Busuttil A. Legal Medicine in Europe-The Past and the Future. Adli Tip Bülteni , 1996; 1(1): 6-10.

Bu yazıda, tıp sanatının bilinen en eski zamanlardan günümüze mahkemeler ve hukuk sisteminde aldığı yer ve gelişmeler kronolojik bir yapıda aktarılmıştır. Orta çağ, Rönesans ve sonrası dönemlerde tıp biliminin hukuktaki rolü, adli tıp kavramının gelişmesi anlatılmıştır. Avrupa Bir- liği'nin gerçekleşmesi ile yakın geçmişte adli tıp uzmanlık alanının tanınması ve bu uzmanlık alanı ile ilgili mezuniyet öncesi ve sonrası eğitim programlarının Avrupa Birliği üyesi ülkelerce standartlaştırılmasına yönelik çabalar, konu ile ilgili uluslararası çalışma grupları ve uğraşları, hedefledikleri amaçlar, düzenledikleri temel belgelerin amaç ve içerikleri tanıtılmıştır.

“ It may not be feasible to construct an internationally curriculum which will meet the requirements laid down by the certifying and registering authorities in the different parts of the world. This would not however stand in the way of creating an internati onally recognised qualification which may prove acceptable; for specialist registration in many if not most parts of the world .”

Prof. H.A Shapiro - V th. Internationa ! Meeting of Forensic Sciences- Edinhurgh - Septemher 1972

The “art of medicine as practised by the physician” have permeated and infiltrated the courts and the practice of law throughout known historical times. This influence has been well established on the Continent of Europe for over two thousand years though medical involvement in the law was well enshrined in forensic practice in Chinese, Persian, Arabic and other non-European civilisations well before the Greco-Roman era.- for example, papyri relating to the times of Roman Occupation of Egypt refer to the advice and opinions sought from doctors by judges in reaching the more appropriate judicial verdicts.

By the time that Justinian, Eastern Roman Emperor died in November 565 A D his fame as a legislator and codifier had been well established- his Codex, Institutiones, Digesta and Nouellae together with the Cotpus Juris Civilis had consolidated the work of his predecessor Theodosius (346 - 395 A D) who after being proclaimed emperor ( while in England), had done his utmost to structure and catalogue Roman Law; Rome was indeed the “caput mundi" in terms of its codes of law; Justinian incorporated into Roman law matters relating to a medical impute into legal matters

Once established as the official church, the Holy See of Rome particularly, though not exclusively, in matter in which morals and law came together, had a further major impact on medico-legal matters. St. Ambrose of Milan, considered as one of the more eminent “fathers” of the early Church, had a major influence on the thoughts of Theodosius and later emperors. In such ethico-legal matters as insanity, premature births, virginity, wounding, impotence, medical men were asked to testify.

The Church's influence was further established with the convocation of the Fourth Lateran Council by Pope Innocent III in 1215 and the birth of the “Sacred” Inquisition to counteract heresy and with it the establishment of a new system of evidence gathering and forensic procedure; this overruled, on pain of excommunication for priests, the still prevailing antecedent system of trial “by ordeal” The underlying principle was that the judge had to be absolutely sure of the guilt of the accused before he sentenced him, no matter how this guilt was actually established and the confession of the accused to the crime elicited.

Other popes continued to have a major influence in the non-ecclesiastical courts. For example Gregory IX (1148-1241) promulgated the CompiladoDecretalium which concerned itself with such matters as nullity of marriage, sexual offences, the use of torture and crimes against the person. John XXII (1316-1334) from his stronghold in Avignon pronounced on the criteria by which leprosy should be diagnosed. Gregory XII in 1582 is credited the legal aphorism “the physician is to be believed in his own medical field”.

These innovations transferred quite imperceptibly from church and Canon Law to the Civil and Criminal Courts in the legislatures of most of the European nations which bore allegiance to the Church of Rome and that encompassed most of the European courts. The remarkable exception was that of Great Britain where Common Law and Court system - with the exception of the Coroner's courts - have retained an adversarial rather than inquisitorial system of court procedure exporting this system to its colonies, protectorates, dependencies and Commonwealth.

In the later Middle Ages and during the Renaissance, medical expertise was sought in the courts as required, and it was often those doctors connected with the papacy at the Curia, or to cardinals and other high officials of the church, were deemed to be the persons best suited to assist the courts. As universities consolidated their status and autonomy, the apprenticeship system of learning medicine was supplemented by formal tuition in these seats of learning. The Medical School of Salerno in Southern Italy had been well established by the 9 th Century; The Medical School of Montpellier in France had functioned from 1137. Bologna had a medical faculty in 1156 and gradually all the other universities in Tuscany were endowed similarly. Paris had its separate medical faculty by 1273. In Great Britain medical faculties took a longer period to become established: Oxford had a small and indistinguished medical faculty in 1303 and Cambridge a medical faculty, of even lesser international repute, in 1350. Most of these court physicians were also monks trained in the current centres of medical excellence through their ability to read Latin; they also functioned as apothecaries and blood-letters.

This tradition appears to have been maintained till well into the seventeenth century. Indeed the seminal work on legal medicine, the nine-volume Quaestiones medico-legales - was that written by Paolo Zacchias who was the principal physician of Pope Innocent X and later of Alexander VII; this magnum opus was published between 1621 and 1666.

This “ad hoc" arrangement of medical involvement with the courts of law persisted until the various medical faculties also started to teach Medical Jurisprudence as a separate subject. Chaussier, a prison doctor at Dijon started to teach this subject as a separate curricular entry in 1790; this event was closely followed by the establishment of chairs in the speciality of Medical Jurisprudence by the Universities of Paris (occupied by Mahon), of Strasbourg (occupied by Fodere - closely associated with Bonaparte ) and of Montpellier, by the beginning of the nineteenth century. In Edinburgh the first Professor of “Medical Jurisprudence and Medical Police" - with the latter aspect of the subject developing into Public Flealth Medicine - was established by Royal Decree in 1807 with the subject being taught informally for several years prior to that. Berlin and Vienna also had professors teaching this speciality at about the same time

Medical expertise was also called for and firmly established as a sine qiui non in connection with civil matters such as compensation for injuries at work, industrially-acquired diseases, claims in relation to insurance policies etc.. Indeed in most of Europe this aspect of forensic medicine -referred to as “Medicina Socialis”- has often become one of the more prominent aspects of the speciality.

This diversity of interests and court systems, and the autonomous development of medical curricula of each university resulted in a very individual and markedly disparate teaching of Forensic Medicine as an undergraduate and post-graduate speciality in different countries and in different universities. Furthermore as medical advances required that the undergraduate medical curriculum covered newer and more directly clinically-relevant subjects, such subjects as immunology, clinical genetics, clinical biochemistry and molecular biology had to find space in the teaching programmes. One of the consequences of this was that less and less forensic medicine was being taught. This coupled with the increasing realisation that crimes such as in terrorism, drugs and prostitution do not respect boundaries and the increasing incidence of multinational disasters led to Professor Don Luis Frontela Carreras of Seville. Spain to call together in 1986 a meeting of several well established names in the forensic medical field (mostly pathologists), to discuss these matters. A Manifesto was put together and signed by the Seville Working Group (SEVILLE MANIFESTO) on the 6 th September 1986, and representations were made to the European Council to persuade them to accept the principles of harmonisation of practice and teaching in this speciality.

One concrete result was this was the so-called Morris document (Doc.633) which formed the basis of a report from the Committee of Legal Affairs and Human Rights. It was adopted by the Standing Committee on behalf of the Assembly on the 28 th June 1991 in the Forty - Third Plenary Session of the Council of Europe and issued as Recommendation 1159 (1991) "on the harmonisation of autopsy rules “ (see Appendix 1).