Forensic medicine in the next century: some ethical challenges.

The authors, after having defined the concepts of ethics, morality, and legality, debate the main ethical problems that forensic medicine will face in the next century. The authors foresee that the technological advancement will present imposing challenges, including those concerning genetic manipulation and the keeping of confidentiality regarding electronic files. On the other hand, old problems will recur, the most important being the vital question of research with prisoners and the use of torture by agents of the state. The authors also discuss the role of the forensic physician in these contexts and conclude that there is a need for international legislative mechanisms that would establish a set of explicit rules of behavior, thus diminishing the possibility of ethical dilemmas. Forensic medicine is the practice of any medical act that is at the direct service of the judiciary power, either enlightening facts of a technical nature indispensable to the correct use of the law before adjudication, or as a result of judicial action being practiced after sentencing. The former would occur in the forensic sphere itself, with the physician acting exclusively as an expert; the latter would happen basically in the prison setting, when both expert and therapeutical actions may take place. Forensic medicine, therefore, can be considered as a very particular form of medical practice. On one hand, it does not primarily aim at the medical benefit of the person under examination (in the case of expert evaluation). On the other hand, when it is essentially therapeutical, the relation established between the doctor and the patient is basically of a triangular nature because it is directly and equally linked to a third party, that is, the prison authority or the penal order for medical intervention. Ordinarily, the physician in his professional role must strictly abide by the laws in force and by the ethical principles that guide medical practice. In forensic medicine, however, this task becomes difficult on account of the seemingly antithetical roles of the physician and the demands of third systems. Thus, because of its characteristics, forensic medicine presents a fertile ground where ethical and legal problems may fester. In this article, the authors intend to examine some of the potential ethical dilemmas that forensic medicine of the next century will probably face. The article proceeds from a discussion of the concepts of what is ethical, moral, and legal, International Journal of Offender Therapy and Comparative Criminology, 43(2), 1999 188-201  1999 Sage Publications, Inc.