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Department of Legal Medicine

Osaka Metropolitan University Graduate School of Medicine

The Immediate Objective

In order to gain a deeper understanding of society and plan improvements in the objectivity and accuracy of medico?legal autopsies, firstly, it is important to nurture and functionalize sub-specialities for conducting routine work in each forensic facility.

In addition, for our achievements to receive appropriate evaluation as “normal” social contributions, it is important for us to actively disseminate information in society as facilitators.

In other words, to overcome prejudices and misunderstandings against medico?legal autopsy, which have become rooted due to an excessive emphasis on the “investigation of the cause of death,” especially to exclude the individual and empirical “discretion” of experts as much as possible, it is socially important to utilize test methods of medical biochemistry, molecular pathology, and toxicology, which have a high degree of objectivity and post-mortem imaging study based on the fundamental concepts of forensic pathological diagnosis, to “visualize” the pathophysiology of a complex death, and to comprehensively and exhaustively analyze it.

Further, the systematic and coordinated development of autopsy imaging and biochemistry and molecular pathology is beneficial for the objective “visualization” of morphological and pathophysiological diagnostic evidence and is the minimum requirement in the practice of “precise and accurate autopsy” for conducting diagnosis of the cause of death and evaluation of the process of death.

Prospects

In forensics, which is widely related to the protection of human rights and social risk management, the fundamental concept and goal of forensic medicine is to think about medicine and healthcare and other related systems from the perspective of protecting every individual’s human rights and maintaining fairness and the interest of the community, while maintaining collaboration with various relevant disciplines with overlapping objectives, such as health care risk management studies, medical law, compensation science and medicine, and life ethics, and to comprehensively and inter-disciplinarily give back to society through forensic practices.

For this, unless the academic information and know-how obtained in forensic practices in each facility reflect the advances in medical science and have a high commonality, they will not be accepted as “scientific and fair medical judgements”.

The prerequisites for this are updated forensic pathology and practical forensic toxicology that include biochemistry and molecular pathology. The importance of toxicology has been indicated frequently whenever there is a “failure”, but no signs of fundamental improvement have been seen at all.

It is necessary for us and the society as a whole to now thoroughly think about ways to respond to these challenges. Medical education that arouses an abnormal interest in the “investigation of the cause of death” and that makes one think that any doctor can thoroughly perform an autopsy or diagnose injury is not desirable.

In research, what is important is planning with the goal that the autopsy data of a “person” should provide to medical treatments and society. In medico-legal judgment, experts should include one’s own discretion and not trust books unquestioningly; further, they should apply practical experience and expertise, based on the latest objective clinical analysis data through validation of oneself and others through research and consider it as the foundation of their “scientific and fair medical judgements”. The transfer of this know-how should be the principle of education and on-the-job training.

Challenges

In the future, it is necessary to improve and systematize forensic medicine and efficiently functionalize it considering that forensic medicine is the foundation of the “support for the judicial system” from the perspective of crisis management and assistance for victims in the local communities and the prevention of false charges. Specifically, it is important to focus on the following issues 1) establishment of a social system that enables the performance of tasks related to medico-legal autopsy under social responsibilities and social contribution as one, 2) arrangement of infrastructure, facilities/equipment, and staff required for the same, 3) establishment of a budget based on practical achievements, and 4) disseminating information that ensures that these achievements receive appropriate evaluation as social contributions.

Further, apart from the standardization of medico-legal autopsy methods, the establishment of autopsy-related testing systems including forensic radiology, histopathology, toxicological chemistry, biochemistry, molecular biology, and microbiology/serology; further, routine work is indispensable for on-the-job-training, self-evaluation, life-long learning, and third-party evaluation. Moreover, in the future, it is important to aim for the introduction of a certification system in line with international standards.