Diagnosing Crime and Diagnosing Disease: Bias Reduction Strategies in the Forensic and Clinical Sciences

Cognitive effort is an essential part of both forensic and clinical decision‐making. Errors occur in both fields because the cognitive process is complex and prone to bias. We performed a selective review of full‐text English language literature on cognitive bias leading to diagnostic and forensic errors. Earlier work (1970–2000) concentrated on classifying and raising bias awareness. Recently (2000–2016), the emphasis has shifted toward strategies for “debiasing.” While the forensic sciences have focused on the control of misleading contextual cues, clinical debiasing efforts have relied on checklists and hypothetical scenarios. No single generally applicable and effective bias reduction strategy has emerged so far. Generalized attempts at bias elimination have not been particularly successful. It is time to shift focus to the study of errors within specific domains, and how to best communicate uncertainty in order to improve decision making on the part of both the expert and the trier‐of‐fact.     

Assessing Cognitive Bias in Forensic Decisions: A Review and Outlook

In recent years, a number of studies have demonstrated that forensic examiners can be biased by task-irrelevant contextual information. However, concerns relating to methodological flaws and ecological validity attenuate how much the current body of knowledge can be applied to real-life operational settings. The current review takes a narrative approach to synthesizing the literature across forensic science. Further, the review considers three main issues: (i) primary research on contextual bias within forensic science; (ii) methodological criticisms of this research; (iii) an alternative perspective that task-irrelevant contextual information does not always lead to error. One suggestion for future research is outlined, which is that studies on contextual bias in forensic decisions should be conducted in collaboration between forensic scientists and cognitive psychologists. Only then can rigorous and ecological valid experiments be created that will be able to assess how task-irrelevant contextual information influences forensic analysis and judgments in operationally valid settings.     

A risk-based approach to cognitive bias in forensic science

Over the past decade, the potential impact of cognitive bias in forensic science has instigated much discussion and debate between academics, scientists and those in the justice sector. Evidence of bias influencing subjective decision-making across a range of forensic disciplines has been described in the literature. Forensic service organisations are being urged to address cognitive bias in subjective decision-making by designing processes or procedures to limit access to (irrelevant) contextual information or reduce dependence on cognitive functions. Although some laboratories have implemented bias mitigating strategies, with varying impact on operational efficiency, there has been no systematic assessment of the risk posed by cognitive bias. Forensic Science SA assessed the potential impact of bias on forensic interpretations across multiple disciplines, using a risk management framework. This process proved useful in assessing the effectiveness of existing bias mitigating strategies and identified the latent level of risk posed. While all forensic organisations should seek to implement bias limiting measures that are simple, cost-effective and do not adversely impact efficiency, using a risk-based approach has contextualised the limited benefit of introducing resource hungry measures, as postulated in the literature. That is not to suggest that forensic organisations should dismiss the potential influence of cognitive bias but they need to strike an appropriate balance between risk and return, as they do with any business risk.     

The Power of Contextual Effects in Forensic Anthropology: A Study of Biasability in the Visual Interpretations of Trauma Analysis on Skeletal Remains

The potential for contextual information to bias assessments in the forensic sciences has been demonstrated, in several forensic disiplines. In this paper, biasability potential within forensic anthropology was examined by analyzing the effects of external manipulations on judgments and decision‐making in visual trauma assessment. Three separate websites were created containing fourteen identical images. Participants were randomly assigned to one website. Each website provided different contextual information, to assess variation of interpretation of the same images between contexts. The results indicated a higher scoring of trauma identification responses for the Mass grave context. Furthermore, a significant biasing effect was detected in the interpretation of four images. Less experienced participants were more likely to indicate presence of trauma. This research demonstrates bias impact in forensic anthropological trauma assessments and highlights the importance of recognizing and limiting cognitive vulnerabilities that forensic anthropologists might bring to the analysis.     

Context effects and observer bias--implications for forensic odontology

Psychologists have long recognized the effects of contextual and extraneous information on decision making. Such information renders the subject susceptible to both motivational and cognitive bias; yet, it is difficult to assess the extent to which these influence forensic odontologists opinions as there have been no studies to date on this subject. This article explores the various types of contextual effects and biasing influences that potentially impact on the analysis of bitemarks in forensic odontology. It appears that the current practice of bitemark analysis is rich in sources of potentially biasing influences. In addition to the fundamental recognition that some form of bias is likely to exist, ways in which these should be minimized include: separation of the collection and analysis phases; limiting the amount of contextual information available to the odontologist responsible for the analysis; and ensuring that evidence that is ambiguous or of poor quality is identified as such prior to analysis.     

ISO Standards Addressing Issues of Bias and Impartiality in Forensic Work

The ISO/IEC 17020 and 17025 standards both include requirements for impartiality and the freedom from bias. Meeting these requirements for implicit cognitive bias is not a simple matter. In this article, we address these international standards, specifically focusing on evaluating and mitigating the risk to impartiality, and quality assurance checks, so as to meet accreditation program requirements. We cover their meaning to management as well as to practitioners, addressing how these issues of impartiality and bias relate to forensic work, and how one can effectively evaluate and mitigate those risks. We then elaborate on specific quality assurance policies and checks and identify when corrective action may be appropriate. These measures will not only serve to meet ISO/IEC 17020 and 17025 requirements, but also enhance forensic work and decision-making.     

Metric forensic anthropology decisions: Reliability and biasability of sectioning-point-based sex estimates

Subjective decisions make human cognitive processes more susceptible to bias and error. Specifically, research indicates that additional context biases forensic anthropologists’ morphological analyses. To address whether metric analyses are also subject to bias, we conducted a pilot study in which 52 experienced osteologists measured a difficult-to-classify human femur, with or without additional contextual information. Using a metric sectioning-point sex-estimation method, participants provided a sex estimate for individual skeletal element(s) and, when given multiple elements, the combined skeletal assemblage. Control group participants (n = 24) measured only the femur. In addition to the femur, bias group participants (n = 28) either measured a female humerus and viewed a female-biasing photograph (n = 14) or measured a male humerus and viewed a male-biasing photograph (n = 14). We explored whether the experts in the different groups would differ in: (1) femoral measurements; (2) femoral sex-estimation conclusions; and (3) final sex-estimation conclusions for the skeletal assemblage. Although the femoral measurements and femoral sex estimates were comparable across groups, the overall sex estimates in the female-biased group were impacted by contextual information—differing from both the control and male-biased groups (p < 0.001). Our results demonstrate that cognitive bias can occur even in metric sex-estimation conclusions. Specifically, this occurred when the metric data and single-element sex estimates were synthesized into an overall estimate. Thus, our results suggest that metric methods are most vulnerable to bias when data are synthesized into an overall conclusion, highlighting the need for bias countermeasures and comprehensive statistical frameworks for synthesizing metric data to mitigate the effects of cognitive bias.     

How Cross‐Examination on Subjectivity and Bias Affects Jurors’ Evaluations of Forensic Science Evidence

Contextual bias has been widely discussed as a possible problem in forensic science. The trial simulation experiment reported here examined reactions of jurors at a county courthouse to cross‐examination and arguments about contextual bias in a hypothetical case. We varied whether the key prosecution witness (a forensic odontologist) was cross‐examined about the subjectivity of his interpretations and about his exposure to potentially biasing task‐irrelevant information. Jurors found the expert less credible and were less likely to convict when the expert admitted that his interpretation rested on subjective judgment, and when he admitted having been exposed to potentially biasing task‐irrelevant contextual information (relative to when these issues were not raised by the lawyers). The findings suggest, however, that forensic scientists can immunize themselves against such challenges and maximize the weight jurors give their evidence by adopting context management procedures that blind them to task‐irrelevant information.     

A Perspective on Errors,Bias, and Interpretation in the Forensic Sciences and Direction for Continuing Advancement*

Abstract: The forensic sciences are under review more so than ever before. Such review is necessary and healthy and should be a continuous process. It identifies areas for improvement in quality practices and services. The issues surrounding error, i.e., measurement error, human error, contextual bias, and confirmatory bias, and interpretation are discussed. Infrastructure is already in place to support reliability. However, more definition and clarity of terms and interpretation would facilitate communication and understanding. Material improvement across the disciplines should be sought through national programs in education and training, focused on science, the scientific method, statistics, and ethics. To provide direction for advancing the forensic sciences a list of recommendations ranging from further documentation to new research and validation to education and to accreditation is provided for consideration. The list is a starting point for discussion that could foster further thought and input in developing an overarching strategic plan for enhancing the forensic sciences.     

Cognitive bias in forensic anthropology: Visual assessment of skeletal remains is susceptible to confirmation bias

An experimental study was designed to examine cognitive biases within forensic anthropological non-metric methods in assessing sex, ancestry and age at death. To investigate examiner interpretation, forty-one non-novice participants were semi randomly divided into three groups. Prior to conducting the assessment of the skeletal remains, two of the groups were given different extraneous contextual information regarding the sex, ancestry and age at death of the individual. The third group acted as a control group with no extraneous contextual information. The experiment was designed to investigate if the interpretation and conclusions of the skeletal remains would differ amongst participants within the three groups, and to assess whether the examiners would confirm or disagree with the given extraneous context when establishing a biological profile. The results revealed a significant biasing effect within the three groups, demonstrating a strong confirmation bias in the assessment of sex, ancestry and age at death. In assessment of sex, 31% of the participants in the control group concluded that the skeleton remains were male. In contrast, in the group that received contextual information that the remains were male, 72% concluded that the remains were male, and in the participant group where the context was that the remains were of a female, 0% of the participants concluded that the remains were male. Comparable results showing bias were found in assessing ancestry and age at death. These data demonstrate that cognitive bias can impact forensic anthropological non-metric methods on skeletal remains and affects the interpretation and conclusions of the forensic scientists. This empirical study is a step in establishing an evidence base approach for dealing with cognitive issues in forensic anthropological assessments, so as to enhance this valuable forensic science discipline.     

Sexual assault examinations and forensic medical samples

Recent studies and a review in the United States have identified that tens of thousands of used but untested sexual assault examination kits containing medical examination specimens are to be found in police station evidence rooms, forensic science laboratories, hospitals and rape crisis centres. A 2007 survey undertaken by the National Institute of Justice in the United States explored some of the reasons why forensic specimens are not tested by forensic science laboratories. Many of these relate to lack of knowledge on the part of investigators as to how scientific information can assist the investigation process, even if not used subsequently at trial. Cost factors and laboratory casework overload were also identified as significant. For the medical practitioner, the lack of testing poses issues that include quality management of the forensic medical examination and informed consent in a setting requiring the balancing of public and private benefits for the examinee. Limiting scientific testing, even with intelligence-led triaging of sample testing, could have an adverse effect on both prosecution and defence decision-making and ultimately could adversely affect trial outcomes.     

Naturalistic decision making in forensic science: toward a better understanding of decision making by forensic team leaders

This study uses the naturalistic decision-making (NDM) perspective to examine how Dutch forensic team leaders (i.e., the officers in charge of criminal forensic research from the crime scene until the use of laboratory assistance) make decisions in real-life settings and identifies the contextual factors that might influence those decisions. First, a focus group interview was conducted to identify four NDM mechanisms in day-to-day forensic decision making. Second, a serious game was conducted to examine the influence of three of these contextual mechanisms. The results uncovered that forensic team leaders (i) were attracted to obtain further information when more information was initially made available, (ii) were likely to devote more attention to emotionally charged cases, and (iii) used not only forensic evidence in the decision making but also tactical, unverified information of the police inquiry. Interestingly, the measured contextual influences did not deviate significantly from a control group of laypeople.     

“Identified”, “probable”, “possible” or “exclude”: The influence of task-irrelevant information on forensic odontology identification opinion

In a mass disaster situation, identification of the deceased utilising comparison of dental features is frequently heavily relied upon to facilitate rapid and accurate outcomes. The method consists of the comparison of clinical and radiographic records depicting oral structures and dentition to allow an opinion to be produced on a presumed identity. Current forensic odontology identification opinions are expressed as categories of levels of identification. Categories such as “Identified”, “Probable”, “Possible” and “Exclude” are used in various forensic odontology identification scales. The boundaries between the levels of the scales are not fixed; hence, category selection is highly subjective. It is uncertain how extrinsic factors such as exposure to contextual task-irrelevant information or operator experience influence category selection. In this study, forensic odontologist and dentist participants read task-irrelevant context case information containing either strong or weak identification or non-identification suggestions before evaluating and comparing pairs of true matching and non-matching dental radiographs. They were then asked to form an opinion regarding identification using one of four categories from the INTERPOL scale. Context information was found to influence categorical decisions. The magnitude and direction of influence depended on the type of participant, the true match status of the radiographs, and the strength and direction of bias of the context. The results of this study demonstrate the contextual effect and fluidity of the boundaries between the categories on the identification scale and highlight the need for stringent protocols to be developed regarding the use of these categorical scales to enable decision making to be more objective.     

Cognitive forensics and experimental research about bias in forensic casework

Understanding and coping with cognitive bias in forensic science requires multiple studies, utilizing both laboratory-based experiments and data from casework. Neither type of studies has ever been conducted to examine bias in mixture DNA interpretations. A study that includes both types of data has recently been published in Science and Justice. The data and statistical analysis clearly — at the very least — suggest that bias may potentially influence DNA mixture interpretation. This is due, in part, to the subjective elements in interpretation of mixture DNA. The issue of bias and other cognitive influences is of a sensitive nature and presents complex experimental challenges. Our study takes a step in examining these issues and calls for more research.     

法医文证审查100例分析

通过100例法医文证审查案件的分析,发现在目前检察机关文证审查工作中,存在委托数量不足、委托程序不规范、送检材料不全面等问题;在送审鉴定文书中,也存在标准条文掌握不当、鉴定人基础知识欠缺和粗心大意等问题。同时发现,鉴定文书的规范化程度和采信率已经得到有效的提高;且规范化越高的鉴定机构,则其鉴定文书的准确率越高,被采信率也越高。目前有必要加强检察技术部门文证审查的技术水平,进一步积累办案经验,切实增强检察机关的法律监督能力。     

Cognitive issues in fingerprint analysis: inter- and intra-expert consistency and the effect of a 'target' comparison

Deciding whether two fingerprint marks originate from the same source requires examination and comparison of their features. Many cognitive factors play a major role in such information processing. In this paper we examined the consistency (both between- and within-experts) in the analysis of latent marks, and whether the presence of a 'target' comparison print affects this analysis. Our findings showed that the context of a comparison print affected analysis of the latent mark, possibly influencing allocation of attention, visual search, and threshold for determining a 'signal'. We also found that even without the context of the comparison print there was still a lack of consistency in analysing latent marks. Not only was this reflected by inconsistency between different experts, but the same experts at different times were inconsistent with their own analysis. However, the characterization of these inconsistencies depends on the standard and definition of what constitutes inconsistent. Furthermore, these effects were not uniform; the lack of consistency varied across fingerprints and experts. We propose solutions to mediate variability in the analysis of friction ridge skin.     

Doing justice to justice

Adshead's recognition that only when taken together can the many different conceptions of justice accommodate what is called for in the particularly demanding setting of forensic mental health care, is to be applauded. Each must be honoured and built into the systems of assessment and treatment that are the tasks of the forensic psychiatrist, she demonstrates. Adshead's far‐reaching revisions could resolve much that is troubling about the present practice of forensic psychiatry. Yet how much these revisions can overcome the moral dilemmas associated with dual roles in forensic psychiatry, is not so clear.     

Impact of Common Mental Health Disorders on Cognition: Depression and Posttraumatic Stress Disorder in Forensic Neuropsychology Context

The assessment and diagnosis of posttraumatic stress disorder (PTSD) and depression in forensic evaluations may lack an acknowledgement of the neurocognitive impact of these disorders and how they interact with other causative factors, such as traumatic brain injury (TBI), pain or fatigue. Both PTSD and depression have a complex, growing and consolidating neuroscientific and neuropsychological evidence base, and both can affect neuropsychological test results. In forensic neuropsychological assessments, they are often considered to be confounding factors in evaluating TBI and neurodegenerative disorders but not a source of cognitive impairment in their own right. Yet, an accurate neuropsychological assessment of both cognition and affect is vital to causality determination, prognosis and treatment planning. To complicate matters, selective brain injuries, contingent on the location of injury, can produce symptoms of depression that also affect the neurocognitive profile. Therefore, behavior can overlap not only due to overlapping or comorbid diagnoses, but also due to similar neuroanatomical correlates of both conditions. This paper focuses on reviewing and integrating the available empirical evidence from neuroscience and neuropsychology regarding the cognitive impact of PTSD and depression. Our critical review will emphasize the implications of the more recent evidence for forensic assessment determinations regarding causality, diagnosis, and the impact on function, prognosis and treatment. Hence, electronic search engines, PubMed, PsycINFO, and Google Scholar (up to January 2018) were screened and reviewed both for the neuroscience and neuropsychological literature related to depression and PTSD.     

静脉气体栓塞的研究进展

气体栓塞是一种较多见而又威胁生命的医疗操作并发症,在法医学实践中也时有所遇,但易被检验者所忽略;也常因尸体放置较久而给法医学检验和鉴定带来困难。在此综述了静脉气体栓塞的病因、病理生理变化、临床表现及诊断和法医学鉴定的意义及注意事项,认为超声心动图、CT和MRI等现代成像技术在气体栓塞的临床诊断和法医学鉴定中有积极的辅助作用。