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Medico-Legal Journal, Ahead of Print.
Khan v Meadows, which was decided recently by the Supreme Court, will have a profound effect on day-to-day clinical practice and future clinical negligence cases. It has clarified the scope of duty of care and to a significant extent links it to the questions being asked by patients of their doctors and by doctors of their colleagues. Will courts now consider that when a patient consults a doctor, he or she is seeking an answer to a specific question or a more general question hidden within that specific question? Clearly the onus will be on clinicians to define exactly what is wanted by the patient or by a colleague.

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Medico-Legal Journal, Ahead of Print.
This paper discusses the advance decision, which was the subject-matter of Re PW (Jehovah’s Witness: Validity of Advance Decision) [2021] EWCOP 52. An advance decision is basically a decision, made by a person with mental capacity, that they should not be given a particular medical treatment if they lack such capacity later. This paper considers and comments on some of the terms used to describe the advance decision, some principles relating to it, some arguments for and against it, whether it is revocable, and its standing in relation to the Mental Health Act 1983, as amended. Two limits of an advance decision (it is revocable and can be overridden by the Mental Health Act 1983, s 63) are exposed by the paper.

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Medico-Legal Journal, Ahead of Print.
AimsThe Assisted Decision-Making (Capacity) Act 2015 provides a legislative framework for advance healthcare directives in Ireland. This study assessed Irish consultant physicians’ knowledge of the provisions of the Act relating to advance healthcare directives, and their attitudes towards advance healthcare directives in general.MethodsData were collected between May and October 2016. A questionnaire was distributed to all consultant physicians listed in the Irish Medical Directory under general internal medicine specialties. True/false questions assessed knowledge of the provisions of the Act. Likert-type questions assessed attitudes towards advance healthcare directives.ResultsThe overall response rate was 28.7% (238/830). Only 42.1% of respondents were aware of the provisions of the Act relating to advance healthcare directives. Of the seven questions that assessed knowledge of those provisions, the mean score was 3.31/7.78.7% agreed that advance healthcare directives are helpful when making treatment decisions for incapacitated patients. Only 15.7% regularly advise their patients to create advance healthcare directives.DiscussionIrish physicians are broadly supportive of advance healthcare directives but there are deficiencies in their knowledge of the law relating to them. Efforts should be made to educate physicians regarding the provisions of the Act prior to its commencement.

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Medico-Legal Journal, Ahead of Print.
Background and objectiveSudden cardiac death can be defined as a sudden, unexpected death caused by loss of heart function. Notwithstanding major developments in the diagnosis and treatment of heart disease, it remains the major contributing factor for deaths. This considers the pattern of sudden cardiac deaths.Methodology: This prospective study was conducted on all cases subjected to medico-legal autopsy in the forensic medicine department at a tertiary care hospital for a period of 18 months. All sudden cardiac deaths satisfying the WHO criteria were included. Unknown cases and bodies in advanced stage of decomposition were excluded.ResultsSudden cardiac deaths accounted for 55% (82 cases) of 149 cases of sudden natural deaths and 6.5% of total autopsies conducted. The age group most commonly affected by sudden cardiac death ranged from 31 to 50 years. The majority of the cadavers had 90–95% degree of stenosis of left anterior descending artery, 70–80% of right coronary artery and 60–70% left circumflex artery. Coronary insufficiency was the major cause for sudden cardiac deaths with a total of 53 (64.63%) cases.ConclusionSudden cardiac deaths accounted for 6.5% of all the autopsies conducted and males outnumbered females with M:F ratio of 10.7:1, with mean age of 44.5 ± 12.63 years. The largest number – 60.97% – were aged between 31 and 50 years. Coronary insufficiency accounted for 64.63% of sudden cardiac deaths.

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Medico-Legal Journal, Ahead of Print.
The surgeon is consulted by the patient, the situation is fully explained to the patient, the patient agrees to the operation. The patient is anaesthetised. An unexpected situation arises, things are not as the surgeon had imagined. Should he carry on and hope for the best? Or call the whole thing off? The law.

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Medico-Legal Journal, Ahead of Print.
Self-mutilation is defined as a “deliberate destruction or alteration of body tissue without conscious suicidal intent”. The prevalence of self-mutilation is about 1%, however the voluntary cutting of the genital organs remains extremely rare with fewer than 100 cases of genital self-mutilation reported in both sexes in the English literature to date. Genital self-mutilation is most often associated with psychiatric disorders, but it has also been reported in nonpsychotic individuals owing to various reasons. Here, we present the case of a 45-year-old man who was found deceased in his home in a pool of blood with a knife and a pair of scissors lying next to him. In addition to this, parts of the intestine were found next to the body. The patient was diagnosed with hydrocoele and had a known history of tomophobia which caused him to take matters into his own hands by incising his scrotum which led to his demise. Self-orchidectomy is an extremely rare phenomenon and is most often associated with psychiatric illness.

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Medico-Legal Journal, Ahead of Print.
The finding of a partially mummified body presenting signs of trauma requires the forensic pathologist to conduct a careful and complex examination; multidisciplinary analysis is often necessary.We report a case where the partially mummified corpse of an elderly man was found in his own home more than seven years after death. Complete post-mortem investigation revealed a cranial fracture and an acute subdural haematoma.An in-depth multidisciplinary analysis provided important information on the modality and cause of death but it was not possible to establish whether the trauma and death resulted from an accidental event or from an assault.

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Medico-Legal Journal, Ahead of Print.
There have been at least two deaths in Albania linked to ritualistic/satanic practices, which have provoked considerable public concern. Until the 1990s, Albania was strictly atheist. However, since then some religious sects have been establishing themselves. In fact, satanic killings and ritualistic deaths are rare in Albania. We describe two such cases that occurred in 2020 along with consideration of the psychological profiles of perpetrators and victims.The first case involved two deaths: a mother and daughter whose bodies were found near each other, with another daughter in attendance who was diagnosed as clearly psychotic, and legally did not face any charge thereafter. This daughter was witnessing the decomposition of her sister’s mummified corpse. She said she was waiting for the “Messiah” to resurrect her. Apparently, while performing ritualistic ceremonies, the daughter and her mother refused food until the mother died from starvation. It was at that point that police broke into the house and discovered the situation.The second case involved a young woman who was found dead, apparently following a trivial infection. Her body (abdomen and dorsum) had written symbols on it, suggesting Satanism and the occult.A detailed analysis of the death scenes and crime scenes provide valuable data for further proceedings, but psychological evaluation of the perpetrators may prove more difficult, and more so where the victims have died.

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