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Forensic medicine in Scotland
61
Forensic
Medicine in Scotland
Though Scotland is part of the United Kingdom, its legal system is quite separate and has different origins. As Scotland was not politically combined with England, Wales and Northern Ireland until relatively late in its history (1707), its system of jurisprudence was retained after the union and has more affinity with continental legal systems derived from Roman law, than with English law which is basically Anglo-Saxon. Thus there has never been any coroner’s system in Scotland and, although recent statutory legislation tends either to be identical with, or similar to, the Acts of Parliament in London, many differences remain, some of which have a profound effect upon medico-legal matters. Scotland has a longer tradition of forensic medicine than the rest of the United Kingdom, and in fact the first university Chair in forensic medicine was established in Edinburgh as long ago as 1807, many years before a professorship was established in London. From that time, there has been a strong leaning towards forensic medicine (or “medical jurisprudence” as it tends to be named in Scotland) and, in consequence, the undergraduate teaching programme has always been much more extensive than that in England or Wales. Some of the famous names in academic forensic medicine have come from Scotland, such as Harvey Littlejohn, Sir Sidney Smith, and the two John Glaisters, father and son. These names are also familiar through their well-known textbooks, which have been used in all parts of the Englishspeaking world. Thus legal medicine in Scotland cannot be easily included in a general survey of Great Britain, as there are so many differences. The discipline is dealt with in four university centres, comprising the capital Edinburgh, Glasgow, Dundee, and Aberdeen. In Edinburgh and Glasgow there are Chairs of forensic medicine, both being described as “Regius” Chairs, indicating that they were set up by royal assent. At the moment the Chair of Forensic Medicine in the University of Edinburgh is held by Professor J. K. Mason, formerly a senior pathologist of the Royal Air Force and an international authority on aviation pathology. In Glasgow, the Regius Professor is W. A. Harland and this Department is by far the largest in Scotland, and indeed in Great Britain, as it also has wide interests in forensic science, especially in toxicology. The Department in the University of Dundee is headed by a senior lecturer, as is the Department at the University of Aberdeen. In the University of Strathclyde, there is a department of forensic sciences, but no medical jurisprudence department. About six doctors are employed in legal medicine in the above departments, as well as about five toxicologists who do not have medical qualifications. The departments are financed from university funds, though there is
68
also some income from fees for services provided by them. The departments provide service facilities in forensic pathology and toxicology, but there is variation between the different universities as far as subjects like forensic psychiatry and clinical examination of living patients are concerned. The large department in Glasgow has extensive toxicology and serology facilities, but purely criminalistic facilities are provided by the police laboratories. There is no separate State medical legal service, though Scotland has a well-developed “police surgeon” system which provides clinical forensic medicine facilities. In some of the universities the senior lecturer of the academic department functions as a police surgeon, and in Edinburgh half his salary is paid by the police authority. In Glasgow, the police surgeon is separate from the university department. As mentioned above, the undergraduate teaching programme in Scotland is extensive, compared with the rest of Britain. Medical jurisprudence is a compulsory topic in the medical curriculum and in Glasgow University forensic medicine is examined separately as a subject in the final examination for qualifying as a doctor. In the other universities there is an examination which is internal in nature, without external examiners as in Glasgow. In addition, the Scottish departments of legal medicine provide tuition to law, medical and dental students, and in fact the teaching programme for law students is frequently more extensive than that given to medical and dental students. In the University of Edinburgh, tuition is given to medical students for one term in the 5th year of study extending over 26 hours. These are all lectures and seminars with no practical instruction. Autopsy instruction is not given. Edinburgh teaches its dental students for two terms in the final year, totalling 15 hours of lectures. The Edinburgh law students are taught in their 3rd year for three terms extending over 64 hours. In Glasgow, medical jurisprudence is taught during the 4th year and consists entirely of lectures, with no practical or autopsy instruction. In all the universities, the full range of topics is dealt with, including forensic pathology, medical ethics and the physician’s relations with the State and its laws. In Edinburgh, instruction is given in respect of clinical legal medicine, such as the examination of sexual offences and drunken persons. The portion of the time of the department staff devoted to teaching varies, and in Glasgow approximates to about 5%. Post-graduate instruction in legal medicine is not organised into formal courses, but individual arrangements are made to teach junior assistants attached to the department. In Edinburgh, there is a post-graduate course in forensic medicine as a part of the Diploma in Criminology. There is also post-graduate teaching given to the Procurators-Fiscal, the law officers who carry out the functions approximating to the English coroner. There is also a heavy teaching commitment to police forces. Scotland has no post-graduate qualifications or diploma in legal medicine, this being included in the general system for Great Britain. The examination for the Membership of the Royal College of Pathologists in London is the major qualification for pathologists generally, and the final examination for
69
this Membership may be “slanted” towards forensic pathology. There is also the Diploma in Medical Jurisprudence (D.M.J.) granted by the Society of Apothecaries in London, both in Pathology and in Clinical Forensic Medicine, and other specialists may obtain a Doctorate in Medicine (M.D.) by writing a thesis on a forensic subject. A medico-legal expert does not have to hold any of these degrees before he is legally entitled to carry out medico-legal work, but the career structure of medicine in Great Britain is such that those doctors who reach a specialist consultant grade, either in the National Health Service or in the university service, are unlikely to obtain such appointments without a higher qualification. The medical staff of the university institutes is paid a fixed academic salary but there are variations in the retention of certain fees for items of service such as clinical examinations and medico-legal autopsies. Fees obtained for attendance at court are also frequently retained by the doctor. Fees paid by State of city authorities for routine autopsy services are usually paid to the university. The facilities of these institutes are equally available to the prosecution or to the legal representatives of the opposite party, whether in a civil or criminal action. This function of also advising defence in a criminal prosecution is frequent throughout Britain, though naturally the same medico-legal expert cannot give advice to both sides simultaneously, as in the Scandinavian system where the medical opinion is delivered mutually to the court rather than to one or other of the opposing parties. As stated, the forensic institutes do not offer purely criminalistic facilities such as firearms examination, etc., though Glasgow has an extensive commitment to toxicolo,T and serology, not shared by the other institutes. The Department of Forensic Science in Strathclyde University is unique in Britain in that if offers a university course in non-medical forensic science subjects. Compared to the English departments of forensic medicine, the Scottish institutes are concerned much more in forensic scientific matters and this is reflected in some of the traditional Scottish textbooks which contain much which is nowadays considered to be the province of the criminalistics laboratory, such as fibre comparison and quite extensive sections on serology and toxicology. Like the professional examinations, there are no specifically Scottish professional societies concerned with legal medicine, Scottish experts participating fully in the overall British complex of associations. These include the Royal College of Pathologists, the Forensic Science Society, the British Association in Forensic Medicine and the British Academy of Forensic Sciences, All these organisations are entirely within the medical profession and have no connection whatsoever with the State. Several journals are published in Britain, but not specifically in Scotland, and these are described more fully under England and Wales; they comprise “Medicine, Science and the Law”, the “Journal of the Forensic Science Society”, the “Police Surgeon” and the “Medico-Legal Journal”.
70
The Home Office in London does not have jurisdiction over the legal system in Scotland, this being the responsibility of the Crown Office, which is, effectively, the Department of Justice for Scotland. It is situated in the capital, Edinburgh, and controls much of the legal system including, amongst many other things, the Procurator-Fiscal service. The Crown Office does not direct the work of the university institutes of legal medicine but, as it is responsible for the framework of law, within which medico-legal experts work, it is naturally an important aspect of legal medicine in the country. The Crown Office is a government appointed department containing lawyers and public servants and is not elected in any way. When State regulations or other legislation which affect the practice of medicine are drafted (and they may be different from those issuing from London) the medical profession, either as individuals or as university representatives, is generally asked to give evidence, either orally or in writing, to the relevant committee which is considering the change in the law. Though the Crown Office does not certify certain doctors to act as medico-legal experts, they are in effect appointed by the Procurator-Fiscal in various areas to carry out his work, which will be described below. Naturally, appointments are influenced by professional status and qualifications, though insufficient experts are available to cover all the areas of the country. The investigation of deaths which cannot be certified by the attending physician is, in Scotland, the responsibility not of the coroner but the Procurator-Fiscal. The Procurator-Fiscal is a law officer who has a number of functions, including the initiation of criminal prosecutions, together with some of the powers of a magistrate and of the investigative officer in unnatural deaths. Certification of death in Scotland can be carried out by any doctor, whether or not he was in attendance upon the deceased during life. A law which came into effect in 1966 provided that either the doctor in attendance upon the deceased or, if there was no such doctor, any other doctor was able to issue a certificate. As in England and Wales, the doctor does not legally have to see the body after death in order to issue a certificate, though this is usually done. Where no such certificate is issued, cases are almost always reported to the Procurator-Fiscal, and 16% of deaths in Scotland are so reported for medico-legal investigation. Of these, 25% are subjected to a full autopsy examination. Such autopsies are made by either forensic institutes or, in some cases, police surgeons at the direction of the Procurator-Fiscal. This officer usually takes the advice of his medico-legal expert as to the necessity for an autopsy, but the actual decision rests with the ProcuratorFiscal and not with the doctor. Strictly speaking, the Procurator must obtain a warrant for the post-mortem examination from the Sheriff, who is a judge of a lower court, but this is really only a formality. The duties of the Procurator-Fiscal investigating sudden or suspicious deaths differ from the English system in that there is no public inquest. The enquiry takes the form of a “precognition” of witnesses which is an in-
71
formal statement, not under oath, which could form the basis of testimony in any subsequent trial. This statement is taken by a Procurator-Fiscal at a private meeting. There is a Procurator-Fiscal for each Sheriff Court District and his main responsibility is the initiation of prosecutions of criminal offences. The Procurators are appointed by the Lord Advocate and in many ways the system is comparable to that of the Public Prosecutor in many continental legal systems. Unlike the English coroner’s system, where most deaths are reported to the coroner by doctors or the police, the main source of reported deaths to the Scottish Procurator-Fiscal comes from the Registrar of Births and Deaths, the officer of the civil administration responsible for recording deaths and providing material for statistics. The Registrar is obliged to notify the Procurator-Fiscal of all deaths which fall into any one of nineteen categories, which were established in 1966. Before that time there was a less comprehensive system in force. The types of death which must be reported are as follows: ( 1) Any uncertified death. (2) Any death which was caused by an accident arising out of the use of a vehicle, or which was caused by an aircraft or rail accident. (3) Any death arising out of industrial employment, by accident, industrial disease or industrial poisoning. (4) Any death due to poisoning (coal gas, barbiturate, etc.). (5) Any death where the circumstances would seem to indicate suicide. (6) Any death where there are indications that it occurred under an anaesthetic. (7) Any death resulting from an accident in the home, hospital, institution or any public place. (8) Any death following an abortion. (9) Any death apparently caused by neglect (e.g. malnutrition). (10) Any death occurring in prison or a police cell where the deceased was in custody at the time of death. (11) Any death of a new-born child whose body is found. (12) Any death (occurring not in a house) where the deceased’s residence is not known. (13) Death by drowning. (14) Death of a child from suffocation (including overlaying). (15) Where death occurred as the result of smallpox or typhoid. (16) Any death as a result of a fire or explosion. (17) Any sudden death. (18) Any other death due to violence, suspicious or unexplained causes. (19) Deaths of foster children. Like the European continental systems, the autopsy rate in Scotland is far lower than in England and Wales and again is often directed towards the main necessity for confirming or excluding criminality or negligence. The police surgeons are more involved in the system than in England and frequently make external examinations which may decide whether or not a full
12
autopsy is necessary. The police surgeon, or indeed the pathologist, can issue a death certificate himself if he is satisfied that the death has no suspicious features. Certain categories of death are reportable by the Procurator-Fiscal to the Crown Office, which is the government department responsible for the administration of justice. These include: (1) Where there are any suspicious circumstances. (2) Where death was caused by an accident arising out of the use of a vehicle. (3) Where the circumstances point to suicide. (4) Where the death was caused by an accident, poison or disease, notice of which is required to be given to any government department or to any inspector or other officer of a government department under or in pursuance of any Act. (5) Where the death occurred in circumstances continuance of which, or possible recurrence of which, is prejudicial to the health and safety of the public. (6) Where the death occurred in industrial employment. (7) Where the death occurred in any prison or police cells or where the deceased was in custody at the time of his death. (8) Where death occurred under an anaesthetic, or in unusual circumstances, or if there are features which suggest negligence, (9) Where death was due to gas poisoning. (10) Where death was directly or indirectly connected with the actions of a third party, whether or not criminal responsibility rests on any person. (11) Where any desire has been expressed that a public enquiry should be held into the circumstances of the death or where the ProcuratorFiscal is of the opinion that a public enquiry should be held under the Fatal Accidents and Sudden Death Inquiry (Scotland) Act, 1906. In Scotland, where medical evidence upon a death is given to the higher courts, usually in criminal cases or those involving fatal negligence, two doctors must have conducted an autopsy, again a parallel with certain European continental countries. There is no necessity for their opinions to be identical, but both are giving evidence on behalf of the prosecution and should be distinguished from any other medical experts called for the defence. The only public enquiries held into deaths in Scotland, apart from actual trials, are exceptional cases where the public interest is involved. Another exception is where there has been a fatal industrial accident and here the Sheriff must hold an enquiry. Enquiries into other types of accidents are possible, but very unusual. Doctors must always attend court to give oral evidence, their documentary evidence not being acceptable alone. Both prosecution and defence have a right in criminal cases to question the medico-legal expert either at trial, or in private before trial - the process called “precognition”.
73
The Scottish system presents certain advantages and a few disadvantages compared to the rest of Great Britain. Some hold that the low post-mortem rate is an advantage, feeling that the high autopsy rate on natural deaths in England and Wales is unnecessary. The two-doctor autopsy in criminal cases is also felt to be an advantage and the flexibility of disposal of cases without inquest enquiries and also by the pathologists themselves without reference to the legal authorities again assist in an efficient system. Though, for its size, Scotland has an extensive medico-legal system, the inevitable complaints are made that there is understaffing in the medical specialist field. Recruitment is very low indeed, this being common throughout Britain, partly due to the discouraging system of higher examinations and career structure. In common with the rest of Britain, there is a need for a revision of the training programme and method of accreditation of medico-legal specialists so that more trained doctors are made available.
Forensic
Medicine in Scotland
Though Scotland is part of the United Kingdom, its legal system is quite separate and has different origins. As Scotland was not politically combined with England, Wales and Northern Ireland until relatively late in its history (1707), its system of jurisprudence was retained after the union and has more affinity with continental legal systems derived from Roman law, than with English law which is basically Anglo-Saxon. Thus there has never been any coroner’s system in Scotland and, although recent statutory legislation tends either to be identical with, or similar to, the Acts of Parliament in London, many differences remain, some of which have a profound effect upon medico-legal matters. Scotland has a longer tradition of forensic medicine than the rest of the United Kingdom, and in fact the first university Chair in forensic medicine was established in Edinburgh as long ago as 1807, many years before a professorship was established in London. From that time, there has been a strong leaning towards forensic medicine (or “medical jurisprudence” as it tends to be named in Scotland) and, in consequence, the undergraduate teaching programme has always been much more extensive than that in England or Wales. Some of the famous names in academic forensic medicine have come from Scotland, such as Harvey Littlejohn, Sir Sidney Smith, and the two John Glaisters, father and son. These names are also familiar through their well-known textbooks, which have been used in all parts of the Englishspeaking world. Thus legal medicine in Scotland cannot be easily included in a general survey of Great Britain, as there are so many differences. The discipline is dealt with in four university centres, comprising the capital Edinburgh, Glasgow, Dundee, and Aberdeen. In Edinburgh and Glasgow there are Chairs of forensic medicine, both being described as “Regius” Chairs, indicating that they were set up by royal assent. At the moment the Chair of Forensic Medicine in the University of Edinburgh is held by Professor J. K. Mason, formerly a senior pathologist of the Royal Air Force and an international authority on aviation pathology. In Glasgow, the Regius Professor is W. A. Harland and this Department is by far the largest in Scotland, and indeed in Great Britain, as it also has wide interests in forensic science, especially in toxicology. The Department in the University of Dundee is headed by a senior lecturer, as is the Department at the University of Aberdeen. In the University of Strathclyde, there is a department of forensic sciences, but no medical jurisprudence department. About six doctors are employed in legal medicine in the above departments, as well as about five toxicologists who do not have medical qualifications. The departments are financed from university funds, though there is
68
also some income from fees for services provided by them. The departments provide service facilities in forensic pathology and toxicology, but there is variation between the different universities as far as subjects like forensic psychiatry and clinical examination of living patients are concerned. The large department in Glasgow has extensive toxicology and serology facilities, but purely criminalistic facilities are provided by the police laboratories. There is no separate State medical legal service, though Scotland has a well-developed “police surgeon” system which provides clinical forensic medicine facilities. In some of the universities the senior lecturer of the academic department functions as a police surgeon, and in Edinburgh half his salary is paid by the police authority. In Glasgow, the police surgeon is separate from the university department. As mentioned above, the undergraduate teaching programme in Scotland is extensive, compared with the rest of Britain. Medical jurisprudence is a compulsory topic in the medical curriculum and in Glasgow University forensic medicine is examined separately as a subject in the final examination for qualifying as a doctor. In the other universities there is an examination which is internal in nature, without external examiners as in Glasgow. In addition, the Scottish departments of legal medicine provide tuition to law, medical and dental students, and in fact the teaching programme for law students is frequently more extensive than that given to medical and dental students. In the University of Edinburgh, tuition is given to medical students for one term in the 5th year of study extending over 26 hours. These are all lectures and seminars with no practical instruction. Autopsy instruction is not given. Edinburgh teaches its dental students for two terms in the final year, totalling 15 hours of lectures. The Edinburgh law students are taught in their 3rd year for three terms extending over 64 hours. In Glasgow, medical jurisprudence is taught during the 4th year and consists entirely of lectures, with no practical or autopsy instruction. In all the universities, the full range of topics is dealt with, including forensic pathology, medical ethics and the physician’s relations with the State and its laws. In Edinburgh, instruction is given in respect of clinical legal medicine, such as the examination of sexual offences and drunken persons. The portion of the time of the department staff devoted to teaching varies, and in Glasgow approximates to about 5%. Post-graduate instruction in legal medicine is not organised into formal courses, but individual arrangements are made to teach junior assistants attached to the department. In Edinburgh, there is a post-graduate course in forensic medicine as a part of the Diploma in Criminology. There is also post-graduate teaching given to the Procurators-Fiscal, the law officers who carry out the functions approximating to the English coroner. There is also a heavy teaching commitment to police forces. Scotland has no post-graduate qualifications or diploma in legal medicine, this being included in the general system for Great Britain. The examination for the Membership of the Royal College of Pathologists in London is the major qualification for pathologists generally, and the final examination for
69
this Membership may be “slanted” towards forensic pathology. There is also the Diploma in Medical Jurisprudence (D.M.J.) granted by the Society of Apothecaries in London, both in Pathology and in Clinical Forensic Medicine, and other specialists may obtain a Doctorate in Medicine (M.D.) by writing a thesis on a forensic subject. A medico-legal expert does not have to hold any of these degrees before he is legally entitled to carry out medico-legal work, but the career structure of medicine in Great Britain is such that those doctors who reach a specialist consultant grade, either in the National Health Service or in the university service, are unlikely to obtain such appointments without a higher qualification. The medical staff of the university institutes is paid a fixed academic salary but there are variations in the retention of certain fees for items of service such as clinical examinations and medico-legal autopsies. Fees obtained for attendance at court are also frequently retained by the doctor. Fees paid by State of city authorities for routine autopsy services are usually paid to the university. The facilities of these institutes are equally available to the prosecution or to the legal representatives of the opposite party, whether in a civil or criminal action. This function of also advising defence in a criminal prosecution is frequent throughout Britain, though naturally the same medico-legal expert cannot give advice to both sides simultaneously, as in the Scandinavian system where the medical opinion is delivered mutually to the court rather than to one or other of the opposing parties. As stated, the forensic institutes do not offer purely criminalistic facilities such as firearms examination, etc., though Glasgow has an extensive commitment to toxicolo,T and serology, not shared by the other institutes. The Department of Forensic Science in Strathclyde University is unique in Britain in that if offers a university course in non-medical forensic science subjects. Compared to the English departments of forensic medicine, the Scottish institutes are concerned much more in forensic scientific matters and this is reflected in some of the traditional Scottish textbooks which contain much which is nowadays considered to be the province of the criminalistics laboratory, such as fibre comparison and quite extensive sections on serology and toxicology. Like the professional examinations, there are no specifically Scottish professional societies concerned with legal medicine, Scottish experts participating fully in the overall British complex of associations. These include the Royal College of Pathologists, the Forensic Science Society, the British Association in Forensic Medicine and the British Academy of Forensic Sciences, All these organisations are entirely within the medical profession and have no connection whatsoever with the State. Several journals are published in Britain, but not specifically in Scotland, and these are described more fully under England and Wales; they comprise “Medicine, Science and the Law”, the “Journal of the Forensic Science Society”, the “Police Surgeon” and the “Medico-Legal Journal”.
70
The Home Office in London does not have jurisdiction over the legal system in Scotland, this being the responsibility of the Crown Office, which is, effectively, the Department of Justice for Scotland. It is situated in the capital, Edinburgh, and controls much of the legal system including, amongst many other things, the Procurator-Fiscal service. The Crown Office does not direct the work of the university institutes of legal medicine but, as it is responsible for the framework of law, within which medico-legal experts work, it is naturally an important aspect of legal medicine in the country. The Crown Office is a government appointed department containing lawyers and public servants and is not elected in any way. When State regulations or other legislation which affect the practice of medicine are drafted (and they may be different from those issuing from London) the medical profession, either as individuals or as university representatives, is generally asked to give evidence, either orally or in writing, to the relevant committee which is considering the change in the law. Though the Crown Office does not certify certain doctors to act as medico-legal experts, they are in effect appointed by the Procurator-Fiscal in various areas to carry out his work, which will be described below. Naturally, appointments are influenced by professional status and qualifications, though insufficient experts are available to cover all the areas of the country. The investigation of deaths which cannot be certified by the attending physician is, in Scotland, the responsibility not of the coroner but the Procurator-Fiscal. The Procurator-Fiscal is a law officer who has a number of functions, including the initiation of criminal prosecutions, together with some of the powers of a magistrate and of the investigative officer in unnatural deaths. Certification of death in Scotland can be carried out by any doctor, whether or not he was in attendance upon the deceased during life. A law which came into effect in 1966 provided that either the doctor in attendance upon the deceased or, if there was no such doctor, any other doctor was able to issue a certificate. As in England and Wales, the doctor does not legally have to see the body after death in order to issue a certificate, though this is usually done. Where no such certificate is issued, cases are almost always reported to the Procurator-Fiscal, and 16% of deaths in Scotland are so reported for medico-legal investigation. Of these, 25% are subjected to a full autopsy examination. Such autopsies are made by either forensic institutes or, in some cases, police surgeons at the direction of the Procurator-Fiscal. This officer usually takes the advice of his medico-legal expert as to the necessity for an autopsy, but the actual decision rests with the ProcuratorFiscal and not with the doctor. Strictly speaking, the Procurator must obtain a warrant for the post-mortem examination from the Sheriff, who is a judge of a lower court, but this is really only a formality. The duties of the Procurator-Fiscal investigating sudden or suspicious deaths differ from the English system in that there is no public inquest. The enquiry takes the form of a “precognition” of witnesses which is an in-
71
formal statement, not under oath, which could form the basis of testimony in any subsequent trial. This statement is taken by a Procurator-Fiscal at a private meeting. There is a Procurator-Fiscal for each Sheriff Court District and his main responsibility is the initiation of prosecutions of criminal offences. The Procurators are appointed by the Lord Advocate and in many ways the system is comparable to that of the Public Prosecutor in many continental legal systems. Unlike the English coroner’s system, where most deaths are reported to the coroner by doctors or the police, the main source of reported deaths to the Scottish Procurator-Fiscal comes from the Registrar of Births and Deaths, the officer of the civil administration responsible for recording deaths and providing material for statistics. The Registrar is obliged to notify the Procurator-Fiscal of all deaths which fall into any one of nineteen categories, which were established in 1966. Before that time there was a less comprehensive system in force. The types of death which must be reported are as follows: ( 1) Any uncertified death. (2) Any death which was caused by an accident arising out of the use of a vehicle, or which was caused by an aircraft or rail accident. (3) Any death arising out of industrial employment, by accident, industrial disease or industrial poisoning. (4) Any death due to poisoning (coal gas, barbiturate, etc.). (5) Any death where the circumstances would seem to indicate suicide. (6) Any death where there are indications that it occurred under an anaesthetic. (7) Any death resulting from an accident in the home, hospital, institution or any public place. (8) Any death following an abortion. (9) Any death apparently caused by neglect (e.g. malnutrition). (10) Any death occurring in prison or a police cell where the deceased was in custody at the time of death. (11) Any death of a new-born child whose body is found. (12) Any death (occurring not in a house) where the deceased’s residence is not known. (13) Death by drowning. (14) Death of a child from suffocation (including overlaying). (15) Where death occurred as the result of smallpox or typhoid. (16) Any death as a result of a fire or explosion. (17) Any sudden death. (18) Any other death due to violence, suspicious or unexplained causes. (19) Deaths of foster children. Like the European continental systems, the autopsy rate in Scotland is far lower than in England and Wales and again is often directed towards the main necessity for confirming or excluding criminality or negligence. The police surgeons are more involved in the system than in England and frequently make external examinations which may decide whether or not a full
12
autopsy is necessary. The police surgeon, or indeed the pathologist, can issue a death certificate himself if he is satisfied that the death has no suspicious features. Certain categories of death are reportable by the Procurator-Fiscal to the Crown Office, which is the government department responsible for the administration of justice. These include: (1) Where there are any suspicious circumstances. (2) Where death was caused by an accident arising out of the use of a vehicle. (3) Where the circumstances point to suicide. (4) Where the death was caused by an accident, poison or disease, notice of which is required to be given to any government department or to any inspector or other officer of a government department under or in pursuance of any Act. (5) Where the death occurred in circumstances continuance of which, or possible recurrence of which, is prejudicial to the health and safety of the public. (6) Where the death occurred in industrial employment. (7) Where the death occurred in any prison or police cells or where the deceased was in custody at the time of his death. (8) Where death occurred under an anaesthetic, or in unusual circumstances, or if there are features which suggest negligence, (9) Where death was due to gas poisoning. (10) Where death was directly or indirectly connected with the actions of a third party, whether or not criminal responsibility rests on any person. (11) Where any desire has been expressed that a public enquiry should be held into the circumstances of the death or where the ProcuratorFiscal is of the opinion that a public enquiry should be held under the Fatal Accidents and Sudden Death Inquiry (Scotland) Act, 1906. In Scotland, where medical evidence upon a death is given to the higher courts, usually in criminal cases or those involving fatal negligence, two doctors must have conducted an autopsy, again a parallel with certain European continental countries. There is no necessity for their opinions to be identical, but both are giving evidence on behalf of the prosecution and should be distinguished from any other medical experts called for the defence. The only public enquiries held into deaths in Scotland, apart from actual trials, are exceptional cases where the public interest is involved. Another exception is where there has been a fatal industrial accident and here the Sheriff must hold an enquiry. Enquiries into other types of accidents are possible, but very unusual. Doctors must always attend court to give oral evidence, their documentary evidence not being acceptable alone. Both prosecution and defence have a right in criminal cases to question the medico-legal expert either at trial, or in private before trial - the process called “precognition”.
73
The Scottish system presents certain advantages and a few disadvantages compared to the rest of Great Britain. Some hold that the low post-mortem rate is an advantage, feeling that the high autopsy rate on natural deaths in England and Wales is unnecessary. The two-doctor autopsy in criminal cases is also felt to be an advantage and the flexibility of disposal of cases without inquest enquiries and also by the pathologists themselves without reference to the legal authorities again assist in an efficient system. Though, for its size, Scotland has an extensive medico-legal system, the inevitable complaints are made that there is understaffing in the medical specialist field. Recruitment is very low indeed, this being common throughout Britain, partly due to the discouraging system of higher examinations and career structure. In common with the rest of Britain, there is a need for a revision of the training programme and method of accreditation of medico-legal specialists so that more trained doctors are made available.