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Logical reasoning and clinical medicine vol. 1 & 2
(University of Peradeniya, 1989) Babapulle, C.J.
From a multiplicity of what was seemingly characterised as expert medical evidence and opinion given and expressed in the course of a trial at bar holden in Colombo: State v. Rev. Mathew Peiris, 1984 (and contained in a Judgement (abbreviated 'Jt.')} this study has attempted to extract from that Judgement just those proofs (arguments designed to demonstrate) of those events which would prima facie provide grounds for a charge of murder in respect of two deaths - those of Russel Ingram and Mrs. Eunice peiris. These events, connected as by a causal chain, were many, and were uncannily similar in regard to both deceased. These essential events, connected in the style of a causal chain with an arrow ' ' indicating causal influence, were: (Refer the original thesis for flow chart). The immediate (medical) cause of death (in each instance) was pneumonia, the legal cause, the administration (in each instance) of a hypoglycemic agent (called glibenclamide) by the accused to the deceased. The administration of the drug was considered by the medical witnesses to be 'sufficient in the ordinary course of nature to cause death' (in each of the two instances). Accordingly, the proofs for the occurrence of each of these essential events in each of the deceased is automatically the subject of critical inquiry and so too the causal nexi claimed to have existed between these events. Thus, in the reverse order of the causal sequence, is critically inquired into the events: death, pneumonia, prolonged unconsciousness, permanent brain damage, hypoglycemic coma; their separate proofs and proof of their different causes. Other, less essential/minor, effects, eg. bed sores, dehydration, etc. also receive some attention. The critical inquiry necessitated a digression into the meanings of terms (semantical considerations) and these have been attended to. Each essential (and less essential/minor) event is made part of ~speaking logically) an argument, ie. a conclusion, and the argument for the conclusion then logically appraised, evaluated for logical correctness, soundness (based on truth), absence of fallacies and so acceptability. The worth of the arguments ranging from nil, weak, and moderate to strong, very strong and deductively valid is assessed in respect of the different arguments presented. Interestingly, the moderate, strong and very strong arguments presumably have their counterparts in the legal notions of proof on a "balance of probabilities·, "beyond reasonable doubt" and "beyond all reasonable doubt" respectively. only those arguments assessed as deductively valid and strong were considered as being of adequate standard for the needs of medical diagnosis and for the needs of Court in criminal proceedings. The results of the appraisal revealed that many of the medical opinions were inadequate, unacceptable by the standards set. Chapter I deals, in a preliminary and general sort of way, with such matters as: Medicine and Truth (theories, notions and the ways/methods of searching for it): Rational, Reason, Reasoning and Inference (including varieties of inference); Logic and Argument (identification, layout, appraisal and purposes); Logic and Medicine; Proof (layout, appraisal, standard or quantum of proof, etc.), including too some aspects of probability relevant to proof. Finally to the Aims and Methods of study, ending with some comments of an explanatory nature. Chapter II is more specific and deals in turn with expert medical testimony and opinion, medical diagnoses (diagnosis = opinion) regarding which the matter of particular/singular occurrences and those matters concerning proofs of particular/singular statements and of particular/singular causal statements assume considerable significance. These are the subject of comment/discussion and are additionally dealt with in connected Annexures (to be found along with all other Annexures after the end of Chapter V). Chapters III and IV deal with the logical appraisal of the several proofs concerning the deaths of Russel Ingram and Mrs. E. Peiris, respectively and provide the bulk of the material of this study. Finally, to Chapter V which: (a) summarises those (traditional/classical and newer) logics which are used and needed in medical reasonings, (b) summarises the weaknesses/fallacies in argument evidenced in Chapters III and IV which are, on occasion, generated by failure to use these logics and (c) adds an explanation for some of these failures. Additionally Chapter V summarises the causal (and statistical) notions which play so important a part in medical reasonings (evidenced here). Some researchable areas are identified. The implications (drawing on the results of this study) in respect of expert medical opinion, medical diagnoses and medical education form the concluding parts of this Chapter, which ends with some remarks pertaining to the generalizability of the results of this study. The study makes a case for reasoning at the highest achievable standard of logical reasoning deductive (ideally), leaving/making room/allowance for uncertainty by way of contingent premises. Alternatively, where this standard cannot be met then, inductive reasoning using the highest standards of support (very strong, strong) for the conclusion. Be it from a health/disease/death aspect (medical/ medico-legal) or a justice/injustice aspect (legal), that no lesser standard of reasoning is justifiable or acceptable becomes apparent.
Medico-legal aspect of offences against the person
(University of Peradeniya, 1988) Babapulle, C.J.
The Penal Code of Ceylon (Sri Lanka) modelled on the Indian Penal Code and enacted in 1883 has remained substantially the same despite developments in many of the disciplines to which the law is related. Medicine is one such discipline and the progress it has made has rendered many provisions of the Code (of medico-legal importance) in need of restatement.. Whilst the requirement of. reform has been accepted in principle by such acts as the creation of a Law Reform Commission, little headway has been made. That reform should be preceded by research including n comparative study of our law with the law of those jurisdictions having n similar social and political background has also been recognized. With the need for reform, of research and of comparative analysis in mind, this study was undertaken to review the medico-legal aspects of offences in respect of the person (dealt with in chapter XVI, of the Sri Lankan Code) so as to indicate some avenues along which a restatement of the 1a\-.' in respect of the "person" may be undertaken. The scope was restricted to the substantive law (adjectival law being dealt with only peripherally) with aspects relevant to the victim being the main consideration. Chapter one presents the grounds which justify the study its aims and objectives, and the methods employed. Included in this chapter is a section providing material of general interest dealing with the criminal law, its relationship to society and ·morality, criminal' liability, the codified and common law traditions, the Continental and' 'Commonwealth' Codes the later incg1udirig discussion .of the Indian Penal Code as well. 'Then follow sections dealing with the criminal law of Sri Lanka and the place of the Penal Code in the criminal law. Concerned as this study is with the "person", the second chapter inquires into the legal and non-legal aspects of "person" and "personality" distinguishing the legal notions from the psychological and philosophical' notions. A basic difficulty presented' itself in that the Chapter of the Code of relevance was titled "offences affecting the Human Body" - there being no direct ,reference to "person ", This necessitated and enquiry.. into some aspects of legal biology (with which Chapter. Two commences) viewing the human organism developmentally and progressively rather than episodically. The division of a human organism into a body and mind appeared artificial - the interdependence of one on the other being emphasized. The notion of legal personality seemed to be tied up with "beingness" - these aspects receiving due consideration. The Chapter draws implications from the discussion and points out certain anomalies and deficiencies in the Code. A brief enquiry into "offence and offences in respect of the person" concludes this chapter. The next chapter undertakes the task of systematisation of "offence affecting the human body (the person?)". Having first presented the broad grouping as presently found in our Code, the classification of similar laws in other jurisdictions Together with the criticisms . 1evelled atl some of these classifications, the chapter proceeds to present several tables . of classification of the existing law and also new proposals, The latter is based on the concepts of health, legal interest and harm, the harm to a person being initially either physical or psychological, but in either event involving the entire "being" or organism. A category of :"social harm" can be distinguished, but this has been accommodated under the category of psychological (mental) harm. Classification which is "as near as we possibly can (get) to the throbbing heart of the legal process" requires awareness of the meanings of terms and the identification of characteristics to serve as criteria for distinguishing one class from another. The chapter pays attention to this aspect. Chapters four to seven inclusive deal in turn with in-depth analyses of the offences (i) affecting life; (if) causing miscarriage, injuries to unborn children, exposure of infants and surreptitious disposal of the dead body of a child; (iii) hurt and (iv) sexual offences. Only those aspects of medico-legal relevance have been dealt with, with particular reference to the victim (patient). Peripherally, the doer (actor, offender, defendant) has also been considered as in the case of infanticide The final chapter concludes by indicating some avenues for restatement of the provisions in respect of the human body / person and of some of the general sections connected therewith.
Physics as applied to injuries of the calvarium
(University of Peradeniya, 2001) Babapulle, C.J.
With respect to injuries of the calvarium e.g., cracks, fractures, deficiencies, depressions, indentations etc., the medicolegist is often called upon by court to express opinions on the nature of the injury/ies, the manner and mode of causation and, where relevant, the nature of the physical object responsible for the injury and the ferocity of the attack. The opinion may also include the type of human action, which brought about the injuries seen in the victim (patient or dead body). An opinion which starts with injuries as its data and seeks to connect such injuries ~.ith a weapon/s and also the associated human action requires a theory which provides a sound scientific basis connecting injury/ies with weapon/s and human action. Over several years two hypotheses have been dominant in guiding medicolegists in their determinations. These are the hypotheses of Gurdjian et al and Rowbotham. Gurdjian's hypothesis is limited in scope to blunt trauma and low velocity injury while Rowbotham's hypothesis is even more limited to concentrated forces, bending and depressed fractures. A need for a more broad-based theory to account for the many types of calvarial injuries was required. This study seeks to provide such a broad-based theory based on engineering physics. Engineering physics inquires into the fractures and deformations of engineering materials. These materials characteristically have as features continuity, homogeneity, of being isotropic and linearly elastic. Apart from linear elasticity, . human bone however shows none of the other features of typical engineering materials. Furthermore, human calvarial bone shows many variations in terms of geometry - size and shape - thickness of bones, grooves and foramina (which dominate the base of the skull). There is also a tri- laminar or uni-laminar structure and the joints (called sutures) show many variations. The many variations of the calvarium make difficult the handling of the actual material. Despite the difficulties and possible limitations, the view was taken that engineering physics would provide the required theory to link injuries of the calvarium with a causative physical object or human action. Four concepts of engineering physics were identified. These are those of energy, stress, shell theory and stress concentration. The nature and the strength of bone were subordinate to the four engineering concepts stated. Several models were created _ particularly that of treating the vault of the skull as a truncated cylindrico- sphere and the base of the skull as composed of six truncated spheres .. Several simplifying assumptions were made to enable analysis . The four notions of engineering physics, the models, the assumptions were applied in turn to a host of skulls with injuries, all part of the collection of skulls located in the museum of the Dept. of Forensic Medicine, Faculty of Medicine, University of Peradeniya. The study was conducted over several years preceding the year 200 I. The results of these analyses are contained in Ch. 3 and organized on the basis of energy considerations, stress considerations - especially of excessive stress, shell theory and stress concentration where these were the dominant consideration; There were occasion when a combination of concepts e.g., stress, shell theory and stress concentration were operative. The study was expanded to include the results of previous experimental work, the interpretations given thereto and also to provide explanations as to why the calvarium takes on features of a weapon. Attention was also given to answer the question as to whether a head was supported, free to move or moving at the time of the injury . The results of the study was that all (or perhaps all) injuries of the calvarium are analyzable and explicable in terms of the four concepts of engineering physics stated above, operating alone or in combination and that the strength of bone and the nature of bone merely influence the stress necessary to injure the bone. Avenues for future research conclude the study.
The effects of early clinical training on cognitive ability in anatomy and physiology
(University of Peradeniya, 1983) Babapulle, C.J.
The main objectives of the study were to determine the effect of early clinical training on the acquisition of cognitive abilities in structure and function of (selected parts of) the human body and on the development of perceptual motor (clinical) skills. Clinical training was provided under controlled conditions to three stratified and randomly matched groups in respect of three instructional topics (cardiovascular, respiratory and nervous systems). For each system, one group had clinical training before the lectures, another had clinical training after the lectures, whilst a third group was exposed to lectures only on that system. The groups were randomised in respect of the instructional method for the three systems. The results show that, in respect of cognitive ability the groups which received clinical training before the lectures, performed significantly better than the group Which received lectures only. Two of the three groups which received clinical training after the lectures performed significantly better than the lecture only group. There was no significant difference between the groups which received clinical training though the mean scores of the group that received clinical training before the lectures was higher than the group which received the clinical training after the lectures. With respect to the development of perceptual-motor (clinical) skills the groups that received clinical training performed significantly (p "0.001) better than the control I (lecture only) group. There was no significant difference between the groups which received the clinical training, though the groups which received the training after the lectures had mean scores above that of the group which received the training before lectures.The other purpose of the study was to determine the effects on short and long term retention the former being evaluated immediately after instruction and the latter three months after the conclusion of experimental treatment. With respect to sort term retention in cognitive ability all groups showed significant gains ( p < 0.01) after instruction, on all three system, With regard to long- term retention there were slight games in cognitive ability in respect of the cardiovascular and respiratory systems, with a slight drop in knowledge in respect of the nervous system. Where perceptual-motor skills were concerned lecture only (contro1.) groups showed mean sc0re gains over 'their first performance though their performances were always significantly poorer than the clinically trained groups Adequate long-term retention of skills was observed in the clinlcul1y trained ·groups - there being no significant change in four of the six groups, over the three month period. One group however recorded significant drops in mean scores (p <0.05) on two occasions with regard to prediction of performance, the result: revealed that post instructional scores cannot reliably be predicted from pre- instructional score in respect of cognitive ability. However, on re- test three months after the post-instructional tests reliable predictions of scores could be made in respect in cognitive ability in the cardiovascular but not of the nervous system. Scores on a second clinical test (three months after the first) cannot be reliably predicted from scores on the first test. The overall analysis revealed that probably about 28 percent of the variance in cognitive ability can be attributed to clinical training while the training would explain nearly 85percent of the variance in respect of perceptual-motor (clinical) skills .

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