摇晃婴儿综合征:科学(与非科学)专家的一场真实交战

本文从科学和法律层面介绍了摇晃婴儿综合征的有关内容,就关于摇晃婴儿综合征的科学和非科学专家证言的可采性进行了评价,称在科学和非科学专家之间正在发生一场真实的交战。     

摇晃婴儿综合征争议及研究进展

摇晃婴儿综合征是常见的虐待性颅脑损伤,其病理表现为三联征:脑实质病变、硬脑膜下出血、视网膜出血。虽然摇晃婴儿综合征被广泛运用于医学及法律领域,但是由于目前尚无直接证据证实成人摇晃儿童能造成严重脑损伤甚至死亡的后果,因此摇晃婴儿综合征存在学术争议。争议内容包括摇晃婴儿综合征的生物力学机制、病理生理机制等方面。由于某些疾病也能导致病理三联征,因此在诊断摇晃婴儿综合征过程中,应当注意外伤史、案情调查等。     

新生儿和婴儿他杀案件特点及法医学检查要点

正新生儿和婴儿死亡案件的调查是法医学上的一个难点。杀害新生儿最常见方式为遗弃。杀害婴儿的行为可分为5类:受虐儿童综合征、忽视和饥饿、窒息、摇晃婴儿综合征、其他。新生儿和婴儿的他杀案件往往与成人不同。一是其自我保护能力极弱,且轻微的暴力攻击可致其死亡;二是解剖时不易发现暴力作用的痕迹,由于脏器小,暴力作用面积小,采用传统的成人解剖方式可能     

论科学证据的实质审查

对于科学证据的审查有遵从模式和教育模式两种不同模式：前者要求裁判者应当尊重科学证据,一般只要求对科学证据进行形式审查;后者则在为裁判者提供一定科学知识的基础上要求裁判者对科学证据进行实质审查。我国的科学证据审查总体上属于遵从模式。随着新类型科学证据的增加以及科学证据范围的扩张,我国的刑事法官在维持原有形式审查的基础上,必须对科学证据进行一定程度的实质审查,仅进行形式审查无法保障科学证据的科学性和可靠性。因法官作为非科学专家的普通人,对科学证据的审查无法达到科学界的同行审查水平,故其审查并非从科学视角对科学证据原理的检验,而只须从诉讼证明视角审查科学证据的原理是否可靠、该原理是否被正确适用。原理的可靠性审查主要是审查科学证据的原理是否明确、是否有可信证据证明原理的可靠性、是否存在对原理的根本性争议几个方面;原理适用的正确性审查主要是审查科学证据的操作过程和方法、分析和计算方法、专家对意见的论证是否符合科学原理的要求。在科学证据的审查中,多元专家的参与有助于法官的实质审查,但应对不同类型专家的功能进行清晰划分;专家的辅助性意见应予以公开并接受异议;同时应保障法官对科学证据的独立判断权。     

科学证据的风险及其规避

现代司法越来越多地利用乃至依赖科学证据，但科学证据在帮助司法机关发现事实的同时，也暗藏了巨大的风险。随着专家垄断事实的常态化和普遍化，专家与法官角色出现混同，首先重创了程序正义。而法庭上的坏科学与有组织的不负责任，以科学掩盖事实，又使实体正义屡遭挫败。为了化解上述风险，既要重申法官自由心证的权能，更要帮助法官掌握科学证据的评价方法，同时引入中立专家以弥补法官专业知识的不足。法官独立于专家而进行的自由心证，除了实现个案正义，还有效地关注了社会正义，即通过司法实现社会公共价值。总之，在司法领域，科学专家永远只是帮助法官发现事实的“仆人”，法官才是事实认定的“主人”。     

中美法庭科学技术交流与研讨班在北京举办

20 0 0年 11月 3日至 7日 ,中国法医学会在北京举办了中美法庭科学技术交流与研讨班。该班以“2 1世纪的法庭科学”为主题 ,交流研讨了下列内容 :(1)犯罪现场勘查技术与程序 ;(2 )法庭科学实验室管理要素、质量控制、资源最大化应用、资格认定 ;(3)法庭科学专家出庭程序及举证规范化 ;(4 )如何达到第一流的犯罪实验室工作水平及对辛普森案件法庭科学鉴定结果的反思 ;(5 )婴儿死亡和婴儿急死综合征 ;(6 )婴儿急死综合征的组织病理学研究 ;(7)虐待儿童案例介绍 ;(8)儿童死亡时间和死后尸体变化 ;(9)迟发性创伤性颅内出血和死亡方式的确定 ;(10…     

英美法国家科学证据的历史沿革评述

从18世纪到20世纪,英美法国家有关科学证据的法庭运用,所表明的基本思想是,将科学证据评价的事实问题,通过三种方法转化为法律问题,以此保证法官在科学证据评价中承担更多的审查义务,以减少陪审团在科学证据判断上出错的可能性。这三种法律转化方法分别是,专家资格审查、专家证言的形式审查、专家证言的实质审查。这在20世纪的美国审判中,表现得更为突出。     

科学证据司法评估的进步轨迹:我的个人视角

不可否认,许多鉴定技术缺乏充分的科学性核验,并且法院在审查基于该些技术的专家证言可靠性时过于松懈.诚然,本文作者对迄今为止的科学证据司法审查进展(或不足)方面持有不同看法.尽管评论家们针对存有缺陷的专家证言发出警告的做法是正确的,但从一个长期视角来看,自20世纪70年代起至今,对这些证言的司法审查已经取得了重大进步.几...     

论科学证据的证明力

在事实认定日益科技化的现代诉讼中,科学证据的使用越来越普遍。但由于人们对科学的盲目崇拜,导致了司法实践中对科学证据证明力的误解和盲从时有发生。事实上,科学证据的＂科学性＂有很大的不确定性,有些科学方法的有效性还有待验证。在操作层面上,检材的收集保管过程、鉴定设备和方法以及专家的知识水平和职业操守对科学证据的证明力均有重要影响。作为新一代的＂证据之王＂,科学证据虽然具有非常重要的证明价值,但仅凭科学证据定案是很危险的,从而需要给科学证据设立补强规则。     

英美法国家科学证据的历史沿革评述

从18世纪到20世纪,英美法国家有关科学证据的法庭运用,所表明的基本思想是,将科学证据评价的事实问题,通过三种方法转化为法律问题,以此保证法官在科学证据评价中承担更多的审查义务,以减少陪审团在科学证据判断上出错的可能性。这三种法律转化方法分别是,专家资格审查、专家证言的形式审查、专家证言的实质审查。这在20世纪的美国审判中,表现得更为突出。     

Shaken baby syndrome and the death of Matthew Eappen: a forensic pathologist's response

Subdural hemorrhage, retinal hemorrhage, and cerebral edema have been considered diagnostic for a "shaken infant" since the syndrome was described almost 30 years ago. However, the specificity of these findings has been disputed by defense witnesses in recent U.S. criminal prosecutions. This review examines the scientific basis for the shaken baby syndrome.     

Case analysis of brain-injured admittedly shaken infants: 54 cases, 1969-2001

The English-language medical case literature was searched for cases of apparent or alleged child abuse between the years 1969 and 2001. Three-hundred and twenty-four cases that contained detailed individual case information were analyzed yielding 54 cases in which someone was recorded as having admitted, in some fashion, to have shaken the injured baby. Individual case findings were tabulated and analyzed with respect to shaking as being the cause for the injuries reported. For all 54 admittedly-shaken-infant cases, the provided details regarding the shaking incidents and other events are reported. Data in the case reports varied widely with respect to important details. Only 11 cases of admittedly shaken babies showed no sign of cranial impact (apparently free-shaken). This small number of cases does not permit valid statistical analysis or support for many of the commonly stated aspects of the so-called shaken baby syndrome.     

Representation of cerebral bridging veins in infants by postmortem computed tomography

The postmortem diagnosis of shaken baby syndrome, a severe form of child abuse, may be difficult, especially when no other visible signs of significant trauma are obvious. An important finding in shaken baby syndrome is subdural haemorrhage, typically originating from ruptured cerebral bridging veins. Since these are difficult to detect at autopsy, we have developed a special postmortem computed tomographic (PMCT) method to demonstrate the intracranial vein system in infants. This method is minimally invasive and can be carried out conveniently and quickly on clinical computed tomography (CT) systems. Firstly, a precontrast CT is made of the infant's head, to document the original state. Secondly, contrast fluid is injected manually via fontanel puncture into the superior sagittal sinus, followed by a repeat CT scan. This allows the depiction of even very small vessels of the deep and superficial cerebral veins, especially the bridging veins, without damaging them. Ruptures appear as extravasation of contrast medium, which helps to locate them at autopsy and examine them histologically, whenever necessary.     

Asphyxia protracted after shaking trauma

A case of "shaken baby syndrome" (SBS) is reported. A 3 1/2 months old female baby has been found by his mother death in bed. The circumstances predicted a case of Sudden Infant Death Syndrome (SIDS), but the father, a disc-jockey, who had to look for the baby, had left a notice: "Gitti--i didn't want it, I don't know what had happened, I'm sorry!". The corpse of the baby had no external signs of violence. At the medicolegal examination we found small subarachnoidal and subdural hemorrhage from ruptured bridge veins and signs of prolonged asphyxia. Few hours later the father could be arrested. He told that he had shaken the baby, because she didn't stop crying. The infant lost conscious and he layed him down to the bed with his face below. Then he looked TV for at least a few minutes. After insufficient reanimation he had left the house. The court found the man to be guilty of fatal infant child abuse and convicted him to detention of 8 months. The main signs of SBS are discussed (subarachnoidal and subdural hemorrhage, intraretinal and periretinal hemorrhages, brain edema). Especially in the german speaking Europe many medical examiners are not familiar with this form of infant child abuse.     

The shaken baby syndrome: a serious diagnosis on an insecure foundation?

The discussion concerning the causes of infantile subdural bleedings (SDB) as well as retinal hemorrhages has become quite controversial in the last few years. The long-standing interpretation that most of these cases are the result of abuse--especially by the shaken baby syndrome (SBS)--was doubted, and the role of accidental events was emphasized. In many cases, there are no objective witnesses who observed the incident and no unambiguous traces of abuse, so that the diagnosis "shaken baby syndrome" often has to be established indirectly. A subdural bleeding (SDB) in an infant can undoubtedly be due both to an accidental and an intentional injury. Therefore, the SDB itself does not allow to draw far-reaching conclusions as to its cause. However, if an infant died or was hospitalized in a deep coma with several bridging vein ruptures and minor subdural bleeding, these findings are not compatible with an alleged minor fall. In the presence of several bridging vein ruptures, most authors are of the opinion that this is the result of a significant traumatization. In contrast to most other reports, the reliable demonstration of BV ruptures is a routine element of the postmortem diagnostic procedures at the Berlin institute of forensic medicine. In this way, a mechanical trauma can be clearly identified as the cause of the infant's death. If several bridging veins are torn, this proves a significant trauma and rules out a banal incident. The current controversial discussion on the reliability of the SBS diagnosis often makes it difficult not only for the clinician, but also for the forensic expert, to draw safe conclusions in the presence of a combination of findings long considered typical of the shaken baby syndrome. This situation is the background for presenting and discussing the major SBS findings reported in the literature and comparing them with our own expiriences. In our opinion there is still no justification for a fundamental change in the position to interpret such cases as a consequence of severe trauma caused by another person.     

Cerebral traumatism with a playground rocking toy mimicking shaken baby syndrome

Shaken baby syndrome (SBS), one of the most deadly and devastating forms of child abuse, is caused by violent shaking. The combination of subdural hematoma, retinal hemorrhage, brain swelling, and diffuse axonal injury is highly typical of this syndrome and faced with these autopsy findings, induced traumatic lesions are strongly considered. However, it is known that motor-vehicle accidents and falls from great height can also produce this pattern of injury. Nevertheless, stories of arms fall, couch fall, or bumped head while the baby is being carried are generally considered incompatible with SBS. We here report a case of a 2-year-old boy presenting with all the classic autopsy findings of SBS from a playground rocking toy shaken by an older child.     

Fatal child abuse-maltreatment syndrome. A retrospective study in Ontario,Canada, 1990-1995

Child death due to repeated episodes of physical assault or neglect has been termed the child abuse-maltreatment syndrome (CAMS). We characterized the injuries in a series of fatally abused or maltreated child to delineate objective diagnostic criteria for the CAMS for use by clinicians and pathologists. All deaths (age <17 years) investigated by the Office of the Chief Coroner for Ontario, Canada during the time period 1990-1995 were reviewed. Cases of CAMS were defined as death due to lethal recent injury or malnutrition in the presence of significant old (healing or healed) injuries indicative of repeated episode of inflicted trauma. The nature and frequency of the various injuries was determined. The frequency of the shaken baby syndrome, and the types and frequency of ano-genital injuries were also studied. Twenty-one cases of fatal CAMS were found in the study period. Most cases had significant recent head injury with intra-cranial hemorrhage (71%). Other significant recent injuries commonly observed included blunt injuries of the skin and soft tissues (67%), blunt abdominal trauma with visceral injuries (14%), and fractures (18%). Eight cases (38%) fulfilled accepted criteria for the shaken baby syndrome. Many children with fatal head injuries had evidence of older head trauma (38% of all cases). A significant minority of cases had evidence of malnutrition due to neglect (10%) or ongoing ano-genital injuries (10%). Most cases of child homicides due to repeated episodes of abuse or maltreatment involve head trauma including shaken baby syndrome. Fractures of long bone and ribs, the classical markers of child abuse, were relatively infrequent compared with head injury. A proportion of cases had ano-genital injuries due to repeated sexual abuse or punitive maltreatment. All clinicians and pathologists must recognize the wide spectrum of injuries in child abuse to ultimate protect the victim or other children in an at-risk situation.     

Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.