Clinical Testimony Research Articles

Epistemic Privilege, Phenomenology and Symptomatology in Functional/Dissociative Seizures

ABSTRACT Much work on clinical testimony assumes that none can know better than the patient what they experience. We show that in certain contexts this assumption is unwarranted; clinician expertise encompasses disease phenomenology, to the extent that the clinician may know better than the patient what the patient is experiencing or has experienced. Conversations between clinicians and people with functional/dissociative seizures (FDS) show that initial phenomenological reports of FDS (what we call ‘surface’ phenomenology) are often inconsistent with more fine-grained descriptions produced after detailed inquiry (‘reflective’ phenomenology). Assuming the initial reports are made in good faith, this process involves the clinician showing the patient something about their experience they did not already (explicitly) know. Failure to engage in this reflective process can result in misdiagnosis and mistreatment. Thus, uncritical acceptance of patient testimony – an unwarranted credibility excess – may be as harmful as its unwarranted dismissal. We conclude that: the epistemically just clinician cannot rely on expertise in le corps objectif alone, they must also cultivate an understanding of le corps propre for the patients they encounter; and epistemic (in)justice cannot be considered solely something a clinician does to the patient. Instead, epistemic justice in the clinical encounter is an intrinsically collaborative process.

Computational studies on breast cancer analysis

In women, breast cancer is a heterogeneous type of cancer; its classification is entirely established on clinical testimony and needs pathological advice for biological clarification. Various problems are associated with breast cancer research like its diagnosis, prognosis, redundancy prediction and survivability. Only relevant treatment according to cancer type is helpful. This paper deals with analysing the gene expression data for accurately identifying breast cancer type using deep learning model. It highlights how deep learning can be powerful tool for the cancer classification thus giving them required treatment. Our results show that Deep Learning can be an effective tool to interpret micro-array gene expression data and help in identifying breast cancer according to its ER status. The proposed model has shown effectiveness in terms of accuracy as compared to other machine learning algorithms.

Psychological and Legal Aspects of Dangerous Sex Offenders: A Review of the Literature

The purpose of this article is to review legislation on ‘dangerous sex offenders’ critically. Most modern legislation determines an individual to be ‘dangerous’ if he or she is at unacceptably high risk of committing further sexual violence. While the decision is judicial in practice, clinical testimony is utilised to inform courts’ decision-making. Dangerousness may be a normative (legal) construct, but it is reliant on clinical assessment. Offenders are not at risk only due to historical factors; the possibility of committing sexual violence in the future is likely affected by temporal factors such as response to therapy, substance misuse, and proximity to victims. It is not clear that mental illness would place an offender at risk, although certain personality disorders are considered to be risk factors. In reporting actual risk, clinicians need to consider a range of variables, and not exclusively use actuarial measures or unstructured clinical interviews.

Effectiveness of Wharton’s jelly stem cells in gastroschisis repair using the inner surface of the umbilical cord as a patch

Objective This retrospective study was designed to assess and compare the anatomical, functional, and esthetic appearance of the umbilical area in patients after repair of gastroschisis using the inner surface of the umbilical cord (UC) and in patients with omphalocele conservatively treated. Background Our procedure transformed gastroschisis into an ‘artificial–surgical omphalocele’ in which the prolapsed intestine was covered with an umbilical patch, the inner surface of which contained Wharton’s jelly (WJ). Methods We have summarized an experience of 17 years in repairing gastroschisis using the inner surface of the UC. From 1986 to 2003, 21 infants with gastroschisis and one with a ruptured omphalocele were treated with this technique. We used Eagle’s medium to prove the validity of the umbilical stump and the duration of its viability. The inner surface of the umbilical patch is a ‘live’ structure with WJ, which contains mucoid connective tissue and fibroblast-like cells – that is, stem cells producing cutis, adipose, and connective tissue. Results Using our method, early control assessment of 18 of 21 patients with gastroschisis, at intervals of 1–3 months, showed good functional and esthetic results. Clinical long-term results in terms of anatomical, clinical, and functional findings were excellent. Besides clinical testimony, we used high-frequency ultrasonography to make an appraisal of the effectiveness of WJ stem cells in the repair of gastroschisis, and compared our results with healthy volunteers and patients with omphalocele conservatively treated. Conclusion This paper describes the effect of the local application of WJ – that is, mesenchymal stromal cells derived from the inner surface of the umbilical stump – and its influence on the healing process of the birth defect and wound. Keywords : gastroschisis, high frequency ultrasound imaging, inner surface of umbilical patch, ruptured omphalocele, Wharton’s jelly

Outpatient commitment and procedural due process

A large empirical literature on Kendra's Law has assessed the impact of court ordered outpatient treatment on outcomes such as treatment adherence, psychiatric hospitalization, quality of life, and treatment costs. Missing from the empirical literature, however, is a better understanding of procedural due process under Kendra's Law. Procedural due process concerns the safeguards that must be in place when governments deprive persons of their liberties, for example – notice, the right to a hearing and the right to appeal. This article reports the findings from a qualitative study of procedural due process and assisted outpatient treatment hearings under Kendra's Law. Attorneys reported significant barriers to effective advocacy on behalf of their clients. Further, despite the shift from a medical model of civil commitment to a judicial model in the 1970s, by and large judges continue to accord great deference to clinical testimony.

A clivagem psíquica e o paralelismo discursivo na clínica psicanalítica

O ponto de partida da discussão é a constatação clínica de um paralelismo discursivo, em alguns pacientes, entre duas modalidades de enunciados que, apesar de coexistirem lado a lado, jamais estabelecem relações conflitantes ou formações de compromisso. Nossa hipótese é de que o paralelismo discursivo em questão é efeito de uma clivagem psíquica. A base para a discussão é o modelo de aparelho psíquico da"Carta 52".

Surrogate Decision Making 2.0: Digital Evidence as Clinical Testimony

Over the last decade there has been a steady stream of literature published on the relationship between digital media and the ethics of clinical practice. The vast majority of it, though, has been ...

The Competing Faces of Mental Health Law: Recovery and Access versus The Expanding Use of Preventive Confinement

Mental illnesses are the leading cause among all illnesses of disability in the United States, Canada, and Europe. Mental illness and physical health are interrelated, with individuals with chronic disorders often suffering depression, and suicide ranking as the leading cause of violent death in the world. In countries with established market economies, mental illnesses, including suicide, account for more than 15 percent of the burden of disease, and depressive orders are the top cause of years of healthy life lost to illness in both high and low income countries. On October 10, 2010, the UN Secretary General launched its Mental Health Gap Intervention Guide, and asserted:

The effects of labelling, expert testimony, and information processing mode on juror decisions in SVP civil commitment trials

AbstractExpert witnesses offering testimony in sexually violent predator civil commitment trials may use diagnostic labels that are either familiar (e.g. ‘psychopath’) or unfamiliar (e.g. ‘paraphilia’) to jurors. Using predictions based on cognitive experiential self‐theory, we explored the influence of testimony type (clinical versus actuarial) and diagnostic label (psychopath versus paraphilia) on jurors motivated to adopt either an experiential processing mode (PM; in which heuristic cues may be strongly relied upon) or an analytic rational PM. Consistent with previous research, our results indicated that when given a psychopathic diagnostic label, mock jurors motivated to process information experientially were more influenced by clinical testimony, whereas mock jurors induced into a rational mode were more influenced by actuarial testimony. However, experientially oriented jurors given a paraphilia diagnostic label did not show the expected influence of clinical expert testimony, and instead were more persuaded by actuarial testimony. These findings are discussed from a judgement and heuristics cues framework. The implications of several procedural suggestions are examined. Copyright © 2009 John Wiley & Sons, Ltd.

Clinical Evidence in Guardianship of Older Adults Is Inadequate: Findings From a Tri-State Study

This preliminary study compared clinical evaluations for guardianship in three states with varying levels of statutory reform. Case files for 298 cases of adult guardianship were reviewed in Massachusetts, Pennsylvania, and Colorado, three states with varying degrees of statutory reform. The quality and content of the written clinical evidence for guardianship and the hearing outcome were recorded. The quality of the written clinical evidence for guardianship was best in Colorado, the state with the most progressive statutory reform, earning a grade of B in our ratings, and worst in Massachusetts, a state with minimal reform, earning a grade of D - with nearly two thirds of the written evidence illegible. Information on specific functional deficits was frequently missing and conclusory statements were common. Information about the individual's key values and preferences was almost never provided, and individuals were rarely present at the hearing. Limited orders were used for 34% of the cases in Colorado, associated with more complete clinical testimony, but such orders were used in only 1 case in either Massachusetts or Pennsylvania. In this study, states with progressive statutes that promote functional assessment are associated with increased quality of clinical testimony and use of limited orders. A continuing dialogue between clinical and legal professionals is needed to advance reform in guardianship, and thereby provide for the needs and protect the rights of adults who face guardianship proceedings.

Determining dangerousness in sexually violent predator evaluations: cognitive–experiential self‐theory and juror judgments of expert testimony

Past research examining the effects of expert testimony on the future dangerousness of a defendant in death penalty sentencing found that jurors are more influenced by less scientific clinical expert testimony and tend to devalue scientific actuarial testimony. This study was designed to determine whether these findings extend to civil commitment trials for sexual offenders and to test a theoretical rationale for this effect. In addition, we investigated the influence of a recently developed innovation in risk assessment procedures, Guided Professional Judgment (GPJ) instruments. Consistent with a cognitive-experiential self-theory based explanation, mock jurors motivated to process information in an experiential condition were more influenced by clinical testimony, while mock jurors in a rational mode were more influenced by actuarial testimony. Participants responded to clinical and GPJ testimony in a similar manner. However, participants' gender exerted important interactive effects on dangerousness decisions, with male jurors showing the predicted effect while females did not. The policy implications of these findings are discussed.

Private space: The contrasting nature of clinical and medico-legal access to the self

Clinicians face demands to assess or detain people who are perceived to be a danger to society when little or nothing that is clinically possible can ameliorate the risk of future violence. This creates significant conflict in the clinician's role between the needs of the individual and the needs of society. Such assessments require clinical observation and testimony regarding the person's thoughts, feelings, and actions. The criminal justice system has limits to how far it can go in pursuing private aspects of the self including the right to silence, and the rules that surround confessions. Clinicians, on the other hand, are permitted, through a very long history of clinical ethics, to have access to the private self to meet health needs. Some of the issues of conflict between societal demand for protection, and clinico-ethical duties to the person, have emerged in the debate regarding the concept of the ‘forensicist.’ The assessee may have difficulty separating the clinical from the criminal justice involvement of a clinician. Both assessor and assessee are potentially subject to a desire to please those in authority. This paper reconsiders these old tensions from the perspective of the rules and conditions that allow access to or protect private aspects of the self, in the context of the assessment of the criminal defendant.

The Role of Research in Forensic Psychological Testimony: Do Judges Listen?

ABSTRACT This article presents a case in which two experts proffered forensic testimony in a criminal hearing in which the defendant was charged with multiple serious felonies, including murder. The prosecution expert would testify that he had diagnosed the defendant as having antisocial personality disorder, which precluded a diagnosis of schizophrenia, and that the defendant was malingering schizophrenic symptoms, which was further evidence that he was not schizophrenic. In contrast, the defense expert would testify that schizophrenia and antisocial personality disorder can and do coexist, and that even schizophrenics can malinger symptoms. While the defense expert based his testimony on a review of the professional and scientific literature, the prosecution expert provided no such evidence in support of his opinions. Yet despite empirically based evidence on these issues, the judge ruled that the testimony of both experts could be admitted and merely represented two differing opinions of qualified experts. After briefly discussing the research supporting the defense expert's opinions, the article focuses on the problem of why judges fail to listen to relevant scientific evidence, and the steps experts and litigants may take to persuade courts of the value of scientifically based professional opinion as compared to clinical testimony lacking such foundation.

Measuring Medical Practice Patterns: Sources of Evidence from Health Services Research

The prevailing approach for establishing the legal standard of care in medical malpractice litigation is for competing expert witnesses to testify based on their impressions and experience. Health services research is a field that includes the objective and scientific documentation of physician behavior. The data sources and research techniques of health services research thus offer litigants a more empirical approach to establishing the standard of care. To facilitate this endeavor, this Article provides lawyers an overview of health services research and its pertinent methods and data sources. Several examples are used to illustrate and analyze the efficacy of determining the legal standard of care with empirical evidence about how physicians actually behave when faced with particular clinical issues. The Authors ultimately propose not to displace expert witnesses, but rather to supplement subjective clinical testimony with more objective and scientifically sound evidence.

What judges and lawyers think about the testimony of mental health experts: a survey of the courts and bar.

The testimony of mental health experts is often important evidence considered by criminal courts in determining issues arising throughout the adjudicative process, but not all evidence provided by experts is equally valid or probative. Using a hypothetical insanity defense case, we compared the preferences of Virginia judges, prosecutors, and defense attorneys for different types of forensic mental health evidence, including descriptive and diagnostic testimony, testimony about relevant research and actuarial data, and ultimate issue testimony. In addition, we determined their preferences for different types of mental health professionals. Four key findings emerged. First, many participants preferred that psychiatrists, rather than psychologists or other mental health professionals, conduct forensic evaluations for the court. Second, while participants were interested in most types of mental health evidence, they were primarily interested in clinical diagnosis, followed by an analysis of whether the condition met the relevant legal threshold, and an ultimate opinion on the legal issue. Third, participants were less interested in research or actuarial evidence. Fourth, participants differed in their evidentiary preferences in ways that reflect their respective roles in the adversary system. The findings suggest that while courts and attorneys find traditional clinical testimony useful in criminal cases, they also favor ultimate issue testimony, and view research data or statistically based information as less helpful. Mental health professionals should consider how to educate the courts and bar about the dangers inherent in over-reliance on the conclusory legal testimony of mental health experts, the utility of scientific data as such information becomes more routinely introduced as evidence at trial, and the expertise available from various mental health professionals.

The effects of clinical and scientific expert testimony on juror decision making in capital sentencing.

The effects of clinical and scientific expert testimony on juror decision making in capital sentencing.

The Psychiatrist as Expert Witness

This article discusses the two different types of legal situations involving participation by psychiatrists--clinical testimony and forensic expert testimony--and presents guidelines and ethical considerations for the psychiatrist participating in the criminal justice system.

Expert Clinical Testimony and Professional Ethics

The practice of giving expert clinical testimony about a psychological or psychiatric assessment in the presence of the subject of that evaluation is examined. The potential that this practice has for inflicting psychological trauma to the subject is considered, and discussed in the context of the principles of professional clinical ethics. It is proposed that current practice may violate certain of these principles. Suggested remedial action is outlined.

Let Us Give the Russians Their Due

A current report by an Academy committee (Pediatrics, 31:512, 1963) credits Sir Edward Mellanby in 1920 with the discovery of the antirachitic potency of cod liver oil. While in no way deprecating Mellanby's excellent work, it should be pointed out that the value of cod liver oil was firmly established more than a decade before Mellanby's report. There was clinical testimony to support its use during the latter part of the nineteenth century, but it was the Russian pediatrician J. A. Schabad of St. Petersburg who gave the first convincing demonstration of its efficacy.

Hyposensitization against Rhus dermatitis.

This paper deals with immunologic prophylaxis of Rhus dermatitis due to Rhus radicans (poison ivy) and Rhus toxicodendron (poison oak). A comprehensive summary of the clinical biology of Rhus dermatitis has been given in a previous paper, which forms the prelude to the present theme.1 A striking feature of the literature on Rhus prophylaxis is the contradictory nature of many reports. Students of the subject hold diametrically opposed views. Some achieve remarkable results which are just as remarkably denied by others. Despite genuine advances in the basic knowledge of allergic contact dermatitis, the issue of hyposensitization is one in which there is no end of clinical testimony but relatively little in the way of objective research. Therapeutic ambitiousness has colored the picture with extravagant claims. The paramount aim of the present effort is to test the soundness of the concept of hyposensitization and