Forensic Medicine: Questionable Injuries are Not Acts of God.
Africa and indeed Nigeria are blessed with abundant human and material resources: that is a fact. That we are underachieving and underdeveloped is a settled matter and I will not be discussing that point here. What is most concerning is the magnitude of abuse of humans and other resources that we have been blessed with to improve our lives. We the residents of this frontier called Nigeria (and Africa) are the principal perpetrators of such abuses against our fellow human beings and it has been on-going for millennia.
A couple of weeks ago, we discussed abuse in its various forms. I pointed out then that abuse can result into physical, psychological, financial injuries or death of the victims. Abuse is not the only cause of deaths as we all know. Deaths can result from accidents, very often as a result of one person’s negligence or the other. There is no doubt that deaths of anyone—young or old—very frequently results from natural causes such as definite disease states such as cancer. In the elderly, death may come due to old age. Death may therefore not be due to natural causes. Death that is questionable may be as a consequence of a deliberate act of harm (abuse) such as beating a person to death, poisoning, burning or deprivation of necessaries. Death may also result from negligence (act of not paying due care and attention to what one is doing or a person is not carrying out his/her duty to the standard expected of that individual and position that the person occupies).
Now, it’s the subject of such questionable deaths and injuries that we shall explore in this article. In medical professional circle and in law, the medico-legal examination of such questionable deaths is carried out by a Coroner. Coroner cases are integral part of forensic medicine. It’s a very important aspect of every decent society to question and find the root causes of what caused the death or injury of a member of the society that we all belong to.
We will examine the nature of forensic medicine and how it applies to you and the society that we live in. We will also take a look at how you and your family can benefit from forensic medical work. In addition, we will examine the reasons why forensic examination is almost a taboo or why the practice of forensic medicine suffers from a high resistance in Nigeria. First, the scope of forensic medicine and the law.
Let us deal with the word: “Coroner”: The history of coroner and indeed the name “coroner” (from Crown) came from the English in the 11th Century England. The principal reason for establishing coroner is simply to protect the interest of the Crown in Criminal Proceedings. The coroner was formally established in England by Article 20 of the “Articles of Eyre” in September 1194 to “keep the pleas of the Crown”) from which the word “coroner” is derived. In those days, it was the duty (as its now) of the local county official to defend and protect the interest of the Crown in courts. By the year 1215 when the Magna Carta (that brought much human rights to the world as we now know it) came into being, the word “coroner” had been enshrined in law.
Ultimately, it became established that “the person who found a body from a death thought sudden or unnatural was required to raise the “hue and cry” and to notify the coroner” and hence the modern function and meaning of a coroner . Therefore, coroner is a person whose standard role is to confirm and certify the death of an individual within a jurisdiction (say in Lagos State or Nigeria).
With this in mind, we can now look at what is “forensic medicine”. “The application of medical knowledge to the investigation of crime, particularly in establishing the causes of injury or death is called forensic medicine.
The meeting point of Forensic Medicine and Coroner: Coroner and forensic medicine indeed have a meeting point at what is called autopsy: which means examination of the dead to find the cause of death. To use the words of Encyclopedia Britannica, the primary tool of forensic medicine has always been the autopsy. Frequently used for identification of the dead, autopsies may also be conducted to determine the cause of death. In cases of death caused by a weapon, for example, the forensic pathologist ( a medical doctor)—by examining the wound—can often provide detailed information about the type of weapon used as well as important contextual information. (In a death by gunshot, for example, he can determine with reasonable accuracy the range and angle of fire.) Forensic medicine is a major factor in the identification of victims of disaster, such as landslide or plane crash. In cause-of-death determinations, forensic pathologists can also significantly affect the outcome of trials dealing with insurance and inheritance.
Therefore, a common but extremely powerful tool that exposes criminality is autopsy which in the hand of a coroner can bring justice to victims even if dead. Forensic medicine as a whole can bring justice and restitution to the living injured. Next week, we shall examine coroner in more details.
Coroner: Death May Not Be an Act of God
In Nigeria, several thousands (I dare say, probably millions) of deaths result from unnatural causes. Natural causes of death are such as old age in the elderly or severe recognizable diseases in the young. Such deaths such as resulting from assault, battery be it by gun shot, beatings as in child and domestic abuse of spouse, burning of a person (“jungle justice”), rape, denial of food and or poisoning are extra-judicial murders and unnatural causes of death. Unnatural causes may be an accident due to negligence of another party. Unnatural cause of death may even be suicide— act of killing oneself (see later in the series when we shall deal with suicide). It’s the duty of a coroner to determine the cause of such death.
A coroner is a person whose typical duty is to confirm and certify the death of an individual within a particular jurisdiction. Coroner case is simply put, certification of a death. In doing so a coroner performs the following functions which I want to suggest, you should take a good note of:
Duties and responsibilities of the coroner may include overseeing the examination and certification of deaths related to such events as mass disasters that occur within the coroner’s jurisdiction (area of legal authority). A coroner may also conduct or order an inquest into the manner or cause of death, and investigate or confirm the identity of an unknown person who has been found dead within the coroner’s jurisdiction. A coroner’s office characteristically maintains records of death of those who have died within the coroner’s area of legal authority.
Depending on the jurisdiction, the coroner may decide the cause of death personally, or he or she may act as the presiding officer of a special court (a “coroner’s jury”) set up for this purpose. The additional roles that a coroner may oversee in judicial investigations may be subject to the attainment of suitable legal and medical qualifications.
The Law in Nigeria:
It was in 1944, that the first law on coroner autopsies was first established in Nigeria. The law stated and mandated that only sudden deaths that involve non-natives (then white colonists as you can imagine) were to be reported to the coroner. However, by 1958 (on the eve of Nigeria’s Independence) the law was extended to involve all individuals in Nigeria.
Under section 4(1) of the coroners law Cap 131 of 1954, laws of the Federation of Nigeria and Lagos, magistrates are then permitted to conduct inquests under the said law. This law states that every magistrate is authorized to hold inquests about any doubtful death in his or her area of jurisdiction. Coroner autopsies are done when a clinician is legally not in a position to issue a death certificate. Based on cause of death, coroner deaths can be classified thus: natural deaths, accidents, homicides, suicides and undetermined on the basis of manner of death classification. Reports to the coroner about such deaths originate through reports by complaints to the police, reports by health practitioners to the coroner or the police and so forth.
Law of Lagos State on Coroner: In 2007, the Lagos State Government promulgated The Coroner’s System Law that established a new system of investigation of death in the State. The Law is to be cited as Coroner Law. Part 2, Section 4 of the said law empower the coroner to hold inquest on suspicious deaths that comes to his or her knowledge. Such death can be due to any cause that is doubtful such as violence and sudden death including death in psychiatry hospital. Prisoners who died are subject to inquest. This law empowers the coroner to even exhume a person who had been buried for proper determination of the cause of death. Coroner may even postpone cremation or postpone a burial under this law by virtue of Section 9 of the Act.
As you can see, claiming a religious barrier (which is a major obstacle to coroner law enforcement in Nigeria) to inquest or citing a custom or tradition (such as burial of a chief, obas, obis etc) that allegedly forbid medical examination of the dead is not acceptable under the law. Anyone and everyone can be made subject to coroner examination to determine the cause of death. However, either due to natural cause or not, you or relevant person concerned can request an autopsy of the dead.
Your Duty: Under the law, you have a duty. Section 10 of Coroner Law of Lagos State empowered you as follows: “When anybody is found or a person has died in such circumstances as to make the holding of an inquest under this Law necessary or desirable it shall be the duty of any person finding the body or becoming aware of the death forthwith to inform the nearest police officer and upon receiving any such information such police officer shall notify the coroner having jurisdiction to hold an inquest.”
Benefits of Coroner Inquest and Autopsy. Our society and country continue to suffer from shady deaths and grief from suspicious deaths. You can prevent future deaths by requesting for a coroner inquest. In the barest minimum, you can request for an autopsy of a death person that you are concerned about whose death you suspect is a foul play. The benefits of autopsy is huge. In the least, a disease that runs in the family may be exposed to help prevent such death occurring in the family or occurring in the children of the dead. If the cause of death is of public interest such as infection, the public and government may bring preventive measures into place to protect the living. Our society is rife with superstitions and false claims of evil forces of witchcraft killing another while in reality, the dead may have been chronically ill of a serious disease. Autopsy and inquest may bring such undue false claims to an end and establish a clear material medical truths. Further, doctors, lawyers, and academics learn from autopsy to help the living avoid early deaths. You too can help by taking autopsy or coroner inquests seriously. Next week, we shall examine other areas of Forensic Medicine of interest when we will take a look at personal injury.
Personal Injuries: Get Justice with Forensic Medicine
In the last two weeks, we discussed the role of coroner, inquest, autopsy and forensic medicine and how it applies to you. This week, we will take a very close look at how the knowledge of forensic medicine, coroner inquest and autopsy can bring you justice and restitution on one hand as well as penalty to the perpetrator of harm. Justice requires evidence. The legal system needs evidence to arrive at cause and effect and hence to give you fairness of judgement.
Between you, your injury and equity stands the medical doctor and allied clinicians who will examine your injuries, causes and possible cost to repair the injury if possible.
Those injuries be it physical, mental or injury that you sustain that are not due to your own fault but to the fault of others, is called personal injuries. Personal injury is a legal term for an injury to the body, mind or emotions, as opposed to an injury to physical property such as your car or house.
Personal injury term is most frequently used to denote a type of tort (offence) lawsuit in which the person bringing the suit (the injured person or victim or relation), or “plaintiff,” has suffered harm to his or her body or mind. Personal injury lawsuits are filed against the party or entity that caused the harm through act of negligence, gross negligence, reckless conduct or behavior, or intentional misconduct. Different legal jurisdictions describe the damages (or, the things for which the injured person may be compensated) in different ways, but damages typically include the injured person’s medical bills, pain and suffering, and diminished quality of life. Very often, the compensation of restitution is financial or economic.
Areas where personal injuries is applicable:
Areas where personal injuries claims are commonly made include road traffic accidents in which the accident causing the injury is the fault of another, work place accidents, tripping accidents at work whereby a member of the public or worker get injured as a result of the negligence of the contractor or the party that got the contractor. Assault claims such as rape can both lead to personal injury claims and criminal prosecutions. Defective product leading to harm of the consumer or causing accidents (product liability) can lead to personal injury claims. The term personal injury also incorporates medical and dental accidents (which lead to medical negligence claims). Cases classified as industrial disease cases such as asbestosis, chest diseases (e.g., emphysema, bronchitis, asthma, chronic obstructive pulmonary disease, and chronic obstructive airways disease), vibration white finger, occupational deafness, occupational stress, contact dermatitis, and repetitive strain injury cases are all forms of personal injuries.
Taking a look at the cause of death, coroner and personal injury cases in Nigeria, accidents, product liability and automobile collisions will probably be amongst the highest causes of injuries. Personal injury cases may also include toxic torts, in which a contaminant transmitted by air or water causes illness, injury, or death. Wrongful deaths of a relative can also lead to claim of personal injury by those concerned. Such wrongful death may also be a cause of criminal prosecution in which case coroner and or forensic examination would have taken place.
Pursuit of personal injury claims is not a child’s play. It may be tortuous and painful. It may take a long time to arrive at resolution and require expensive investigations. In general, the society is better off as the parties that are involved will now take caution not to cause similar injuries in the future. Suffice to say that government at various levels and big corporations are not immune to personal injury claims. It’s on this basis that sane and insightful parties would have taken the steps to insure their products, work and services against personal injury claims.
Forensic Medicine and Personal Injuries: Forensic medical practitioners including coroners are specialty workers that determine the cause, nature and extent of injuries to a person. As I stated earlier, these professionals work along lawyers in resolving death and injury issues so that justice can be obtained for the victims. Next week, we shall take a look at suicide in concluding our series on medicine and law.
Suicide: You Have No Right to Self-Terminate
There had been events that made headlines in Lagos State of late in respect of individuals killing themselves. The first story is that a medical doctor was being driven on Third Mainland Bridge, the story went, and he asked his chauffeur to stop. In the middle of the said bridge, he apparently had spoken to someone on the phone earlier, got out of the car and launched a dive into the deep ocean. His body was recovered later, apparently died due to suicide. Few weeks after the first event recording the demise of the doctor, a businesswoman attempted to repeat what the doctor had done but she was saved by the vigilance and quick reaction of the people around. As it turned out, the woman had lost a substantial amount of her business funds by whatever means. The poor woman was charged to court on account of attempted suicide. Ultimately, the court freed her and she vowed not to attempt to take life ever again.
These events represents as I have illustrated above, the tip of the iceberg of suicide rates in Nigeria. Contrary to popular belief, that is to say, suicide is not uncommon in the jurisdiction of Nigeria. Suicide is the act of taking one’s life or termination of one’s life. Suicide may be accidental or intentional. In contract, murder or homicide is the intentional killing of an individual by another person. Secondary murder (USA definition) or manslaughter (UK and other common law jurisdiction definition) is the unintentional killing of another person.
Globally, about a million people commit suicide every year. Put more specifically, an estimated 12 individuals for every 100,000 people take their own lives every year. In Nigeria, this figure is that approximately 7 persons will commit suicide for every 100,000 of the population. Sadly, suicide affects the dynamic and most energetic group of a country’s population. That is to say, the very young and productive people seem to succumb to suicide. Thus, suicide is one of the three leading causes of death among those in the most economically productive age group (15–44 years).
Whilst individuals are often the victims of suicide, there is also a trend of joint suicidal enterprise (otherwise called suicide pact): persons who come together to take their own lives. This is yet uncommon in Nigeria but a feature of Asian communities.
Thou shall not kill thyself: religion and the law: There is no doubt that Nigeria is heavily a religious nation featuring different religious beliefs though about 10-13% of Nigerians are atheist. Yet, despite having been the happiest nation on earth in recent memory, murder and suicide rates in Nigeria are not falling.
While there is no reservation that our various religions may be stemming the inclination to commit suicide, the law, as the experience of the woman in the first paragraph shows, takes a frown and dim view of suicide or attempted suicide.
Back in England (UK). Before the Suicide Act 1961, it was a crime to commit suicide, and anyone who attempted and failed could be prosecuted and imprisoned, while the families of those who succeeded could also potentially be prosecuted. In part, that criminalization reflected religious and moral objections to suicide as self-murder as we still have in Nigeria; in part our laws having derived from colonial legacy. The Suicide Act 1961 is an Act of the Parliament of the United Kingdom that decriminalized the act of suicide in England and Wales so that those who failed in the attempt to kill themselves would no longer be prosecuted.
Return to Nigeria: In spite of the monumental change to the law that had taken effect in the UK in respect of suicide, the law in Nigeria remain stern in respect of attempted suicide.
Section 327 of Criminal Code Act, Chapter 77, Laws of the Federation of Nigeria 1990 states: “Any person who attempts to kill himself is guilty of a misdemeanor, and is liable to imprisonment for one year.” Also, if you assist in anyway, a person to commit suicide, you may be sent to prison for life. Of course, no charge can be brought against a person who is already dead, suffice to say.
Causes of suicide, suicidal ideation and attempted suicide: Suicide or attempted suicide is in general a clinical indication that something is wrong with the person. Very often, the person is suffering from depression (20% of Nigerians and indeed world population suffers from depression) which may be caused by financial loses, bereavement, relationship breakdown, poor career prospects or failure, unemployment, social ridicule in whatever age group, academic failure, existing mental illness such as schizophrenia with hearing of voices, religious misdirection, existing of chronic physical illness such as HIV and cancers and chronic pain amongst others. While women tends to attempt suicide unsuccessfully, men seems to actually kill themselves. Being unmarried also tend to push individuals toward suicide.
Preventions: In the eyes of healthcare practitioners and as it is in England of 1961 Suicide Act, suicide should not be a criminal offence any longer in Nigeria. Suicide should be seen as a cry for help which went unheard. Attempted suicide is a clear cry for help and support. Suicidal persons need credible social, healthcare and family support rather than being blamed and imprisoned. If you are feeling low in your spirit, seek urgent medical intervention. Help is available.
The role of coroner in suicide: If however, a person is found to have committed suicide, under the current law, an inquest, at the behest of the coroner, should be held to determine cause of death. But, the coroner or the police will first of all need to be informed of the death. What appears to be suicide, may actually in the end, be a homicide. In all, personal injuries, attempted suicide and unlawful deaths, can be remedied. Depression can be treated and social issues can be resolved. All you need to do is to ask for help. You will find it.