Expertiza Medico-legala Între Etic Si Juridic

EExxppeerrttiizzaa mmeeddiiccoo--lleeggaall nnttrree eettiicc ii jjuurriiddiicc

Daniela Damir, Elena Toader

Daniela Damir M. D., Ph. D., Asistent universitar, Disciplina de Medicin Legal, Etic Medical i Bioetic, Universi-tatea de Medicin i Farmacie Gr. T. Popa, Iai, Romnia

Elena Toader M. D., Ph. D., ef de Lucrri, Disciplina de Medicin Legal, Etic Medical i Bioetic, Universitatea de Medicin i Farmacie Gr. T. Popa, Iai; Medic primar gastroenterolog, Institutul de Gastroenterologie i Hepatologie, Iai, Romnia

REZUMAT

Activitatea expertal asigur mijloacele de prob cu caracter tiinific necesare soluionrii cauzelor penale, civile sau de alt natur, urmare a solicitrii organelor de urmrire penal sau a instanelor de judecat, contribuind, astfel, prin mijloace specifice, legale, la stabilirea adevrului. Un domeniu aparte, ce implic o atenie deosebit, datorit implicaiilor etice pe care le are att asupra individului i societii, ct i asupra sferei juridice cu care se afl n strns legtur, este cel al psihiatriei expertale. n acest caz, criteriul discernmntului este, cel mai adesea, supus riscului de eroare expertal. Datorit complexitii problematicii discernmntului i determinis-mului psihosocial al acestuia, este necesar individualizarea nuanat a aprecierii lui, fr ela-borarea unor scheme ablon care s stabileasc relaii ntre tipul bolii i discernmnt. Principiile etice ce caracterizeaz responsabilitatea expertului legist sunt asemntoare cu cele care guver-neaz responsabilitatea profesiei medicale, n general, cu precizarea c n cazul psihiatriei ex-pertale, apar implicaii etice att asupra individului i societii, ct i asupra domeniului juridic cu care este n strns legtur.

CUVINTE-CHEIE

etic, juridic, expertiz medico-legal, epistemologie medico-legal, discernmnt

INTRODUCERE

Caracterul interdisciplinar al medicinii legale i, implicit, al activitii expertale este dat de rela-

iile pe care aceasta le stabilete, pe de o parte, cu tiinele biomedicale (fiziopatologie, medi-cin intern, endocrinologie, genetic) i, pe de

28 BuletindePsihiatrieIntegrativ Serienou Iunie2014 AnulXX nr.2(61)

alt parte, cu tiinele socio-juridice (n special cu dreptul penal i criminologia). Putem carac-teriza, astfel, medicina legal ca o disciplin de grani ntre tiinele medicale i cele juridice, ea aprnd din necesitatea de a gsi rezolvri la problemele ntlnite n practica juridic penal i civil, soluii ce nu pot fi oferite dect cu aju-torul cunotinelor medicale. [20]

Dintre numeroasele definiii ce au fost atribuite acestei discipline de-a lungul timpului, definiii mai mult sau mai puin cuprinztoare, redm una care subliniaz specificul specialitii: me-dicina legal este o disciplin care i pune cu-notinele sale n slujba justiiei ori de cte ori, pentru lmurirea unei cauze judiciare, sunt ne-cesare anumite precizri cu caracter medico-bi-ologic. Altfel spus la solicitarea organelor de urmrire penal sau a instanelor de judecat, precum i la cererea persoanelor interesate, ac-tivitatea expertal asigur mijloacele de prob cu caracter tiinific necesare soluionrii cau-zelor penale, civile sau de alt natur, con-tribuind, astfel, prin mijloace specifice, legale, la stabilirea adevrului. [8, 14]

Referitor la rolul medicinii legale n justiie, pu-tem afirma cu certitudine c dreptul penal este domeniul care stabilete cele mai frecvente i strnse legturi cu practica medico-legal, aceasta reflectndu-se n rezultatele activitii expertale sub toate formele sale (necropsie, traumato-logie, psihiatrie expertal). Dar nu numai drep-tul penal este cel care beneficiaz de aportul activitii expertale medico-legale. Aceasta se regsete i n dreptul civil, dreptul procedural penal, dreptul familiei, criminalistic. Contribu-ia medicinii legale n soluionarea cauzelor cu caracter penal se evideniaz n ncadrarea juri-dic a unor fapte (ncadrarea n infraciunile de vtmare corporal se realizeaz i n baza tim-pului exprimat n zile de ngrijiri medicale pen-tru vindecare) [14]. De asemenea, intervine n definirea subiectului infraciunii n raport cu in-fraciunea, definirea obiectului i coninutului infraciunii. Conform Codului Penal, infrac-

iunea este fapta care prezint pericol social, care este svrit cu vinovie i este prev-zut de legea penal. Putem afirma existena vi-noviei atunci cnd fapta care prezint pericol social este realizat cu intenie sau din culp. Elementele ce caracterizeaz infraciunea sunt reprezentate de obiectul infraciunii (valorile sociale crora li se aduce atingere prin fapta pe-nal), subiectul infraciunii, adic autorul aces-teia, latura obiectiv (modalitatea, scopul i mo-bilul infraciunii) i latura subiectiv (modalita-tea de svrire a faptei, intenia sau culpa, ati-tudinea psihic n momentul comiterii acesteia) [14, 21].

n dreptul procedural penal, activitatea exper-tal medico-legal se regsete n articolele re-feritoare la persoanele ce pot avea calitatea de participani n procesul penal, stabilirea faptului dac starea de sntate a unei persoane i per-mite acesteia participarea sau nu la actele pro-cedurale i la judecat. Alte situaii n care me-dicina legal, implicit activitatea expertal se in-tersecteaz cu dreptul procedural penal sunt le-gate de stabilirea posibilitii nvinuitului/incul-patului de a suporta regimul de detenie, eva-luarea credibilitii altor mijloace de prob, sus-pendarea, amnarea sau ntreruperea executrii pedepsei (pe motive medicale). [21]

Aportul activitii expertale medico-legale la soluionarea cauzelor din dreptul civil se reg-sete n stabilirea condiiilor privind capacitatea civil (n cazul ncheierii unor acte de dispo-ziie), punerea sub interdicie a unor persoane cu afeciuni psihice (aici intervine expertiza me-dico-legal psihiatric pentru stabilirea discer-nmntului), existena unui prejudiciu cauzat de fapte ilicite (infirmitate, incapacitate de munc). [4, 14]

O alt ramur a dreptului la care activitatea ex-pertal medico-legal contribuie n ceea ce pri-vete soluionarea unor cauze civile este cea a dreptului familiei. Este vorba aici despre stabi-lirea existenei condiiilor privind ncheierea, anu-larea i desfacerea cstoriei, stabilirea sexului

Expertizamedicolegalntreeticijuridic 29

civil i a filiaiei biologice. Prezena activitii ex-pertale medico-legale n criminalistic se concre-tizeaz prin punerea la dispoziie a unor tehnici eficiente n domeniul biologic (biocriminalis-tica). [9, 14]

Caracterul concludent i pertinent al probelor medico-legale reprezint condiii de admisibili-tate a acestora n faa organelor judiciare inves-tite cu soluionarea unei cauze, efectuarea n timp util a acestora, utilizarea tuturor mijloa-celor adecvate scopului (obiectivele expertizei), demonstrarea concluziilor i nu afirmarea aces-tora, verificarea lor n raport cu circumstanele faptelor medicale i/sau cu probabilitatea sta-tistic. O alt trstur caracteristic a probelor utilizate n expertizarea medico-legal este re-prezentat de utilitatea acestora n elucidarea unor fapte i mprejurri ce nu au putut fi sta-bilite prin alte probe. De asemenea, este nece-sar a se lua n considerare eroarea aleatorie a instrumentelor utilizate n culegerea datelor i a se manifesta pruden atunci cnd faptele me-dicale sunt interpretabile (nu permit afirmaii certe) sau cnd sunt limitate de progresul tiin-ific (tiina nu dispune de o explicaie a feno-menului).

Cu toate acestea, proba medico-legal nu este o prob absolut, ea putnd fi supus att unor erori de natur obiectiv, ct i subiectiv.

Dintre cauzele obiective ce pot reprezenta sur-sa unor erori n procesul de expertizare, amin-tim: evoluia nespecific a leziunilor, limitele cunoaterii tiinifice, limitele posibilitilor tehnice de investigare. Cauzele de natur su-biectiv ce pot influena expertizarea medico-legal in de mai muli factori: expert, experti-zat, laborator i organele judiciare/judecto-reti. Dintre cauzele obiective ce in de expert, amintim: necunoaterea obligaiilor profesio-nale, examinarea incomplet, superficial, de-pirea competenei i obiectivelor expertizei, opiniile preconcepute, neutilizarea explorrilor complementare necesare confirmrii constat-rilor proprii. [14]

Cauzele ce in de expertizat i care pot con-duce la erori n procesul de realizare a experti-zei sunt reprezentate de simulare i disimulare, iar cele care in de laborator sunt tehnicile ina-decvate, artefactele, falsificarea rezultatelor i neverificarea acestora prin alte metode. Exper-tul legist poate cere relaii suplimentare orga-nului de urmrire penal sau instanei de jude-cat, necesare realizrii expertizei, nlturnd, astfel, erorile ce pot aprea (prin nepunerea la dispoziia expertului a tuturor datelor necesare evalurii corecte, excesul de influen prin ac-ceptarea numai a anumitor date i ncercarea de a obine de la expert concluzii ce susin aceste date, acceptarea necritic i absolutizarea concluziilor medicale fr a le corela cu cele-lalte probe).

Pentru incriminarea i dezincriminarea unor fapte ce prezint pericol social, precum i for-marea convingerii juristului referitor la adevr, este necesar intervenia adevrului tiinific expertal, al crui rol este covritor n aceast situaie, tiut fiind faptul c medicina legal este tributar, n exclusivitate, adevrului ti-inific. Din aceste considerente, putem afirma c medicina legal este o tiin medical a cu-noaterii, bazat pe epistemologie (logica cer-cetrii tiinifice a faptului medical). Este cu-noscut faptul c, prin definiie, dreptul se ba-zeaz pe adevr; prin urmare putem afirma c activitatea tiinific expertal medico-legal vi-ne n slujba acestui adevr, astfel nct adevrul medico-legal devine condiia esenial a adev-rului judiciar care st la baza probaiunii judi-ciare de transformare a unor ipoteze n teze ti-inifice cu valoare de adevr. Pentru stabilirea adevrului, epistemologia judiciar i medico-legal folosete mai multe criterii, printre care: realitatea faptei svrite, realitatea efectelor acesteia, realitatea cauzei ce a produs rezultatul, a intensitii i concordanei sale, precum i a legturii de cauzalitate.

Epistemologia medico-legal are la baz meto-dologia cvadrimensional a adevrului (Bote-


zatu) care presupune concordana ntre ipote-zele mintale ale expertului cu realitatea fapte-lor, reprezentarea valorii adevrului i referina sa la fiecare caz concret i, n final, verificarea sa pentru excluderea eventualelor erori. Totui, dac n cadrul procesului de expertizare, din anumite motive, este antrenat o eroare judi-ciar printr-o eroare expertal, exist posibili-tatea remedierii prejudiciilor, n conformitate cu normele Conveniei Europene privind ap-rarea drepturilor omului i a libertilor sale i cu legile actuale. [20]

Un domeniu aparte, ce implic o atenie deo-sebit, datorit implicaiilor etice pe care le are att asupra individului i societii, ct i asupra sferei juridice cu care se afl n strns legtur, este cel al psihiatriei expertale. n acest caz, cri-teriul discernmntului este, cel mai adesea, su-pus riscului de eroare expertal. Eroarea n eva-luarea expertal poate aprea n diverse situaii, printre care: evaluarea superficial a pacien-tului, evaluarea ambivalent cu nclcarea drep-turilor persoanei, nclcarea autonomiei per-soanei n rezolvarea unor probleme umane, eti-chetarea unei persoane n adaptarea conduitei terapeutice i de reintegrare social, nerespec-tarea dreptului persoanei la o alt opinie exper-tal, riscul de transformare a persoanei ntr-un obiect de prob n cadrul unei anchete, maxi-mizarea sau minimizarea nocivitii comporta-mentale. [3, 16]

Multitudinea de incertitudini i ambiguiti ce se regsesc n psihiatrie i, implicit, n psihiatria expertal justific parial negarea i refuzul anu-mitor principii etice (principiul autonomiei, im-plicit consimmntul informat i principiul be-neficiului), deoarece luarea fiecrei decizii pe baza componentei etice ar duce la apariia unui cerc vicios. Spre deosebire de medicina clinic, unde pacientul nu poate fi tratat fr consim-mntul liber i informat, psihiatrii se con-frunt cu situaia n care trebuie s trateze un bolnav care, uneori, nu este capabil s-i expri-me aceast opiune (aici apare cercul vicios).

Prin urmare, psihiatrul trebuie s ia o decizie i s aplice un tratament fr consimmntul pa-cientului, nclcnd principiul autonomiei. n caz contrar, dac nu se aplic un tratament, se ncalc principiul beneficiului, dar i cel al drep-tii i echitii. n domeniul dreptului interna-ional al drepturilor omului, este cunoscut m-prirea drepturilor i libertilor fundamentale n mai multe categorii privind: drepturile civile i politice, drepturile economice, sociale i cul-turale, la care s-a adugat grupa drepturilor la solidaritate (principiul dreptii i echitii). Dem-nitatea persoanei, ca surs a drepturilor omului, este protejat prin lege i se reflect n multe din-tre drepturile din primele grupe i, implicit, drep-tul la informare i consimmnt informat. [8]

Principiul respectului pentru persoan conine dou elemente eseniale: autonomia ce presu-pune ca cei care au capacitatea de a delibera cu privire la propriile obiective s fie tratai cu res-pect pentru capacitatea lor de autodeterminare; al doilea element are n vedere protecia per-soanelor a cror autonomie este afectat sau diminuat, solicitnd celor care sunt depen-deni sau vulnerabili s le fie oferit securitatea mpotriva rului sau abuzurilor. Persoanele con-siderate a fi vulnerabile sunt cele care nu au puterea, curajul, inteligena, resursele, rezis-tena sau alte capaciti care s le protejeze propriile interese prin negocieri cu privire la consimmntul informat. n aceast cate-gorie, pot fi incluse i persoanele instituiona-lizate, precum bolnavii cu afeciuni psihice, de-inuii, populaiile marginalizate stigmatizate din punct de vedere social sau politic, precum i cei care au o capacitate limitat de nelegere, cum ar fi copiii, persoanele cu afeciuni men-tale i persoanele cu retard mintal [13], n con-cluzie, persoanele al cror discernmnt este diminuat sau abolit n diverse circumstane.

Aspectele etice ce decurg din elaborarea diag-nosticului se refer la ntrebuinarea eronat a acestuia fie printr-o ncadrare excesiv, rigid, ntr-o anumit categorie diagnostic, prin in-

Expertizamedicolegalntreeticijuridic 31

competen, fie prin tendina subiectiv de re-zolvare a unor probleme doctrinare cu caracter socio-economic. Pentru evitarea situaiilor n care apar erori de diagnostic, este necesar ca stabilirea acestuia i observaia clinic s nu ai-b caracter de urgen, n psihiatrie fiind justifi-cat prelungirea observaiilor dac exist suspi-ciunea unor elemente de simulare, disimulare, suprasimulare, metasimulare. De asemenea, es-te necesar existena unei corelaii ntre carac-terul tulburrilor psihice i aspectele infrac-iunii (mobilul crimei), deoarece acestea au ro-lul de a susine diagnosticul ca element pro-bator n justiie. Confirmarea diagnosticului se face n cadrul comisiilor de expertiz medico-legal psihiatric, uneori fiind necesar o reeva-luare a acestuia pentru a evalua gradul de dete-riorare psihic ulterioar, modalitatea de evo-luie a bolii i condiiile n care s-ar putea rea-liza recuperarea i reinseria ulterioar. [1]

Datorit complexitii problematicii discern-mntului i determinismului psiho-social al aces-tuia, este necesar individualizarea nuanat a aprecierii lui, fr elaborarea unor scheme a-blon care s stabileasc relaii ntre tipul bolii i discernmnt.

Una dintre dilemele etice ce se asociaz cu tra-tamentul obligatoriu se refer la predicia peri-culozitii, specialistul avnd obligaia etic de a realiza o cercetare amnunit din punct de ve-dere metodologic pe baza informaiilor pe care le deine i s elaboreze concluzii privind vii-toarea periculozitate, pentru a stabili tratamen-tul adecvat. Un alt aspect etic deosebit ce ca-racterizeaz relaia terapeut pacient i care, n psihiatria expertal, are o importan covri-toare este cel legat de pstrarea confideniali-tii. Acest aspect se refer la aspectele ce nu pot fi dezvluite fr acordul pacientului, i anume: relatrile pacientului n timpul psihote-rapiei, concluziile examinrilor, investigaiile clinice i paraclinice, prognosticul i, nu n ulti-mul rnd, tratamentul aplicat. [3, 20]

Principiile etice ce caracterizeaz responsabili-tatea expertului legist sunt asemntoare cu ce-le ce guverneaz responsabilitatea profesiei me-dicale, n general, cu precizarea c n cazul psi-hiatriei expertale, apar implicaii etice att asupra individului i societii, ct i asupra domeniului juridic cu care se afl n strns legtur.

Alte particulariti legate de etica i deontologia medico-legal, aflate n strns conexiune cu practica judiciar, apar n legtur cu ncadrarea juridic a faptei, principiul prezumiei de nevi-novie, competena oficial i cea personal, existena mai multor ipoteze de anchet, res-pectarea garaniilor procesuale, respectiv a drep-tului de aprare a individului. Nu ntotdeauna, adevrul judiciar, care adapteaz din punct de vedere teoretic sistemul de probe la o anumit ncadrare juridic, este n concordan cu ade-vrul obiectiv. Din acest motiv, medicul legist va evita tendina de a lua n considerare ade-vrul judiciar n defavoarea adevrului obiec-tiv. Dac exist dileme privind interpretarea datelor i rezultatelor expertizei, acestea vor fi redate n raportul de expertiz medico-legal, respectnd astfel, indirect, principiul prezum-iei de nevinovie. O alt particularitate a co-nexiunii deontologice medico-legale i juridice este reprezentat de interdicia de a formula opinii referitoare la ncadrarea juridic a faptei, aceasta fcndu-se strict de ctre organele judi-ciare, deoarece datele obiective furnizate de ex-pertul legist pot fi diferite de ncadrarea juri-dic a organelor de anchet. [14, 19]

n concluzie, putem afirma c prin caracterul su interdisciplinar, activitatea expertal contri-buie la elucidarea probelor prin opinii i con-cluzii motivate tiinific, pe care le pune la dis-poziia organelor de anchet, utiliznd termeni ct mai adecvai pentru asimilarea adevrului ti-inific cu rol integrator n contextul dosarului.


MULUMIRI I DEVOALRI

Autorii declar c nu au conflicte poteniale de interese n legtur cu acest material.

BIBLIOGRAFIE 1. Albernhe, T., Tyrode, Y. Lgislation en Sant mentale. Pratique mdico-lgale, Duphar-Upjohn, 2000, 431-468 2. Astrstoae, V. Genetic versus bioetic, Ed. Polirom, Iai, 2002 3. Astrstoae, V., Trif, B. A. Esenialia n bioetic, Cantes, Iai, 1999 4. Belis, V. i colab. Tratat de medicin legal, Ed. Medical, Bucureti, 1995 5. Belis, V. Medicina legal n practica judiciar, Ed. Juridica, Bucureti, 2002 6. Buergenthal, Th., Weber, R. Dreptul internaional i drepturile omului, Ed. All, Bucureti, 1996 7. Chiri, V., Chiri, Roxana. Etic i psihiatrie, Ed. Symposion, 1994 8. Ciuc, A. Protecia internaional a drepturilor omului, Ed. Sanvialy, 1998 9. Ciuc, A. Conceptul de demnitate a fiinei umane n bioetic i biodrept (II), Revista Romn de Bioetic, vol. 8, nr. 3, 2010 10. Danescu, G. Probleme judiciare n psihiatrie, Ed. Medical, Bucureti, 1973 11. Dasclu, C. G., Cotrutz, C. E., Petreu, T. Considerations about medical questionnaires reliability and factor analysis, Proceedings of World

Academy of Science, Engineering and Technology Academic Science Research, Paris, France, July, 2010, vol. 68, ISSN 2070-3274, 2010 12. Georgescu, M. Psihiatrie Ghid practic, Ed. Naional, Bucureti, 1998 13. Gomien, Donna. Introducere n Convenia european a drepturilor omului, Ed. All, Bucureti, 1991 14. Loue, S. Religia i etica cercetrii: unde se ntlnesc, Revista Romn de Bioetic, vol. 8, nr. 4., octombrie decembrie 2010 15. Moldovan, T. Tratat de drept medical, Ed. All Beck, Bucureti, 2002 16. Robert, J., Duffar, J. Droits de lhomme et liberts fondamentales, Ed. Montchrstien, 1996 17. Scripcaru, Gh., Astrstoae, V., Scripcaru, C. Principii de bioetic, deontologie i drept medical, Omnia, 1994 18. Scripcaru, Gh. Bioetica i drepturile omului, vol. Psihiatria i condiia uman, Ed. Psihomnia, 1995 19. Scripcaru, Gh. Medicina legal, Ed. Didactic i Pedagogic, Bucureti, 1993 20. Scripcaru, C. Medicina legal n justiie, Ed. Cugetarea, Iai, 2001 21. Scripcaru, Gh., Astrstoae, V., Boiteanu, P., Chiri, V., Scripcaru, C. Psihiatrie medico-legal, Ed. Polirom, Iai, 2002 22. Scripcaru, Gh., Astrstoae, V., Scripcaru, C. Medicin legal pentru juriti, Ed. Polirom, Iai, 2005

Coresponden:

DANA DAMIR

Universitatea de Medicin i Farmacie Gr. T. Popa Iai Str. Universitii nr. 16, cod 700115, Iai, Romnia

Tel.: +40 723 338 418

E-mail: [email protected]

Primit: Noiembrie, 12, 2013 Acceptat: Ianuarie, 17, 2014

FFoorreennssiicc iinnvveessttiiggaattiioonn,, bbeettwweeeenn eetthhiiccaall aanndd lleeggaall

Daniela Damir, Elena Toader

Daniela Damir M. D., Ph. D., Assistant Professor, Department of Forensic Medicine, Medical Ethics and Bioethics, Gr. T. Popa University of Medicine and Pharmacy, Iai; Institute of Forensic Medicine, Iai, Romania

Elena Toader M. D., Ph. D., Assistant Professor, Department of Forensic Medicine, Medical Ethics and Bioethics, Gr. T. Popa University of Medicine and Pharmacy, Iai; Senior gastroenterologist, Institute of Gastroenterology and Hepatology, Iai, Romania

ABSTRACT

The expert examination activity provides the scientific means of investigation required for solving criminal cases, lawsuits and legal cases of other nature, at the request of either criminal investigators or courts of law, thus contributing by specific, legal means, to establishing the truth. Psychiatric specialist examination is a special field that requires special attention due to its ethical impact over both the individual and the society, and over the legal system, with whom it is closely connected. In that case, the criteria of discernment are oftentimes subject to exami-national error. Due to the complexity of both discernment and psycho-social determinism, a multi-faceted individualized approach is required, instead of creating paradigm diagrams of the connection between the type of disease and discernment. The ethical principles that define the forensic expert responsibility resemble those that govern the medical profession responsibilities in general, with the point that, in the case of psychiatric expert examination, there is an ethical impact on both the individual and the society, as well as over the legal system, with which the latter is closely connected.

KEYWORDS

ethical, legal, forensic investigation, forensic epistemology, discernment

34 BulletinofIntegrativePsychiatry NewSeries June2014 YearXX no.2(61)

INTRODUCTION

The interdisciplinary character of forensics and of expert examination implicitly, is given by the connection it establishes with biomedical sciences, on one hand (physiopathology, inter-nal medicine, endocrinology, genetics), and with social-legal sciences, on the other hand (mainly, with criminal law and criminology). Thus, we may characterize forensics as a fringe discipline between medical sciences and law, its existence being justified by the need to solve issues that arise from civil and criminal law practice, the latter being solutions offered so-lely by means of medical science. [20]

From among the many definitions attributed to the discipline over time, that were more or less encompassing, we chose to quote one that that underlines the specificity of the specialty: forensics is a discipline dedicated to serving justice, every time some medical-biological emphasis is needed for clarifying a legal case.

In other words, at the request of either the cri-minal investigation authority or that of a court of law, as well as to answer any request filed by some persons who are interested in the case, the expert examination activity provides scien-tific means for establishing evidence, needed for solving either civil or criminal cases, thus contributing by its specific legal means, to esta-blishing the truth. [8, 14]

Regarding the role of forensics in the judicial system, we may ascertain that criminal law is the most closely and frequently connected to forensics practice, the connection being reflec-ted in the results of the expert examination ac-tivity in all its specific aspects (necropsy, trau-matology, expert psychiatry).

Yet it is not solely criminal law that benefits from the forensic expert examination activity. The latter may also be found in civil law, cri-minal procedure law, family law, criminology. The contribution of forensics in solving cri-

minal cases is more remarkable when it comes to legal classification of certain offences (for instance, classifying an offence as bodily harm is also based on the number of days of hospi-talization necessary for healing the injuries). [14]

The expert examination also plays a role in de-fining the subject of the offence in relation with the offence, the objects definition and the content of the offence. According to the Criminal Code, an offence is an act that re-presents social danger and is perpetrated in culpability and stipulated in the criminal legis-lation. We may ascertain the presence of culpa-bility whenever the act that represents social danger is committed deliberately or by negli-gence.

The elements that define the offence are made of the object of the offence (the social values prejudiced by the criminal act), the subject of the offence, meaning the perpetrator, its objec-tive aspect (the method, the purpose and the motive of the offence), and its subjective as-pect (the method of carrying out the offence, whether it was intentional or by negligence, and the psychological attitude at the time of committing the offence). [14, 21]

Within the procedural criminal law, the fo-rensic expert examination activity is located in the articles of law pertaining to persons that may assume the role of participants in the cri-minal prosecution, and the process of esta-blishing whether or not that persons mental health allows them to get involved in the trial and in the procedural actions. Other situations in which forensics and the expert examination implicitly, meet criminal procedural law are co-nnected with establishing the capability of the accused/the offender of enduring incarcera-tion, assessing the credibility of other type of evidence, and suspending, postponing or dis-continuing the sentence (on medical grounds). [21]

Forensicinvestigation,betweenethicalandlegal 35

The contribution of the expert examination activity to solving civil cases is reflected in es-tablishing the conditions regarding civil capa-city (in the case of issuing deeds of settlement), of restricting persons with a mental condition (here, forensic psychiatry is called upon, for establishing discernment) the presence of da-mage caused by illicit acts (infirmity, work in-capacity). [4, 14]

Another branch of the law that benefits of the contribution of forensic expert examination in solving civil cases is family law. It is concerned with the conditions for the carrying out, the cancelation and the dissolution of marriage, the establishing of sex, and of biological pater-nity. Forensic expert examination in criminolo-gy translates in applying efficient techniques from the field of biology (bio-criminology). [9, 14]

The conclusive and pertinent character of fo-rensic evidence represents the condition of their being admitted in court as evidence. Carrying out the forensic investigation on time, making use of all the appropriate means appli-cable in the case (the objectives of the exper-tise), presenting the conclusions and not asser-ting them, verifying in accordance in relation with the medical facts circumstances and/or the statistical probability.

Another feature of the evidence used in foren-sic expertise is their utility in elucidating some facts and circumstances that evidence of other kind were not able to establish. It is also nece-ssary to consider the random deflection of the instruments used for collecting data, and of approaching with caution situations where me-dical facts are subject to interpretation (do not allow for positive assertions) or whenever they present scientific limitations (science does not have yet an explanation for the phenomena).

However, forensic evidence does not represent absolute evidence, the latter being subject to both, objective and subjective errors.

From among the objective reasons that may

cause errors in the process of expertise, we mention: non-specific evolution of injuries, scientific knowledge limitations, limitations in the technical means of investigations. Subjec-tive reasons that may influence forensic exper-tise are related to several factors: the expert, the object of the expertise, the lab, and the ju-dicial authority/court of law. From among the objective reasons related to the expert, we quote: ignorance regarding his/her professio-nal liabilities, incomplete, shallow examination, exceeding his/her competencies and the ob-jectives of the expertise, preconceived opini-ons, and failing to utilize complementary exa-mination required for acknowledging ones own observations. [14]

Reasons related to the object of the expertise and that may be conducive to errors in the process of expertise are represented by si-mulation and dissimulation, whereas those re-lated to the lab are: inadequate techniques, artifacts, forging results and the lack double-checking by other methods. The forensic ex-pert may demand additional information from the investigators or from the court, informa-tion necessary for completing the expertise eliminating thus every error that may be due to insufficient data available to the expert for ac-curate evaluation, influence in excess by selec-ting only certain data and the attempt to ex-tract from the expert conclusions that support that data, accepting, without doubt, and gene-ralizing medical conclusions in the absence of proper correlation to evidence of other kind).

For incriminating or decriminalizing certain acts that represent social danger as well as for convincing the judicial authority of the truth, scientific expert examination is required, who-se role is crucial in this situation, being a recog-nized fact that forensics is utterly subjected to scientific fact. For that reason, we may assert that forensics is a medical science of know-ledge, based on epistemology (the logic of the scientific research of medical facts).


It is a well known fact that the law by defi-nition is based on establishing the truth, there-fore, we may assert that the forensic scientific expert examination activity does serve the truth, so that, consequently, the forensic truth becomes the crucial condition of legal truth, which, in its turn, is the foundation of the ju-dicial probation of converting a mere hypo-thesis into scientific arguments that stand for the truth itself. For establishing the truth, ju-dicial and forensic epistemology employ seve-ral criteria, such as: the actuality of the com-mitted act, the actuality of its effects, the reality of the cause that generated the result, of its in-tensity and consistency, as well as its connec-tion of causality.

Forensic epistemology is based on the quadric- dimensional methodology of the truth (Bote-zatu) that presupposes the consistency bet-ween the experts mental hypotheses and the reality of the facts, and on representing the va-lue of the truth and its connection with every actual case and, eventually, its examination for excluding every possible error. If in the pro-cess of examination, however, for a certain rea-son, a judicial error is committed through ex-pert examination error, a possibility for redre-ssing the damage still exists according to the norms of the European Convention of Human Rights and Liberties and in accordance with the current legislation in force. [2]

A special field, that requires special attention due to its ethical implications over both the individual and the society, as well as over the legal system with which it is closely related, is that of expert examination psychiatry. The dis-cernment criteria is in that case oftentimes subject to the risk of examination error. The error in expert examination evaluation may occur in various cases, such as: shallow eva-luation of the patient, ambivalent examination by violating persons rights, the violation of the persons autonomy in solving human issues, stigmatizing a person by adopting a certain

therapeutic and social re-insertion behavior, violating the persons right to a second experts opinion, the risk of converting the person in an experimental object throughout the inves-tigation, maximizing or minimizing behavioral harm. [3, 16]

The many uncertainties and ambiguities found in psychiatry and in expert examination psy-chiatry implicitly, partly justify ignoring and re-futing some ethical principles (autonomy prin-ciple, the knowledgeable consent implicitly, and the one regarding the benefit), since, ma-king a decision based on ethics, would lead in-to a vicious circle. As opposed to clinical me-dical practice, where a patient may not be trea-ted unless he/she gives a free and knowledg-eable consent, psychiatrist are confronted with situations where they have to treat a patient that sometimes may not be able to express such consent (that causes the vicious circle).

The psychiatrist must therefore make decisions and prescribe treatment absent the patients consent, thus violating the principle of auto-nomy. Otherwise, refraining from prescribing a treatment violates the principle of benefit and, besides, it also violates the principles of fair-ness and equity. The international legislation and human rights both acknowledge the divi-sion of fundamental human rights and liberties in several categories, concerning: civil and po-litical rights, economic and social rights, cul-tural rights, with the addition of the rights to solidarity (the principle of fairness and equity).

Human dignity, as a source of human rights, is defended by the law and it reflects in many of the rights categorized in the first groups, and it implies the right of being informed and the knowledgeable consent. [8]

The principle of respect for the individual in-cludes two crucial elements: autonomy im-plies that those capacitated to make decisions on their own objectives should be treated with respect for their ability towards self-determina-


tion. The second element regards the protec-tion of those whose autonomy is either affec-ted or diminished, requiring the dependant or the vulnerable to be granted security against evil or abuse.

People considered vulnerable are those who lack the courage, intelligence, resources, resili-ence or other capabilities that would protect their own interests through negotiations regar-ding knowledgeable consent. This category includes people who are committed to an insti-tution, as well as those with mental disorders, detainees, marginalized people socially or po-litically stigmatized, as well as those with li-mited understanding capability, such as chil-dren, mentally ill persons, and mentally retar-ded people [13], therefore, people whose capa-city for discernment is either diminished or cancelled under varied circumstances.

Ethical aspects that derive from establishing the diagnosis regard its erroneous application either by means of excessive, rigid classifica-tion, in a certain diagnosis class through in-competence, or by the subjective tendency of solving certain social-economic doctrinaire issues. For avoiding erroneous diagnosis, it is required that clinical observation should not be made under the pressure of urgency, psychi-atric analysis justifying prolonged monitoring in case there exists a suspicion of either simu-lation, or dissimulation, over-simulation, meta-simulation.

It is also required that a correlation be made between the type of psychological disorders and the details of the offence (the motive), since the latter may enforce the diagnosis as evidence in court. The confirmation of the diagnosis is made by forensic psychiatric ex-perts commissions, sometimes re-evaluation being required for assessing the degree of sub-sequent psychological deterioration, the evolu-tion of the disorder and the premise for reha-bilitation and subsequent re-insertion [1].

Due to the complexity of the issue of discern-ment and its psycho-social determinism, a mul-ti-faceted personalized approach is required, by avoiding creating paradigm diagrams for esta-blishing connections between the type of dis-order and discernment.

One of the ethical dilemmas associated with compulsory treatment regards the prediction of potential danger, the expert being ethically responsible for undertaking a detailed metho-dological analysis based on the information at hand and for drawing conclusions regarding possible future danger, and for prescribing the appropriate treatment. Another special ethical aspect that characterizes the relationship bet-ween the patient and the therapist, crucial for expert examination psychiatry, is the one rela-ted to confidentiality. It regards issues that cannot be revealed without the patient con-sent, such as: the patients confessions during sessions, the conclusions of the examination, clinical and paraclinical examinations, the prog-nostic and, last yet not least, the prescribed treatment. [3, 20]

The ethical principles that characterize the forensic expert responsibility are very much alike those that govern medical practice res-ponsibility, in general, with the emphasis that in the case of psychiatric expert examination, there is ethical impact on both the individual and the society, as well as over the closely connected judicial system.

Other forensic medical ethics and deontology related features, closely connected to legal practice, manifest themselves in connection to the legal classification of the offence, the prin-ciple of the presumption of innocence, the official and individual competence, the pre-sence of several inquiry hypotheses, and the defence of guaranty trial, of the individual right to defence, respectively.

It is not always that the legal truth, that the-oretically adapts the system of evidence to


certain legal classification, is in accordance with the absolute truth. For that reason, the forensic expert should obviate the inclination of considering the legal truth as prevailing over the absolute truth. If there is any dilemma regarding data interpretation and expertise result, the latter shall be recorded in the fo-rensic report, so that they indirectly abide to the principle of the presumption of innocence.

Another forensic medical and legal ethics and deontology related feature is the prohibition of voicing opinions regarding the legal classifica-tion of the offence, the latter being at the exclusive discretion of the judicial authority,

given that the objective data provided by the forensic expert may differ from the legal classi-fication established by the investigators. [14, 19]

We may, therefore, conclude that by its inter-disciplinary character, the expert examination activity brings a contribution to clarifying the evidence by scientifically supported conclu-sions and opinions, made available to investi-gating authorities, by employing most appro-priate terms for assimilating the scientific truth playing an integrating role within the context of the prosecution file.

ACKNOWLEDGMENTS AND DISCLOSURE

The authors declare that they have no potential conflicts of interest to disclose.

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Correspondence:

DANA DAMIR

Gr. T. Popa University of Medicine and Pharmacy No. 16 Str. Universitii, code 700115, Iai, Romania

Phone: +40 723 338 418

E-mail: [email protected]

Date of Submission: November, 12, 2013 Acceptance: January, 17, 2014

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Expertiza Medico-legala Între Etic Si Juridic