assessments in psychiatry are examined. We found 189 independent reports relating to mental health homicides, of which 162 independent homicide inquiries were included in the final analysis. No inquiry described how it attributed causation or addressed cognitive biases. A total of 130 of the 162 inquiries (80%) commented on either predictability or preventability: of these, only eight (6%) included a clear definition of predictability and preventability. Homicides were deemed predictable if the inquiry panel felt that the perpetrator's words or actions should have alerted professionals to a risk of significant violence; and preventable if the clinical team had knowledge, legal means, and opportunity to stop the homicide from occurring. 105 inquiries (81%) provided a firm view on both predictability and preventability. Of these, four homicides (4%) were deemed to be both predictable and preventable, ten (9%) were preventable but not predictable, five (5%) were predictable but not preventable, and 86 (82%) were neither predictable nor preventable. The implications of these findings are discussed, with recommendations to national commissioning bodies.

Dental age (DA) estimation plays a crucial role in forensic investigations, clinical diagnosis, and treatment planning. It is considered more reliable than skeletal methods due to the predictable nature of dental development. This study aimed to evaluate the accuracy of three DA estimation methods—Nolla method, Cameriere-European formula, and Blenkin-Evans method—in Turkish children aged 6–14 years. A total of 1014 panoramic radiographs were analyzed. DA was estimated using the three methods and compared with chronological age (CA). Accuracy was assessed based on mean absolute error (MAE), mean difference (DA–CA), and correlation coefficients. Statistical analyses were performed to determine significant differences among methods. The Cameriere-European formula demonstrated the lowest MAE (0.44 for boys, 0.48 for girls, and 0.46 for all samples), indicating the highest accuracy, followed by the Blenkin-Evans (0.54 for boys, 0.53 for girls, and 0.54 for all samples) and Nolla (0.57 for boys, 0.65 for girls, and 0.61 for all samples) methods. However, the Cameriere-European formula slightly underestimated CA, particularly in older children. The Blenkin-Evans method showed relatively stable accuracy but overestimated CA in both sexes. The Nolla method generally underestimated CA, except in boys, where it slightly overestimated age. All three methods exhibited strong correlations with CA (Spearman rho correlation coefficients ranging from 0.953 to 0.970, all p < .001). The Cameriere-European formula provided the most accurate DA estimation method, followed by the Blenkin-Evans and Nolla methods for Turkish children from the Northwestern Anatolia. However, the observed biases highlight the need for population-specific calibrations.

This study assessed the potential of the foramen magnum (FM) in the Malaysian juvenile population to estimate sex using computed tomography (CT) data. A total of 200 (male = 100; female = 100) CT images of Malaysian individuals aged between 8 and 16 were retrieved. The maximum length (FML) and width (FMW), area (FMA 1 and FMA 2), and index (FMI) of the three-dimensional image of the FM were measured and analysed using Mimics software version 20 (Materialise N.V., Heverlee, Belgium). These metric data were then used to develop sex estimation models through discriminant function analysis (DFA) and binary logistic regression (BLR). The results showed that all measurements in males were significantly higher than in females (p < 0.001), demonstrating a high potential for accurate sex classification. Additionally, females exhibited a wider FM than males, as indicated by the FM index. Based on univariate DFA analysis, FML and FMA 2 were identified as reliable variables for sex estimation, achieving an accuracy of 68.5% with a low sex bias rate of 1.2%. The multivariate DFA yielded a higher accuracy of 70.5% compared to the univariate analysis. Similarly, univariate and multivariate BLR analyses demonstrated comparable accuracies of 68.5%. Overall, the DFA showed greater accuracy and lower sex bias across all cases, including original and validation samples. This study suggests that FM parameters can complement existing sex estimation methods and be integrated with other techniques to improve skeletal sex determination.

Electronic monitoring (‘tracking’) of individuals has been used in the UK criminal justice system for over three decades, and its use is increasing. Electronic monitoring has more recently been implemented in forensic psychiatric services, which has generated considerable debate about the appropriateness of its use in clinical settings, and about legal and ethical concerns. The purpose of this article is to formally address the ethical issues that arise from using electronic monitoring in forensic psychiatry. These issues are considered using the Four Principles approach to medical ethics, namely autonomy, beneficence, non-maleficence, and justice. We conclude that by adopting a patient-centred approach, where informed consent is sought, and the patient's best interests remain central to the decision-making process, electronic monitoring is both ethical and justifiable. More robust studies are required to develop standardised clinical guidelines for the use of EM in forensic psychiatry, and to apply the theory of patient-centred, consent-driven care to practice.

This paper examines the death penalty through a public health framework, analysing its systemic impacts on individual and community well-being. Drawing on recent legislative changes in Malaysia, including the 2023 abolition of mandatory capital punishment, the study identifies three critical pathways through which the death penalty threatens public health: prolonged confinement of death row inmates, miscarriages of justice, and punitive drug policies. The research highlights how capital punishment creates trauma that extends beyond death row prisoners and affects families, prison staff, legal professionals, and communities. It emphasises the death penalty's disproportionate impact on marginalised groups, including women, sexual minorities, and individuals with disabilities, who face compounded discrimination in the judicial system. The paper concludes that abolishing the death penalty is not merely a legal imperative but a public health necessity, recommending a shift toward evidence-based, health-centred approaches that prioritise rehabilitation, harm reduction, and restorative justice.

The recent introduction in Italy of unsupervised conjugal visits for prisoners is part of a broader trend that has been well-established across numerous European countries. This provision is grounded in the respect for constitutional rights and the principles set out by the European Court of Human Rights (ECHR), which underscores the centrality of private and family life even for incarcerated individuals. This development raises significant bioethical and medico-legal challenges, which have yet to be fully explored, particularly regarding conception during conjugal visits. The present article critically analyses the bioethical implications related to the right to parenthood in prison, state responsibility towards the unborn child, reproductive health challenges, and related medico-legal issues. It highlights a legislative gap that urgently requires attention and proposes operational strategies for addressing these challenges.