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Forensic medicine in Bangladesh
Legal Medicine 5 (2003) S357–S359 www.elsevier.com/locate/legalmed
Forensic medicine in Bangladesh Muhammad Nurul Islam a,*, Mohammed Nasimul Islam b a
Department of Forensic Medicine, Dhaka Medical College, Dhaka, Bangladesh b Forensic Science Programme, PPSK, University of Sains, Kelantan, Malaysia
Abstract In this paper, we discuss the current medico-legal practice and future plan to improve the medico-legal service of Bangladesh which is rooted in the remnants of British medical jurisprudence. It includes clinical forensic medicine and forensic pathology. In Bangladesh all unnatural deaths are to be reported at the nearest police station and an appointed police officer should visit the scene of crime for investigation and to arrange postmortem if required. The forensic services of the country are delivered partly by academic staffs of Government Medical Colleges and the rest by the Civil Surgeons. Sometimes, residential medical officers in the district hospitals perform the medico-legal work. Most of them have no forensic qualifications except a long exposure in the medico-legal field. Currently academic and professional postgraduate courses are available. The chemical examiner’s laboratory is situated at Dhaka with the facility of quantitative tests only. The Government of Bangladesh is trying to standardize the existing system. A Workshop on medico-legal services has been organized regularly by The Medico-legal Society of Bangladesh. A DNA profiling laboratory at the Dhaka Medical College is in the process of being set up. Such progress will be a milestone in the development of the medico-legal service in Bangladesh. However, with a few exceptions, teaching and training facilities are still lacking. q 2003 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Forensic medicine; Clinical forensic medicine; Unnatural death; Autopsy; Education system
1. Introduction Bangladesh is a developing country located in the South East Asia with an area of 147,570 km 2 and population of 111.4 million. The capital is Dhaka with a population of 6.9 million people [1]. The country is divided into six divisions and 64 districts. The economy of the country is predominantly agriculturebased with a few industries. The present medico-legal system in Bangladesh was inherited from the British
* Corresponding author. Present address: c/o Serious Crimes Unit, UNMISET (United Nations Mission of Support in East Timor), P.O. Box 2436, Darwin, NT 0801, Australia. Tel.: 11-212-9630099x6750. E-mail address: [email protected] (M.N. Islam).
and continued up until today. In our country, we have adopted and follow the Continental System with some modifications in performing medico-legal autopsy. All district hospitals have autopsy facilities including 13 Government medical colleges. According to Bangladesh law, all unnatural deaths that are reported to the police are subject to forensic investigation. The investigative process is carried out by the judiciary. The police officer not below the rank of Sub-Inspector issues an inquest for postmortem examination. The medico-legal investigations of deaths are carried out by available qualified doctors. 2. History of forensic medicine Historical links exist between past and present and benefit the future. The history of Forensic Medicine
1344-6223/03/$ - see front matter q 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S1 344-6223(02)00 132-3
S358
M.N. Islam, M.N. Islam / Legal Medicine 5 (2003) S357–S359
includes development and the present state of the death investigation machinery in its official governmental aspects, and also medical and scientific study of legal problems. Official investigation of unnatural death is basically by two systems, both of European origin [2]. Most countries have a legal procedure for investigating deaths that are not obviously natural. Most countries have a rigid criminal code, which defines the procedure for the investigation of criminal or suspicious deaths, and most have a penal code, which defines the offenses and prescribes punishments. The medico-legal or forensic autopsy is performed on the instruction of the legal authority responsible for the investigation of sudden, suspicious, obscure, unnatural, litigious or criminal deaths [3]. In our country, medico-legal autopsies are carried out under the provision of (i) The Penal Code (1860), (ii) The Code of Criminal Procedure (1898), and (iii) The Evidence Act (1872). 3. The British period (1747–1947) During the British period the Civil Surgeon, who would be a British doctor, was responsible for all the medico-legal work throughout the district under his jurisdiction. The original post of Civil Surgeon is still retained to this day. 4. The Pakistan period (1947–1971) During the Pakistan period no change was made. With the establishment of medical colleges academic departments of Medical Jurisprudence were established to teach the subject to undergraduate students and the Civil Surgeons were appointed as part-time teachers of Medical Jurisprudence. This continued to the end of Pakistan period when it was felt necessary to reorganize the departments with qualified teachers. Professional posts in Medical Jurisprudence in eight medical colleges were thus established. 5. Present day During the Bangladeshi period five new Government medical colleges were established, and the then rudimentary Medical Jurisprudence depart-
ment was replaced by Forensic Medicine and was introduced as an academic subject in the medical curriculum. Medico-legal autopsy and clinical forensic medicine is now the major component of autopsy practice in all teaching centers, dealing with rising crime rates and especially the increase of violence against the life and health of persons, the increase in traffic injuries and traffic deaths as well as the rising frequency of mass disasters, and also civil litigation on health matters requiring standardization of forensic medical teaching and medico-legal practice.
6. Postgraduate education in Forensic Medicine The College of Physicians and Surgeons of Bangladesh is a body similar to that of The Royal College of Physicians and Surgeons in the United Kingdom and is the examining body for postgraduate education in different branches of Medicine. The degree of MCPS (Member of the College of Physicians and Surgeons) in Forensic Medicine is awarded after an examination. Four examiners from different Universities examine the candidate. At present we have 55 forensic pathologists with MCPS degrees. A 1-year full-time course is available in different universities towrds the DFM (Diploma in Forensic Medicine). At present we have 30 forensic pathologists with DFM degrees. In the near future, the Medical University is introducing a 3-year M.Phil. course, which will help in improving forensic science in Bangladesh.
7. Undergraduate education in Forensic Medicine Medical studies consist of a 5-year-program leading to the MBBS degree followed by a year’s internship. Undergraduate education in Forensic Medicine is given for two academic years in the third and fourth year of the MBBS course with a final examination at the end of fourth year. Much emphasis is placed on teaching forensic medicine to undergraduates because in Bangladesh doctors posted to remote areas are required to do medico-legal work on a routine basis. There is a good number of private medical institutions offering undergraduate courses.
M.N. Islam, M.N. Islam / Legal Medicine 5 (2003) S357–S359
8. The medico-legal service The forensic medical service in Bangladesh includes clinical forensic medicine and forensic pathology. The service is given by the state through the Ministry of Health. In our country the police, and sometimes the Magistrates must screen these deaths. After receiving the information of any unnatural death within the jurisdiction of the nearby police station, the legal authority usually send one police officer to the scene of crime and makes an inquest report. An Inquest is an inquiry or investigation into the cause of death. The police officer then sends the dead body to the nearest mortuary. In the cities where a government medical college is available, any academic staff are empowered to perform an autopsy, otherwise by by the Civil Surgeon (district health administrator) in the district hospitals. Residential medical officers are empowered to perform medico-legal work. All autopsy doctors should attend the court for the purposes of providing evidence.
9. Common medico-legal problems in Bangladesh In the present century, progress in the process of crime investigation has continued with advancement in the scientific medico-legal practices. But in our country medico-legal investigations lag behind the normal standard followed. Forensic pathologists handle a very small part of total medico-legal work. In most countries the decision on the ‘manner’ of death is reserved for a legal official, not a doctor [4]. But in our country forensic pathologists are expected to determine the manner of death. The only Chemical Examiner’s Office situated in Dhaka is always overburdened. There are numerous problems involved with the preparation, delivery and use of chemical reports. A Forensic Science Laboratory is yet to be established. The absence of medico-legal specialists in both rural and urban areas and the concomitant undertaking of their duties by doctors who are not qualified in forensic pathology has, unsurprisingly, occasionally resulted in inadequate medico-legal investigations. Attending all the road traffic accident cases in the mortuary creates a huge workload. There is no coordination between ministries of Home, Health, Law and Justice as far as autopsies are
S359
concerned. Teaching and training facilities at the university level, with few exceptions, is lacking in the subject. Most scientists in the profession are not expert by training but are expert by position.
10. Professional organization The Medico-legal Society of Bangladesh, a professional organization of forensic medicine, was established in 1986. It has adopted a constitution and formulated proposals to organize a proper medicolegal system in the country. It organizes training for junior teachers and other doctors in forensic medicine and is also involved in giving lectures concerning aspects of forensic medicine to the police and members of the legal profession, but in a limited way.
11. Possible suggestions On the basis of this discussion we can make some possible suggestions for reforms. Development of the existing setup of the medico-legal system through international support and help is desired. The forensic specialist should perform medico-legal work as oposed to untrained medical graduates as medicolegal work is a highly technical and specialized job. A Registrar for Births and Deaths has yet to be established in this country. Postgraduate study and research should be encouraged and every effort should be taken for the departmental doctors to visit internationally reputed forensic centers. The establishment of a DNA laboratory in the Forensic Medicine Department of Dhaka Medical College could stimulate and enhance medico-legal functions in Bangladesh.
References [1] Bangladesh Bureau of Statistics, Statistics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh. 1997 statistical yearbook of Bangladesh. 18th ed 1998. [2] Mant AK. Taylor’s principles and practice of medical jurisprudence, 13th ed. London: Churchill Livingstone, 1984. p. 215. [3] Knight B. Legal aspects of medical practice, London: Churchill Livingstone, 1997. p. 107. [4] Parikh CK. Parikh’s textbook of medical jurisprudence and toxicology, 4th ed. Bombay: CBS publishers & distributors, 1986. p. 85.
Forensic medicine in Bangladesh Muhammad Nurul Islam a,*, Mohammed Nasimul Islam b a
Department of Forensic Medicine, Dhaka Medical College, Dhaka, Bangladesh b Forensic Science Programme, PPSK, University of Sains, Kelantan, Malaysia
Abstract In this paper, we discuss the current medico-legal practice and future plan to improve the medico-legal service of Bangladesh which is rooted in the remnants of British medical jurisprudence. It includes clinical forensic medicine and forensic pathology. In Bangladesh all unnatural deaths are to be reported at the nearest police station and an appointed police officer should visit the scene of crime for investigation and to arrange postmortem if required. The forensic services of the country are delivered partly by academic staffs of Government Medical Colleges and the rest by the Civil Surgeons. Sometimes, residential medical officers in the district hospitals perform the medico-legal work. Most of them have no forensic qualifications except a long exposure in the medico-legal field. Currently academic and professional postgraduate courses are available. The chemical examiner’s laboratory is situated at Dhaka with the facility of quantitative tests only. The Government of Bangladesh is trying to standardize the existing system. A Workshop on medico-legal services has been organized regularly by The Medico-legal Society of Bangladesh. A DNA profiling laboratory at the Dhaka Medical College is in the process of being set up. Such progress will be a milestone in the development of the medico-legal service in Bangladesh. However, with a few exceptions, teaching and training facilities are still lacking. q 2003 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Forensic medicine; Clinical forensic medicine; Unnatural death; Autopsy; Education system
1. Introduction Bangladesh is a developing country located in the South East Asia with an area of 147,570 km 2 and population of 111.4 million. The capital is Dhaka with a population of 6.9 million people [1]. The country is divided into six divisions and 64 districts. The economy of the country is predominantly agriculturebased with a few industries. The present medico-legal system in Bangladesh was inherited from the British
* Corresponding author. Present address: c/o Serious Crimes Unit, UNMISET (United Nations Mission of Support in East Timor), P.O. Box 2436, Darwin, NT 0801, Australia. Tel.: 11-212-9630099x6750. E-mail address: [email protected] (M.N. Islam).
and continued up until today. In our country, we have adopted and follow the Continental System with some modifications in performing medico-legal autopsy. All district hospitals have autopsy facilities including 13 Government medical colleges. According to Bangladesh law, all unnatural deaths that are reported to the police are subject to forensic investigation. The investigative process is carried out by the judiciary. The police officer not below the rank of Sub-Inspector issues an inquest for postmortem examination. The medico-legal investigations of deaths are carried out by available qualified doctors. 2. History of forensic medicine Historical links exist between past and present and benefit the future. The history of Forensic Medicine
1344-6223/03/$ - see front matter q 2003 Elsevier Science Ireland Ltd. All rights reserved. doi:10.1016/S1 344-6223(02)00 132-3
S358
M.N. Islam, M.N. Islam / Legal Medicine 5 (2003) S357–S359
includes development and the present state of the death investigation machinery in its official governmental aspects, and also medical and scientific study of legal problems. Official investigation of unnatural death is basically by two systems, both of European origin [2]. Most countries have a legal procedure for investigating deaths that are not obviously natural. Most countries have a rigid criminal code, which defines the procedure for the investigation of criminal or suspicious deaths, and most have a penal code, which defines the offenses and prescribes punishments. The medico-legal or forensic autopsy is performed on the instruction of the legal authority responsible for the investigation of sudden, suspicious, obscure, unnatural, litigious or criminal deaths [3]. In our country, medico-legal autopsies are carried out under the provision of (i) The Penal Code (1860), (ii) The Code of Criminal Procedure (1898), and (iii) The Evidence Act (1872). 3. The British period (1747–1947) During the British period the Civil Surgeon, who would be a British doctor, was responsible for all the medico-legal work throughout the district under his jurisdiction. The original post of Civil Surgeon is still retained to this day. 4. The Pakistan period (1947–1971) During the Pakistan period no change was made. With the establishment of medical colleges academic departments of Medical Jurisprudence were established to teach the subject to undergraduate students and the Civil Surgeons were appointed as part-time teachers of Medical Jurisprudence. This continued to the end of Pakistan period when it was felt necessary to reorganize the departments with qualified teachers. Professional posts in Medical Jurisprudence in eight medical colleges were thus established. 5. Present day During the Bangladeshi period five new Government medical colleges were established, and the then rudimentary Medical Jurisprudence depart-
ment was replaced by Forensic Medicine and was introduced as an academic subject in the medical curriculum. Medico-legal autopsy and clinical forensic medicine is now the major component of autopsy practice in all teaching centers, dealing with rising crime rates and especially the increase of violence against the life and health of persons, the increase in traffic injuries and traffic deaths as well as the rising frequency of mass disasters, and also civil litigation on health matters requiring standardization of forensic medical teaching and medico-legal practice.
6. Postgraduate education in Forensic Medicine The College of Physicians and Surgeons of Bangladesh is a body similar to that of The Royal College of Physicians and Surgeons in the United Kingdom and is the examining body for postgraduate education in different branches of Medicine. The degree of MCPS (Member of the College of Physicians and Surgeons) in Forensic Medicine is awarded after an examination. Four examiners from different Universities examine the candidate. At present we have 55 forensic pathologists with MCPS degrees. A 1-year full-time course is available in different universities towrds the DFM (Diploma in Forensic Medicine). At present we have 30 forensic pathologists with DFM degrees. In the near future, the Medical University is introducing a 3-year M.Phil. course, which will help in improving forensic science in Bangladesh.
7. Undergraduate education in Forensic Medicine Medical studies consist of a 5-year-program leading to the MBBS degree followed by a year’s internship. Undergraduate education in Forensic Medicine is given for two academic years in the third and fourth year of the MBBS course with a final examination at the end of fourth year. Much emphasis is placed on teaching forensic medicine to undergraduates because in Bangladesh doctors posted to remote areas are required to do medico-legal work on a routine basis. There is a good number of private medical institutions offering undergraduate courses.
M.N. Islam, M.N. Islam / Legal Medicine 5 (2003) S357–S359
8. The medico-legal service The forensic medical service in Bangladesh includes clinical forensic medicine and forensic pathology. The service is given by the state through the Ministry of Health. In our country the police, and sometimes the Magistrates must screen these deaths. After receiving the information of any unnatural death within the jurisdiction of the nearby police station, the legal authority usually send one police officer to the scene of crime and makes an inquest report. An Inquest is an inquiry or investigation into the cause of death. The police officer then sends the dead body to the nearest mortuary. In the cities where a government medical college is available, any academic staff are empowered to perform an autopsy, otherwise by by the Civil Surgeon (district health administrator) in the district hospitals. Residential medical officers are empowered to perform medico-legal work. All autopsy doctors should attend the court for the purposes of providing evidence.
9. Common medico-legal problems in Bangladesh In the present century, progress in the process of crime investigation has continued with advancement in the scientific medico-legal practices. But in our country medico-legal investigations lag behind the normal standard followed. Forensic pathologists handle a very small part of total medico-legal work. In most countries the decision on the ‘manner’ of death is reserved for a legal official, not a doctor [4]. But in our country forensic pathologists are expected to determine the manner of death. The only Chemical Examiner’s Office situated in Dhaka is always overburdened. There are numerous problems involved with the preparation, delivery and use of chemical reports. A Forensic Science Laboratory is yet to be established. The absence of medico-legal specialists in both rural and urban areas and the concomitant undertaking of their duties by doctors who are not qualified in forensic pathology has, unsurprisingly, occasionally resulted in inadequate medico-legal investigations. Attending all the road traffic accident cases in the mortuary creates a huge workload. There is no coordination between ministries of Home, Health, Law and Justice as far as autopsies are
S359
concerned. Teaching and training facilities at the university level, with few exceptions, is lacking in the subject. Most scientists in the profession are not expert by training but are expert by position.
10. Professional organization The Medico-legal Society of Bangladesh, a professional organization of forensic medicine, was established in 1986. It has adopted a constitution and formulated proposals to organize a proper medicolegal system in the country. It organizes training for junior teachers and other doctors in forensic medicine and is also involved in giving lectures concerning aspects of forensic medicine to the police and members of the legal profession, but in a limited way.
11. Possible suggestions On the basis of this discussion we can make some possible suggestions for reforms. Development of the existing setup of the medico-legal system through international support and help is desired. The forensic specialist should perform medico-legal work as oposed to untrained medical graduates as medicolegal work is a highly technical and specialized job. A Registrar for Births and Deaths has yet to be established in this country. Postgraduate study and research should be encouraged and every effort should be taken for the departmental doctors to visit internationally reputed forensic centers. The establishment of a DNA laboratory in the Forensic Medicine Department of Dhaka Medical College could stimulate and enhance medico-legal functions in Bangladesh.
References [1] Bangladesh Bureau of Statistics, Statistics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh. 1997 statistical yearbook of Bangladesh. 18th ed 1998. [2] Mant AK. Taylor’s principles and practice of medical jurisprudence, 13th ed. London: Churchill Livingstone, 1984. p. 215. [3] Knight B. Legal aspects of medical practice, London: Churchill Livingstone, 1997. p. 107. [4] Parikh CK. Parikh’s textbook of medical jurisprudence and toxicology, 4th ed. Bombay: CBS publishers & distributors, 1986. p. 85.