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Legal medicine in Denmark
Legal Medicine in Denmark
To many foreign forensic specialists, especially in the English-speaking countries, Denmark has long been looked upon as the ideal model for a medico-legal system. Certainly, for such a small country with a relatively small population compared with the major countries of Europe, Denmark has for many years enjoyed an excellent standard of legal medicine which has been the envy of many other states. Legal medicine is the sole monopoly of academic institutes and there are institutes of forensic medicine at the three universities of Copenhagen, Arhus and Odense. The large new institute at Copenhagen, recently completed, is headed by Professor Harald Gormsen, M.D., Assistant Professor Jdrgen Voigt, M.D., seven other medically qualified staff and ten other scientists (chemists). At the institute in Odense, Profestor J@n Simonsen, M.D., has one medical assistant; and at the University of Arhus, Professor J&gen B. Dalgaard, M.D., three other doctors and one chemist comprise the staff. All these institutes are financed solely from university funds, the Copenhagen Institute, for instance, having an annual grant of about 800 000 D.krs. In the Copenhagen Institute, the specialist staff are paid a fixed salary, the fees for services paid by the authorities going to the University. In the other institutes, the medical staff retain the fees per item of service, but it seems that the Copenhagen system will eventually apply to these too. The usual range of activities are carried on at the institute in Copenhagen, such as forensic pathology, toxicology, serology, clinical examination for drunkenness and sex offences, road traffic alcohol analyses, forensic anthropology in cases of disputed paternity, etc. One feature of Danish legal medicine, well known to all foreign forensic practitioners because of the extensive research and publications, is the high degree of development of forensic serology, especially in the field of disputed paternity. In the Copenhagen Institute, Assistant Professor K. Henningsen, M.D., heads a serology section, and other well-known names there include Assistant Professor Alf Lund, Ph.D., the toxicologist. Forensic odontology is also a prominent subject in Denmark, and Dr. S. Keiser Nielsen pursues this at the Royal Dental College in Copenhagen. The in$itutes at Odense and irhus have forensic pathology as their main activity, Arhus also including toxicology. The forensic medical institutes in Denmark do not provide a forensic science or criminalistics service and, unlike their Scandinavian neighbour, Sweden, there are no State medico-legal institutes in parallel with the university departments.
10
Pure forensic science and criminalistics are handled by quite separate laboratories organised by the police force, and these laboratories do not have medical staff and do not handle any medical or biological investigations. The university institutes provide teaching programmes for undergraduate medical students, which are a compulsory part of the medical curriculum. There is an oral examination, but not a written examination, as part of the qualifying degree course. Undergraduate teaching takes place in two terms of the last year of 6% years of study. One term consists of 24 hours of demonstrations and lectures on forensic medicine and the second term provides twelve hours of lectures on legislation of relevance to medicine. There is no compulsory instruction in autopsy work, but students are always welcome to attend the autopsy rooms. From one-third to one-half of the hours of teaching are demonstration of bodies or organs from autopsies with discussion of the cases, but the students are not required to learn the actual autopsy technique themselves The teaching programme is mainly concerned with forensic pathology and the physician’s relation with the State and its laws as they apply to medicine; very little instruction is directed towards medical ethics. The clinical examination of sexual assaults and of drunken persons is taught theoretically, but no practical tuition is given in this aspect. The amount of time devoted by the institute staff to teaching varies from one institute to another and is mostly performed by senior members, who spend perhaps five to ten per cent of their time in this activity. As far as postgraduate instruction in legal medicine is concerned, the Copenhagen Institute holds a course each alternate year for Medical Health Officers; these are community physicians who have a function as a kind of police surgeon and, amongst other duties, must attend deaths and decide upon the desirability of medico-legal investigation. Forensic medicine is one of the items included in these courses, which last for four months. For a doctor who wishes to become a forensic pathologist, there is no formal course of instruction, but he works as a junior assistant at one of the institutes. After the four-month course mentioned above, there is an oral and written examination in forensic medicine, as part of the general course for Medical Health Officers. There is no specific examination for the forensic pathologist, and until recently there was not a well-defined medical specialty in forensic pathology. However, recently it has been proposed that specialists in forensic pathology should be specialists in pathological anatomy, with special training in forensic pathology, in order to establish legal medicine as a specific specialist career. Though there is no actual government certification for a forensic specialist comparable to the American Roard Certification, a specialist has to be accepted by the Ministry of Justice as being a proper person to indulge in this type of work. The facilities of the university institutes are primarily confined to the prosecution authorities, but the legal representative of an accused person can ask for further examinations, though this cannot be done directly but only through a request to the court.
11
One of the well-known features of Danish legal medicine is the existence of the Medico-Legal Council, which is an official committee whose members are appointed by the Crown through the Ministry of Justice. One of the members is a forensic pathologist, who is not elected by his fellow specialists, but is selected by the Ministry of Justice. The functions of the Medico-legal Council are to discuss and agree upon any medico-legal questions which arise in the country: where acriminal or civil case has medical aspects, the Council will evaluate the medical evidence and submit an agreed report to the court. This means that there is no dispute about the medical facts of the case during the trial and the adversary system of prosecution and defence medical witnesses which exists in many countries, notably Britain and the IJ.S.A., is absent in Denmark. Though theoretically a medico-legal specialist can be questioned in court, it very seldom happens, because the Medico-legal Council have already arrived at a composite opinion upon the facts. Where State regulation or Acts of government which affect the practice of medicine are drafted, the Medico-legal Council will offer advice and opinion if it is requested by the State authorities. Though there is no official State approval of doctors working in the field of legal medicine, the Professors of Forensic Medicine at the three universities are State Pathologists and their co-workers act upon their responsibility. In some cases, the State Pathologists are also formally accepted by the Ministry of Justice. There is no national professional organisation confined to Denmark in the field of legal medicine, but as the Scandinavian countries are so closely linked with each other, they all combine to support the Scandinavian Association of Forensic Sciences (Nordisk Retsmedicinsk Forening). The Secretariat is now situated in the University Institute of Forensic Medicine, Rikshospitalet, Oslo, Norway. There is also the Scandinavian Society of Forensic Odontology, probably the leading organisation in this field, with Dr. Splren Keiser Nielsen being very active in this direction. An excellent newsletter is published from Denmark. There is no specifically medico-legal journal published in Scandinavia, but Dr. J@-gen Voigt, the Assistant Director of the Copenhagen institute, is the Editor of the journal in which these articles are published, Elsevier’s “Forensic Science”. The organisations mentioned above are purely professional and have no connection with the State; membership of them is optional and not a condition of being a medico-legal specialist. The function of the Scandinavian Association of Forensic Sciences is to organise scientific meetings and it is not concerned with professional matters in the career sense. About 10% of all deaths in Denmark are submitted to some form of medico-legal examination. The great majority which remain are disposed of by a general physician who issues a death certificate when he is convinced that no unnatural cause is present. He must inspect and examine the body and find convincing signs of death, without any signs of violence or unnatural death. If he cannot fulfil this requirement, the case is reported to the police
12
and, after an investigation, they may request a medico-legal external examination by one of the Medical Health Officers, who are government doctors up and down the country whose function includes this task of examining dead persons who cannot be certified by a general physician. In Copenhagen the doctors of the Institute of Forensic Medicine perform this function. If the police request an autopsy after this preliminary examination they will ask one of the institutes to perform it. The decision whether or not to hold an autopsy is made by a senior police officer: No judge is involved as in the Latin countries and the medico-legal specialists themselves cannot decide to hold a legal autopsy, but naturally they give advice to the police on the advisability of a full post-mortem examination. Of the 10% of total deaths reported for medico-legal investigation, about 20 - 25% are subjected to a full autopsy on average (the percentage is higher at the Copenhagen Institute, being about 40 - 50%). A recent improved Act of Parliament has more clearly defined the type of case which must be reported for medico-legal investigation: this includes homicide, suicide, accidents of all type, sudden unexpected deaths, infant deaths if sudden and unexpected, and all deaths connected with surgical operations and anaesthetics, etc. Deaths in prison or police custody and from industrial diseases must also be reported. No public enquiry is held into any death unless there is a criminal trial and there is nothing comparable to the English coroner’s inquest. With such a model system as Denmark, it is obvious that criticisms are likely to be few, but there are inevitably some areas for improvement. The new Act of Parliament mentioned above helps to indicate more formally those types of case which require medico-legal investigation, but it is felt that the monopoly of the police in deciding when autopsies will be performed is undesirable, and this sometimes makes it difficult to hold an autopsy where the interest is primarily medical rather than from the point of view of administration of justice. Some authoritative opinion in Denmark feels that a move towards the American Medical Examiner system (but still retaining the full attachment to the university institute) would be a welcome change, so that the medico-legal specialist himself could have more power in deciding which cases should be subjected to autopsy. It is felt that the financial support is adequate and the amount of medico-legal specialists manpower is also adequate for the moment, but the new act will presumably render an increase in staff necessary. The autopsy rate is felt to be adequate around the Copenhagen Institute and in some other areas, but in some rural areas it falls to unacceptable levels.
To many foreign forensic specialists, especially in the English-speaking countries, Denmark has long been looked upon as the ideal model for a medico-legal system. Certainly, for such a small country with a relatively small population compared with the major countries of Europe, Denmark has for many years enjoyed an excellent standard of legal medicine which has been the envy of many other states. Legal medicine is the sole monopoly of academic institutes and there are institutes of forensic medicine at the three universities of Copenhagen, Arhus and Odense. The large new institute at Copenhagen, recently completed, is headed by Professor Harald Gormsen, M.D., Assistant Professor Jdrgen Voigt, M.D., seven other medically qualified staff and ten other scientists (chemists). At the institute in Odense, Profestor J@n Simonsen, M.D., has one medical assistant; and at the University of Arhus, Professor J&gen B. Dalgaard, M.D., three other doctors and one chemist comprise the staff. All these institutes are financed solely from university funds, the Copenhagen Institute, for instance, having an annual grant of about 800 000 D.krs. In the Copenhagen Institute, the specialist staff are paid a fixed salary, the fees for services paid by the authorities going to the University. In the other institutes, the medical staff retain the fees per item of service, but it seems that the Copenhagen system will eventually apply to these too. The usual range of activities are carried on at the institute in Copenhagen, such as forensic pathology, toxicology, serology, clinical examination for drunkenness and sex offences, road traffic alcohol analyses, forensic anthropology in cases of disputed paternity, etc. One feature of Danish legal medicine, well known to all foreign forensic practitioners because of the extensive research and publications, is the high degree of development of forensic serology, especially in the field of disputed paternity. In the Copenhagen Institute, Assistant Professor K. Henningsen, M.D., heads a serology section, and other well-known names there include Assistant Professor Alf Lund, Ph.D., the toxicologist. Forensic odontology is also a prominent subject in Denmark, and Dr. S. Keiser Nielsen pursues this at the Royal Dental College in Copenhagen. The in$itutes at Odense and irhus have forensic pathology as their main activity, Arhus also including toxicology. The forensic medical institutes in Denmark do not provide a forensic science or criminalistics service and, unlike their Scandinavian neighbour, Sweden, there are no State medico-legal institutes in parallel with the university departments.
10
Pure forensic science and criminalistics are handled by quite separate laboratories organised by the police force, and these laboratories do not have medical staff and do not handle any medical or biological investigations. The university institutes provide teaching programmes for undergraduate medical students, which are a compulsory part of the medical curriculum. There is an oral examination, but not a written examination, as part of the qualifying degree course. Undergraduate teaching takes place in two terms of the last year of 6% years of study. One term consists of 24 hours of demonstrations and lectures on forensic medicine and the second term provides twelve hours of lectures on legislation of relevance to medicine. There is no compulsory instruction in autopsy work, but students are always welcome to attend the autopsy rooms. From one-third to one-half of the hours of teaching are demonstration of bodies or organs from autopsies with discussion of the cases, but the students are not required to learn the actual autopsy technique themselves The teaching programme is mainly concerned with forensic pathology and the physician’s relation with the State and its laws as they apply to medicine; very little instruction is directed towards medical ethics. The clinical examination of sexual assaults and of drunken persons is taught theoretically, but no practical tuition is given in this aspect. The amount of time devoted by the institute staff to teaching varies from one institute to another and is mostly performed by senior members, who spend perhaps five to ten per cent of their time in this activity. As far as postgraduate instruction in legal medicine is concerned, the Copenhagen Institute holds a course each alternate year for Medical Health Officers; these are community physicians who have a function as a kind of police surgeon and, amongst other duties, must attend deaths and decide upon the desirability of medico-legal investigation. Forensic medicine is one of the items included in these courses, which last for four months. For a doctor who wishes to become a forensic pathologist, there is no formal course of instruction, but he works as a junior assistant at one of the institutes. After the four-month course mentioned above, there is an oral and written examination in forensic medicine, as part of the general course for Medical Health Officers. There is no specific examination for the forensic pathologist, and until recently there was not a well-defined medical specialty in forensic pathology. However, recently it has been proposed that specialists in forensic pathology should be specialists in pathological anatomy, with special training in forensic pathology, in order to establish legal medicine as a specific specialist career. Though there is no actual government certification for a forensic specialist comparable to the American Roard Certification, a specialist has to be accepted by the Ministry of Justice as being a proper person to indulge in this type of work. The facilities of the university institutes are primarily confined to the prosecution authorities, but the legal representative of an accused person can ask for further examinations, though this cannot be done directly but only through a request to the court.
11
One of the well-known features of Danish legal medicine is the existence of the Medico-Legal Council, which is an official committee whose members are appointed by the Crown through the Ministry of Justice. One of the members is a forensic pathologist, who is not elected by his fellow specialists, but is selected by the Ministry of Justice. The functions of the Medico-legal Council are to discuss and agree upon any medico-legal questions which arise in the country: where acriminal or civil case has medical aspects, the Council will evaluate the medical evidence and submit an agreed report to the court. This means that there is no dispute about the medical facts of the case during the trial and the adversary system of prosecution and defence medical witnesses which exists in many countries, notably Britain and the IJ.S.A., is absent in Denmark. Though theoretically a medico-legal specialist can be questioned in court, it very seldom happens, because the Medico-legal Council have already arrived at a composite opinion upon the facts. Where State regulation or Acts of government which affect the practice of medicine are drafted, the Medico-legal Council will offer advice and opinion if it is requested by the State authorities. Though there is no official State approval of doctors working in the field of legal medicine, the Professors of Forensic Medicine at the three universities are State Pathologists and their co-workers act upon their responsibility. In some cases, the State Pathologists are also formally accepted by the Ministry of Justice. There is no national professional organisation confined to Denmark in the field of legal medicine, but as the Scandinavian countries are so closely linked with each other, they all combine to support the Scandinavian Association of Forensic Sciences (Nordisk Retsmedicinsk Forening). The Secretariat is now situated in the University Institute of Forensic Medicine, Rikshospitalet, Oslo, Norway. There is also the Scandinavian Society of Forensic Odontology, probably the leading organisation in this field, with Dr. Splren Keiser Nielsen being very active in this direction. An excellent newsletter is published from Denmark. There is no specifically medico-legal journal published in Scandinavia, but Dr. J@-gen Voigt, the Assistant Director of the Copenhagen institute, is the Editor of the journal in which these articles are published, Elsevier’s “Forensic Science”. The organisations mentioned above are purely professional and have no connection with the State; membership of them is optional and not a condition of being a medico-legal specialist. The function of the Scandinavian Association of Forensic Sciences is to organise scientific meetings and it is not concerned with professional matters in the career sense. About 10% of all deaths in Denmark are submitted to some form of medico-legal examination. The great majority which remain are disposed of by a general physician who issues a death certificate when he is convinced that no unnatural cause is present. He must inspect and examine the body and find convincing signs of death, without any signs of violence or unnatural death. If he cannot fulfil this requirement, the case is reported to the police
12
and, after an investigation, they may request a medico-legal external examination by one of the Medical Health Officers, who are government doctors up and down the country whose function includes this task of examining dead persons who cannot be certified by a general physician. In Copenhagen the doctors of the Institute of Forensic Medicine perform this function. If the police request an autopsy after this preliminary examination they will ask one of the institutes to perform it. The decision whether or not to hold an autopsy is made by a senior police officer: No judge is involved as in the Latin countries and the medico-legal specialists themselves cannot decide to hold a legal autopsy, but naturally they give advice to the police on the advisability of a full post-mortem examination. Of the 10% of total deaths reported for medico-legal investigation, about 20 - 25% are subjected to a full autopsy on average (the percentage is higher at the Copenhagen Institute, being about 40 - 50%). A recent improved Act of Parliament has more clearly defined the type of case which must be reported for medico-legal investigation: this includes homicide, suicide, accidents of all type, sudden unexpected deaths, infant deaths if sudden and unexpected, and all deaths connected with surgical operations and anaesthetics, etc. Deaths in prison or police custody and from industrial diseases must also be reported. No public enquiry is held into any death unless there is a criminal trial and there is nothing comparable to the English coroner’s inquest. With such a model system as Denmark, it is obvious that criticisms are likely to be few, but there are inevitably some areas for improvement. The new Act of Parliament mentioned above helps to indicate more formally those types of case which require medico-legal investigation, but it is felt that the monopoly of the police in deciding when autopsies will be performed is undesirable, and this sometimes makes it difficult to hold an autopsy where the interest is primarily medical rather than from the point of view of administration of justice. Some authoritative opinion in Denmark feels that a move towards the American Medical Examiner system (but still retaining the full attachment to the university institute) would be a welcome change, so that the medico-legal specialist himself could have more power in deciding which cases should be subjected to autopsy. It is felt that the financial support is adequate and the amount of medico-legal specialists manpower is also adequate for the moment, but the new act will presumably render an increase in staff necessary. The autopsy rate is felt to be adequate around the Copenhagen Institute and in some other areas, but in some rural areas it falls to unacceptable levels.