Medicine, science, and the law
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We report three cases of suicide in Scotland where barbecue charcoal was purposely burned in confined areas (an outbuilding, a car and a bedroom). External examination of the three cases revealed a distinctive 'cherry red' discolouration to the post-mortem lividity and blood and there were no marks or injuries to the bodies to give any cause for concern. ⋯ Considering the history, circumstances and external findings, a 'View and Grant' examination was conducted in all three cases and the cause of death was attributed to carbon monoxide poisoning due to inhalation of burning charcoal fumes. This particular method of suicide is not common in Europe and is more widely reported in the Far East.
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Complex regional pain syndrome (CRPS) is a regional pain syndrome of unclear pathophysiology, typically affecting the hand or foot. CRPS can be subject to personal injury litigation and may be the cause of substantial future loss of earnings claims. In clinical practice, a variety of medical experts can be involved in the diagnosis and management of CRPS and this can lead to confusion about the most appropriate expert for lawyers to instruct. ⋯ Psychiatrists do not have expertise in the clinical diagnosis of CRPS, but they are able to assess the presence of co-morbid psychiatric conditions. They can assist the court as experts in the underlying neuro-physiological and psychological processes which may explain some of the important features of CRPS and an individual's psychological vulnerability to CRPS. Their expertise in psychological and psycho-pharmacological interventions should be considered for any multidisciplinary treatment programme for CRPS along with the likely contribution of these interventions to the overall prognosis.
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If a doctor is grossly negligent and the patient dies as a result, the doctor can be charged with manslaughter. We have investigated the difference in opinion between medical professionals and the public on whether doctors should face criminal charges following different fatal medical errors. We conducted a survey of 40 medical professionals and 40 members of public, using a set of questions about negligence and manslaughter relating to four real-life cases of doctors charged with manslaughter where eventual outcomes were known. ⋯ However, across all cases, the public were more likely to respond that the doctor should be charged with manslaughter (OR = 2.1; 95% CI = 1.3-3.2). The public and, to a lesser extent, medical professionals still hold individuals responsible following a death due to medical error. This has implications for those who advocate a systems-based approach for assessing the root causes of medical errors, where there is a limited focus on individual accountability.