Board Review Legal Medicine Brex

Examination and Reporting of Physical Injuries
“The attending physician of any hospital, medical clinic,

sanitarium or other medical establishments, or any
medical practitioner, who has treated any person for
serious or less serious physical injuries as those injuries
are defined in Articles 262, 263, 264 and 265 of the
Revised Penal Code shall report the fact of such
treatment personally or by fastest means of
communication to the nearest Philippine Constabulary*
Legal Medicine, unit without delay. Provided, that no fee shall be
charged for the transmission of such report through
Medical Jurisprudence government communication facilities.”
Number 1, Presidential Decree 169 series of 1973
and Bioethics *Amended by R.A. 6975, the DILG Act 1990 and was
further amended by R.A. 8551, the Philippine National
Police Reform and Reorganization Act of 1998
Joseph Reuel Cruz, BSci., RMT, MD
Board-Licensed Medical Technologist and Physician
Top 8, 2011 Medical Technologist Licensure Examination
Revised Penal Codes (as mentioned)
Lateral Entrant, Medico-Legal Officer, Article 262: Mutilation
PNP Crime Laboratory, Camp Crame, Metro Manila Article 263: Serious Physical Injuries
Article 264: Administering Injurious Substances and
Topics Contents (Ten Parts, Two Series, Twenty Topics)
SERIES I Beverages
Scope of Legal Medicine Article 265: Less Serious Physical Injuries
Evidence
Deception Detection “The report called for in this Decree shall indicate when
Medico-Legal Aspects of Human Body Identification
Medico-Legal Aspects of Human Death
practicable, the name, age; address and nearest of kin
Medico-Legal Aspects of Physical Injuries and Wound Investigation of the patient; the nature and probable cause of the
Sex Crimes, Impotence and Sterility injury; the approximate time and date when, and the
Medico-Legal Aspects of Pregnancy, Birth and Infanticide place where, the injury was sustained; the time, date,
Medico-Legal Aspects of Insanity and Mental Deficiency
and nature of treatment; and the physical diagnosis
Toxicology, Drug Dependence, Alcoholism
and/or disposition of the patient.”
SERIES II Number 2, Presidential Decree 169 series of 1973
Scope of Medical Jurisprudence, Medical Ethics and Bioethics
Law and Medicine “The head of any public or private hospital, medical
Medical Legislation
Medical Education and Regulation in the Philippines
clinic and similar institution, as well as the attending
Physician Contracts and Practice of Medicine physician and nurse, shall report, either orally or in
Physician Torts and Damages writing, to the Department (DSWD) the examination
Criminal Law and/or treatment of a child who appears to have
Evidences
suffered abuse within forty-eight (48) hours from
Hospital and Medical Record Jurisprudence
Principles of Medical Ethics and Bioethics knowledge of the same.”
“Failure of the individuals mentioned in Section 4 above
Legal Medicine and the administrator or head of the hospital, clinic or
similar institution concerned to report a possible case of
 Branch of Medicine which deals with the child abuse shall be punishable with a fine of not more
application of medical knowledge to the than two thousand pesos (P2,000.00). “
purposes of law and in administration of justice. Section 4 and 6, Implementing Rules and Regulations,
 “Medical sciences for legal purposes”, Special Protection of Children Against Abuse,
specifically a branch of Medicine Exploitation and Discrimination Act (RA 7610) of 1992
 Application of basic clinical, medical and
paramedical sciences to elucidate legal matters. “Any healthcare provider, including, but not limited to,
 Technically similar with “Forensic Medicine” an attending physician, nurse, clinician, barangay health
worker, therapist or counselor who suspects abuse or
Legal and Ethical Bases of Legal Medicine Practice in has been informed by the victim of violence shall:
the Philippines (a) properly document any of the victim's physical,
Autopsy emotional or psychological injuries;
“The autopsy and dissection of remains are subject to (b) properly record any of victim's suspicions,
the following requirements: observations and circumstances of the examination or
a.) Persons authorized to perform these are: visit;
1. Health officers (c) automatically provide the victim free of charge a
2. Medical officers of law enforcement medical certificate concerning the examination or visit;
agencies; and (d) safeguard the records and make them available to
3. Members of the medical staff of accredited the victim upon request at actual cost; and
hospitals.” (e) provide the victim immediate and adequate notice
Chapter XXI, Section 95, Subsection a, of rights and remedies provided under this Act, and
The Code of Sanitation of the Philippines (PD 856, 1976) services available to them.“
1 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Revised for Review Season 2022 Cruz, RMT, MD
Section 31, Anti-Violence Against Women and Their Written or Statutory Law (Lex Scripta)
Children Act of 2004 (RA 9262)
 Passed as bills by the Bicameral Congress
“It is the duty of every physician, when called upon by (House of Representatives and Senate) to be
the judicial authorities, to assist in the administration of signed by the President
justice on matters which are medico-legal in character.”  Defined, stated, codified and incorporated by
Article III, Section 2, the Bicameral Congress
Code of Medical Ethics of the Medical Profession of the  Bills can be vetoed by the President
Philippines  Laws be amended or repealed by the Bicameral
Congress
Medical Jurisprudence  Philippine Medical Act of 1959 (RA 2382 as
amended by Republic. Act Nos. 4224 and 5946),
 Latin: “juris” meaning “of law”; “prudentia”
as example
meaning “foresight”
 “Foresight of Medical Law”; essentially a branch
Administrative Law
of Law
 Knowledge of the law in the study and practice
 Laws and memorandum created by
of medicine.
administrative, executive agencies and
 Rights, duties, obligations of a medical
departments
practitioner, among others
 Rules and guidelines in aid of implementation
Key Differentiation  Can always be subject to amendments by
Legal Medicine cabinet secretaries, state implementers and the
Practice of medical science → Legal procedures and President
enforcement  Board Resolutions of the Board of Medicine,
Implementing Rules and Regulations,
Medical Jurisprudence Memorandum, Administrative and Executive
Legal provisions, procedures, and enforcement → Orders (MOs, AO and EOs respectively), as
Practice of Medicine examples
Medical Jurists as Specialists Ordinance Power of the President

Executive Order No. 292, Book III, Title I, Chapter 2
 Specializes in the science of Legal Medicine
 Requires to possess sufficient if not excellent SECTION 2. Executive Orders:
knowledge on medical sciences (like Pathology, Acts of the President providing for rules of a general or
Medicine, Surgery, Gynecology, Toxicology permanent character in implementation or execution of
among others) in aid of application to law and constitutional or statutory powers shall be promulgated
administration of justice in executive orders.
 A Board-licensed physician AND Bar-certified
lawyer as educational requisites SECTION 3. Administrative Orders:
Defining Characteristics of a Medical Jurist Acts of the President which relate to particular aspects
of governmental operations in pursuance of his duties
 Sees injuries and deaths in detail in the aid of as administrative head shall be promulgated in
the law administrative orders.
 Observes, records, and testify under oath
before a competent court of law on the findings SECTION 4. Proclamations:
pertaining to injury, disease, or deaths Acts of the President fixing a date or declaring a status
 Main Perspective: “Investigative on the point of or condition of public moment or interest, upon the
view of cause” existence of which the operation of a specific law or
 Minor Role: Therapeutic regulation is made to depend, shall be promulgated in
proclamations which shall have the force of an
Sources of Laws in the Philippines executive order.”
Constitutional Law
SECTION 5. Memorandum Orders
 State policies, civil rights, privileges and Acts of the President on matters of administrative detail
responsibilities used as the framework of the or of subordinate or temporary interest which only
government concern a particular officer or office of the Government
 Amendments (termed as Charter Change; Cha- shall be embodied in memorandum orders.
Cha) can be proposed by one of three methods:
a People's Initiative, a Constituent Assembly SECTION 6. Memorandum Circulars
(Con-Ass) or a Constitutional Convention (Con- Acts of the President on matters relating to internal
Con). administration, which the President desires to bring to
 Determining basis of any law created (by means the attention of all or some of the departments,
of constitutionality) as determined by the agencies, bureaus or offices of the Government, for
Supreme Court information or compliance, shall be embodied in
 Provisions of the 1987 Constitution including memorandum circulars.
the Bill of Rights, as example
SECTION 7. General or Special Orders Legal Medicine is applied in the following provision of
Acts and commands of the President in his capacity as the Rules of Court (as examples):
Commander-in-Chief of the Armed Forces of the a) Physical and mental examination of a person
Philippines shall be issued as general or special orders. (Rule 28)
b) Proceedings for hospitalization of an insane
Unwritten or Common Law (Lex Non Scripta) person (Rule 101)
c) Rules on evidences (Part IV)
 Unwritten laws based on extensive customary
and cultural usage Special Laws
 Laws and practices that are formed through • Standalone, codified laws not being part of the
widespread public acceptance Civil Code, Penal Code nor the Rules of Court
 Stare Decisis, respect to elders (as a default), Legal Medicine is applied in the following Special Laws
seniority-based hierarchy in the Supreme Court, (as examples):
as example a) Code of Sanitation (PD 86)
b) Dangerous Drugs Act (RA 6425), as amended
Principle of Stare Decisis c) Youth and Child Welfare Code (PD 603), as
• Practiced legal principle following precedent amended
court rulings of identical merits in aid of
decision-making Basic Legal Doctrines in the Application of Legal
• The legal principle of determining points in Medicine
litigation according to precedent. “Ignorantia legis nominem excusat”
• Mechanism for consistency of court decisions Ignorance of the law excuses no one from compliance
therewith
Application of Legal Medicine in Law Article 3, Civil Code
Civil Law • The main reason for the provision is to prevent
• Statutory law that determine and regulates the ignorance of the law as means of defense for
relation of assistance, authority, and obedience violation of the law
between and among members of a family which • Ignorance of the law cannot be used for
exists among members of the society for immunity from punishment nor liability for
protection of private interests actual loss
• Codified and compiled in the Civil Code of the
Philippines (RA 386) “No ex post facto law”
Laws shall have no retroactive effect, unless the
Legal Medicine is applied in the following civil laws (as contrary is provided
examples) Article 4, Civil Code
a) Determination and termination of civil • A law can only be applied to cases after its
personality (Art. 40 and 41) promulgation and must not be given retroactive
b) Marriage and Legal Separation (Book I, Title III application. (with specific exceptions)
and IV)
c) Paternity and filiation (Book I, Title VIII) “Self-determination in waiving rights”
Rights may be waived unless the waiver is contrary to
Criminal Law the law, public order, public policy, morals or good
• Branch of law which defines crimes, treats their customs, or prejudicial to a third person with a right
nature and provides penal provisions for such recognized by law
• A body of specific rules regarding human Article 6, Civil Code
conduct which have been promulgated by • Rights granted to a person by law may be
political authority uniformly applying to all waived but in the following cases, the law
members of the classes to which rules refer. doesn’t allow such waiver:
• Codified and compiled in the Revised Penal 1. When such waiver is contrary to
Code existing law
Legal Medicine is applied in the following provision of 2. When waiving such right is against
the penal code (as examples): public order, public policy, morals and
a) Circumstances affecting criminal liability (Title I) good customs
b) Crimes against persons (Title VIII) 3. When waiving such right is prejudicial
c) Crimes against chastity (Title XI) to a third person with a right recognized
by law.
Remedial Law
• Branch of law which defines rules concerning
pleadings, legal practices and procedures of
courts in the Philippines
• It is a designed law intended as a remedy to a
person injured by a wrongful act.
• Codified and compiled in the Rules of Court of
the Philippines and also in remedial provisions
of Special Laws

Constitution is the fundamental law 1. Evidence obtained in violation of the right against
Administrative or executive acts, orders and unreasonable search and seizure
regulations shall be valid only when they are not 2. Evidence obtained in violation of the privacy of
contrary to the laws or the constitution. communication and correspondence, except upon
Article 7, Civil Code lawful order of the court or when public safety or order
• All acts, administrative or executive orders requires otherwise
contrary to the provision of the constitution 3. Evidence consisting of extra-judicial confessions
shall be deemed void. which are uncounseled, or when the confessant was not
• When the court declares a law to be properly informed of his constitutional rights, or when
inconsistent with the constitution, the law shall the confession was coerced (forced confession).
be void and the constitution shall prevail. 4. Evidence obtained in violation of the right against
• Any existing law which is inconsistent with a self-incrimination
subsequent law is deemed repealed by the
latter law. Types of Evidence
Evidence According to Form
Evidence and Rules of Evidence
“Evidence is the means, sanctioned by the Rules of Physical Evidence
Court, of ascertaining in a judicial proceeding the truth Tangible, material object introduced as evidence under
respecting a matter of fact.” which the crime was committed
- Section 1, Rule 128, Rules of Court Types:
1. Corpus Delicti Evidence (“Body of the crime”
Same rules of evidence in all cases and in all courts evidence)
“The rules of evidence shall be the same in all courts 2. Associative Evidence (Linking evidence)
and on all trials and hearings whether civil or criminal” 3. Tracing Evidence
Section 2, Rule 128, Rules of Court
Intangible Evidence
Admissibility of Evidence Evidences that cannot be held to possession unless
“Evidence is admissible when it is relevant to the issue treated with extraction and documentation procedures
and is not excluded by these rules”
Section 3, Rule 128, Rules of Court Autoptic Evidence
“Real Evidence”, “Demonstrative Evidence”
Relevancy of Evidence • A type of physical evidence
“Evidence must have such a relation to the fact in issue • This is an evidence made known or addressed to the
as to induce belief in its existence or non-existence; senses of the court
therefore, collateral matters shall not be allowed except • Pleading directly to the sense of vision, hearing,
when they tend in any reasonable degree to establish taste, smell and touch
the probability or improbability of the fact at issue” • Subject to limitations in presenting an autoptic
Section 4, Rule 130, Rules of Court evidence
*Collateral matters are those that do not correspond 1. Indecency and Impropriety
with matters in issue. 2. Repulsive Objects and those Offensive to
Sensibilities
Tenets for Admissibility and Exclusion of Evidence “View of an object as an exhibit”
1. “Best Evidence Rule” Section 1, Rule 130, Rules of Court
Original evidence is the best evidence
Presentation of Evidence Containing Sexual Abuse
2. Secondary Evidence Photographs and Recordings
Substitutions departing from the best evidence is (Remedial Law: OCA Circular No. 136-2021)
admissible when obtaining the best evidence is Policy Inclusion:
impossible or not available Evidence containing sensitive photographs and
recordings including sexual abuse images and sound
3. “Parole Evidence Rule” recordings involving women and children
Oral (testimonial) evidence is not admissible to alter nor Policy:
to modify nor to contradict the best evidence Such evidences should only be presented through in-
court proceedings and NOT through videoconferencing.
4. “Fruit of the Poisonous Tree Doctrine”
“Evidence obtained from illegal arrest, search or seizure Testimonial Evidence
shall be inadmissible for any purpose in the court of Orally-expressed Evidence
law.” • Verbally-stated evidences given under oath
1987 Philippine Constitution, Article III, Section 2 • Such evidence is labelled as “testimony”
• Witness expressing testimonial evidence can be
The Following Evidences Are Excluded Under 1987 classified as:
Philippine Constitution 1. Ordinary Witness: testimonies based on
Article III, Section 2 (Fruit of the Poisonous Tree perception of senses not pleading to
Doctrine) sciences or skills of the witness
2. Expert Witness: testimonies of a witness
regarding a question of science, art, or

trade when he is skilled therein (Section 43, • Proof of fact or facts which when taken either
Rule 130, Rules of Court) singly or collectively can be inferred supporting
• Subject to limitations in presenting a Testimonial an assertion
Evidence
1. Privileged Communication (under doctor- When is circumstantial evidence sufficient?
patient relationship) a) Presence of more than one circumstance
Section 24 (c), Rule 130, Rules of Court b) When circumstances from which inferences
2. Hearsay information derived are proven and,
Section 36, Rule 130, Rules of Court c) When the combination of all circumstances is
EXCEPT: Dying Declaration Section 37, such as to produce a conviction beyond
Rule 130, Rules of Court reasonable doubt.
3. Inadmissibility of Opinions Section 4, Rule 123, Rules of Court
Section 48, Rule 130, Rules of Court
Weight and Sufficiency of Evidences for Conviction
Experimental Evidence FOR CIVIL CASES: “PREPONDERANCE OF EVIDENCE”
• A medical witness may be allowed by the court to Section 1, Rule 133, Rules of Court
present experimental findings as a corroborated • The plaintiff (complainant) having the burden of
proof to an expert opinion. proof must establish the civil case by
• Prototype findings from animal models can be preponderance (sheer amount or number) of
presented as evidence evidence.
Example: LD 50 using rat (animal models)
FOR CRIMINAL CASES: “PROOF BEYOND REASONABLE
Documentary Evidence DOUBT”
An instrument of record by means of letters, figures, Section 2, Rule 133, Rules of Court
photographs, inscriptions, marks, maps, plans and • The defendant is entitled to an acquittal unless
engravements for the purpose of documentation his guilt is proven beyond reasonable doubt.
Examples
• Medical Certificates and related documents Deception Detection
(Autopsy Report, Physical Exam Report, Laboratory • Ability to evaluate the truth or falsity of a
Reports, Birth and Death Certificates) statement (a testimony) given by the suspect or
• Tracing, Documentary receipts and forms witness.
(Passports, flight and ship manifest, Clearances from • Methods to ascertain facts from falsehoods in a
PNP and NBI testimony
• Deposition: a written record of evidence given • The task of detecting deception initially lies on
orally and transcribed in writing in the form of the investigator and then the court, thereafter.
interrogator questions and deponent answers which
are signed. Methods Used for Deception Detection
1. Devices which record the psycho-physiological
“Prima facie” Evidence response
Latin: “at first sight” a) Polygraph (Lie detector machine)
Sufficient to establish a fact or raise a presumption b) Word Association Test (Reaction
unless adequately disproved or rebutted Response Time and Congruence
 Prima facie evidence means that the evidence is Consistency)
sufficient to establish a fact; “an evidence good c) Psychological Stress Evaluator
and sufficient on its face”. (G.R. No. 164575,
2006) 2. Drugs that “inhibit the inhibitor”
a) “Truth Serum”
Methods to Preserve Evidence b) Narcoanalysis or Narcosynthesis
• Photographs c) Intoxication with alcohol
• Sketching 3. Hypnotism
o Rough Sketch 4. Keen Observation
o Finished Sketch 5. Scientific Interrogation
• Documentary Description 6. Confession
• Manikin Method
• Embalming/Fixation of cadavers, tissues, and samples Devices Which Record the Psycho-Physiological
using preservatives Responses
Refrigeration Methods:
a) Polygraph (Lie detector machine)
Evidence Necessary for Conviction b) Word Association Test (Reaction Response Time
1. Direct Evidence and Congruence Consistency)
• Evidence proving the fact in dispute without the c) Psychological Stress Evaluator (Voice Analysis)
aid of any inference or presumption All methods are NOT DEFINITIVE for fact finding and
• Precise and actual point evidence proving an thus, inadmissible to court as evidences
issue
2. Circumstantial Evidence Basis: Recording of Autonomic Nervous System (ANS)
shifts during interrogation

a) Sympathetic reacts to physical exertion and/or c) Control questions: intermediate
emotional stressors between relevant and irrelevant
b) Parasympathetic reacts to homeostatic questions; not case related but close to
restoration when stressors are removed relevant questions
Psycho-Physiological Responses Standardized Polygraph Phase 3

1. Heart Rate Post-test interrogation phase
2. Pulse Rate • Formal in nature, can be open-ended
3. Blood Pressure • Purpose:
4. Respiratory rate and depth a) To clarify the findings
5. Psychogalvanic reflex b) To corroborate reasons of subject’s
6. Time of response to question (Processing lag, answer to question
Latency) c) To obtain more information
7. Difference in voice modulation
… and others Supplementary Tests
• Other tests and question sets that can be done
Polygraph (Lie Detector) to draw a better conclusion
Misnomer: Instrument that records physiologic changes • Types:
that (supposed) to occur with fear (not lies) 1. Peak-of-tension tests (Blindsight
Parts: Detector (probe, sensors), signal amplifier, questioning)
computer readout 2. Guilt complex test for inconsistencies
All questions are answerable by yes or no (close-ended), 3. Silent answer test
unless necessary to be open-ended
Measured Parameters: Inadmissibility of the Polygraph
• Body movements “The polygraph test cannot be used as evidence in the
• Diaphragmatic breathing court”
• Chest breathing Reasons:
• Perspiration (in relation to Psychogalvanic reflex) 1. Interrogator-dependent findings, non-
• Pulse Rate standardized
• Blood Pressure 2. Polygraph is capable of high degree of
accuracy only when conducted under
Standardized Polygraph Interrogation Phases controlled conditions by an examiner who is
• Phase 1: Pre-test interview highly qualified due to his ability, experience,
• Phase 2: Actual interrogation and recording education and integrity
phase 3. Examinee may waive the right against self-
• Phase 3: Post-test interrogation incrimination
• Supplementary • Violates the right of the patient not to
be a witness against himself
Standardized Polygraph Phase 1 4. Results may be easily influenced by physical
Pre-test interview phase (20-30 minutes) problems of the subject
• Informal in nature • Blood pressure
• Baseline determination • Heart diseases
• Determining pre-existing • Respiratory diseases
medical/psychiatric conditions and use • Ability of conscious control to different
of prohibited or prescribed drugs instances
• To know any anti-social activity,
criminal record or previous polygraph Word Association Test
tests of the subject Reaction Response Time and Congruence Consistency
• Acclimatization of the subject and the • List of stimulus and non-stimulus questions are read
interrogator to the subject who is instructed to answer as quickly
• Explain to the subject the purpose of as possible.
the examination. • Close-ended, answerable by “yes or no”.
• To develop relevant test questions • The subject cannot be compelled to be subjected to
the test without his consent.
Standardized Polygraph Phase 2
• Formal in nature with all detectors attached to Psychological Stress Evaluator
the subject Voice Analysis
• Standardized questions In a normal speech, there are audible voice frequencies
a) Irrelevant questions: “not case related” and inaudible frequency modulations formed from the
questions (name, age, gender, minute oscillations of the muscles of the voice
educational background, marital status, mechanism.
citizenship, occupation) to determine • Cricothyroid
test baseline • Posterior cricoarytenoid
b) Relevant questions: specific “case • Lateral cricoarytenoid
related” questions under investigation • Transverse arytenoid
• Oblique arytenoid

• Thyroarytenoid
Under stress, the microtremor of the voice is Hypnosis (Hypnotic Suggestion)
moderately or completely suppressed. (absence of the Alteration of consciousness and concentration in which
microtremor frequency is the positive sign) the subject manifests heightened suggestibility while
When the subject is relaxed, the microtremor frequency awareness is maintained (or altered).
are registered clearly. (recorded presence of the • As a crime ‘modus operandi’, it is colloquially
microtremor frequency is a negative sign) referred as “budol” or “budol-budol”.
Not all persons are susceptible to hypnotic induction.
Drugs that Inhibit the Inhibitor Strong-willed subjects like professionals who have
“Truth Serum” (Hyoscine hydrobromide) undergone Socratic theoretical education (lawyers,
Given hypodermally in repeated doses to elicit the side physicians, accountants, psychologists, scientists) are
effect usually less susceptible and non-hypnotizable.
MOA: Tertiary amine antimuscarinic agent; Not admissible in court since the testimony is
Parasympatholytic-Anticholinergic (blocking involuntary and violates the right against self-
acetylcholine and cholinergic derivatives) incrimination (Sec. 5, Rule 115, Rules of Court)
Cerebral cortex and diencephalon are selectively
depressed Other Reasons Why Testimonies Obtained Through
Impaired attention, perception, awareness, thought Hypnosis is Not Admissible in Court
processing, language, and consciousness. 1. Lack of general scientific acceptance and
standardization
Adverse Effects: Constipation, urinary retention, 2. Bias in the trier of facts to give uncritical whilst
hallucinations, agitations, confusion, restlessness, absolute reliability to hypnosis without
psychosis, seizures consideration of flaws to ascertain veracity
• When the proper (over)dose is reached, the 3. Hypnotized subjects may deliberately fabricate
questioning begins and the subject feels a testimonies
compulsion to answer the questions truthfully. 4. Heightened suggestibility in hypnosis produces
Not admissible in court since the testimony is distortion of facts rather than to testify for the
involuntary and violates the right against self- truth
incrimination (Sec. 5, Rule 115, Rules of Court) 5. “The state of mind, skill and professionalism of
the examiner are too subjective to permit
Narcoanalysis or Narcosynthesis (Sodium amytal or admissibility of the testimony”
Sodium penthotal (Sodium thiopental) Am. J. of Trial Advocacy, 1981 p. 603
Given intravenously in repeated doses to elicit the side 6. “Confessions while under hypnotic spell is not
effect admissible as evidence because such
MOA: GABAa receptor blocker (competitive inhibition) “psychiatric treatment” is involuntary and
Decrease both higher cortical brain function and mentally coercive.”
inhibition Leyra v. Demro, 347 US 6, 74 S. Ct. 716, 98, 948
(1954)
Adverse Effects: Sluggishness, incoordination, difficulty
in thinking, slowness and staggering of speech, faulty Observation
judgement, drowsiness, shallow breathing Remember that these are subjective and MAY NOT be
• The drug tends to make subjects verbose and conclusive of deception
cooperative with interrogators however, the 1. Sweating
reliability of confessions are questionable. 2. Color change (flushing)
Not admissible in court since the testimony is 3. Dryness of the mouth
involuntary and violates the right against self- 4. Fidgeting
incrimination (Sec. 5, Rule 115, Rules of Court) 5. “Peculiar feeling”, “Butterflies in the stomach”
and similar observations
Alcohol Intoxication (“In Vino Veritas”) 6. Swearing to the truthfulness of testimony
Ethanol 7. Red herring statements--- “Spotless past
Given orally in repeated doses to elicit the side effect record”, “Religious man”, “Never been in this
MOA: GABAa receptor blocker (non-competitive situation”
inhibition), inhibition of glutamate in NMDA receptors 8. Inability to look at the investigator “straight on
Initial CNS stimulation followed by CNS depression, the eye”
Decrease both higher cortical brain function and 9. Overt expression of “not knowing anything”
inhibition
• Adverse Effects: Sluggishness, incoordination,
difficulty in thinking, slowness and staggering Scientific Interrogation
of speech, faulty judgement, drowsiness, Definition of Terminologies
shallow breathing
• The drug tends to make subjects verbose and 1. Suspect (Akusado)
cooperative with interrogators however, the A person who is being ACCUSED of a wrongdoing which
reliability of confessions are questionable. may or may not constitute a crime.
Not admissible in court since the testimony is 2. Witness (Testigo)
involuntary and violates the right against self-
incrimination (Sec. 5, Rule 115, Rules of Court)

A person other than a suspect who is invited for
questioning and requested to give information Kinds of Confession
concerning an incident. Extra-Judicial Confession
3. Respondent or Defendant (Sinampahan ng Confession made outside of the court prior to the trial
kaso) of the case
Party in a lawsuit that responds against the case “Extra-judicial confession IS NOT a sufficient ground for
4. Plaintiff or Claimant (Nagsampa ng kaso) conviction unless corroborated by evidence of ‘corpus
Party that brings a lawsuit to court delicti’” (Sec. 3, Rule 133, Rules of Court)
5. Convict Types of Extra-Judicial Confession
Declared to be guilty of a criminal offense by the verdict 1. Voluntary: Willful extra-judicial confession;
of a judge in a court of law. without use of force threat nor intimidation
6. Ex-convict 2. Involuntary: Extra-judicial confession obtained
Declared freeman after serving the penal provision by a with use of force, threat and/or intimidation
verdict of a judge in a court of law.
7. Acquitted “Confessions obtained through force, threat,
Declared to be not guilty of a criminal offense as proven intimidation, duress and, violence is null and void and
by a verdict of a judge in a court of law after exhaustive cannot be used against him at the trial”
fact-finding. (US v. Lozada, 4 Phil. 266; US v. Felipe, 5 Phil, 333)
Legal Provisions on the Admissibility of Evidence Judicial Confession (Plea bargain)

Obtained Through Interrogation Confession made within the court trial
(Section 12, Article III, 1987 Philippine Constitution) • Conclusive upon the court and may be
1. “Any person under investigation for the considered to be a mitigating circumstance to a
commission of an offense shall have the right to criminal liability
be informed of his right to remain silent and to • Reduces the punishment by 1 degree
have competent and independent counsel A plea of guilty when formally entered into an
preferably of his own choice. arraignment is sufficient to sustain a conviction of any
If the person cannot afford the services of offense, including capital offense, without further proof.
counsel, he must be provided with one. These *Arraignment is court proceeding at which a criminal
rights cannot be waived except in writing and in defendant is formally advised of the charges against him
the presence of counsel.” and asked to enter a plea to the charges.
2. “No torture, force, violence, threat,
intimidation, or any other means which vitiate Medico-Legal Aspects of Human Body Identification
the free will shall be used against him. Secret
detention places, solitary, incommunicado, or Human Body Identification
other similar forms of detention are Goal: To determine the individuality of a person
prohibited.” Importance:
3. “No person shall be compelled to be a witness 1. To confirm or deny one’s identity
against himself.” (Section 17) 2. Establish a corroboration between a suspicious
Any confession or admission obtained in violation of this disappearance of a person from a unidentified
or Section 17 hereof shall be inadmissible in evidence cadaver
against him. 3. To confirm the identity of a unrecognizable
cadaver after a fire, beheading or accident
“Miranda Rights” 4. To determine (and exclude) paternity, lineage
(Miranda v. Arizona, 384 US 436, 1966) and heir
If a person is to be interrogated, he must be first
warned and advised that: General Methods of Human Body Identification
1. “You has the right to remain silent; By comparison
2. Anything that you say can be used against you • Preset identification criteria during investigation
in court of law; are compared to a known control (records)
3. You has a right to consult with an attorney and available in the file
to have the attorney present during • Post-mortem findings are compared versus
questioning; and ante-mortem records
4. If you cannot afford an attorney, you will be
appointed for one prior to any questioning if By exclusion
you desire so.” • Deduction: If two or more persons are
identified and are known to be with someone
not yet identified, the one whose identity has
Affirmation of such waiver constitutes an answer to the not been established may be known by the
next questions: process of elimination and or comparison.
a) Do you understand each of these rights I have
explained to you? Ordinary
b) Having these rights in mind, do you wish to talk • No special training is required
to us now? • No special skills, materials or instruments were
used
Confession (Kumpisal, Pag-amin) • Pleading to senses (usually to sight)

2) Head measurements: Length and
Scientific breadth of head, bizygomatical
• Special techniques and skills are utilized by an diameter, length of the right ear
observer 3) Measurement of the limbs: Length of
• Critical analyses and laboratory methods are the left foot, length of the left middle
required and left little fingers, length of the left
• Primarily rely on comparison or exclusion arm and hand from the elbow to the tip
of the outstretched middle finger
Ordinary Method of Human Body Identification
Transient, Can be easily changed variables “Portrait Parle” (Spoken Picture)
• Growth of hair, beard, moustache • Professional artist rendering of a verbal,
• Clothing, apparel accurate and picturesque description of the
• Frequent place to visit (habitus) person being identified
• Personal belongings Requirements:
• Grade and marks of profession 1. General impression: type, personality, apparent
• Body ornamentation social status
• Memories 2. Age and gender
• Speech 3. Race or color
• Gait 4. Height
• Mannerisms 5. Weight
• Eye color 6. Built- Thin, slender, medium or stout
• Skin color 7. Posture- Erect, slouching, round shoulder
• Facial features
• Facies Requirements of “Portrait Parle”, continued,
• Left or right-handedness 8. Head shape and size
• Built, nutritional status 9. Hair- color, length, baldness pattern
• Physical deformities 10. Facial impression: reconstruction of even the
smallest details of the face
Other Important Variables 11. Neck: shape, thickness, length, protrusions
Occupational marks: Identifying characteristic of an 12. Shoulder: width and shape
occupation 13. Wrist: size and shape
Race: 14. Hands: Length, size, hair distribution pattern
a) Skin color 15. Fingers: Length, thickness, stains, shape of the
b) Facial features nails, condition of the nails
c) Head and skull 16. Arms: Length, built (lean muscular, flabby),
d) Wearing/apparel thickness of the wrist
Tattoo markings and pigmentation; includes birthmarks 17. Feet: Dimensions, size and deformities
Weight approximation
Deformities Extrinsic Factors for Identification
Injuries with permanent outcomes 1. Ornamentations: Rings, bracelets, necklace,
Moles hairpins, earrings, corsage
2. Personal belongings: Letters, wallets, driver’s
Other Important Variables license and professional licenses, residential
Scars certificate, personal club cards
Tribal marks, branding, piercings 3. Wearing apparel: Tailor marks, laundry marks,
Sexual organ: Either male or female printed name of the owner, embroidery
markings, size, style, footwear, socks
Anthropometrics (Bertillon System) 4. Foreign bodies: Dust in clothing, cerumen in the
Alphonse Bertillon: Devised the scheme of ears, nail scrapings
anthropometrical measurement of the human body as a 5. Vouched identification by relatives and
basis of identification. acquaintances
Premise of its use: 6. Identification records on file at the PNP, NBI,
1. The human skeleton is unchangeable after 20- hospitals, licensing institutions and others
years of age 7. Identification photographs
2. It is impossible to find two human beings having
bones that are exactly alike Scientific Method of Human Body Identification
3. Necessary measurements can easily be taken
with the aid of a simple instrument Fingerprinting
Single most valuable method of scientific human body
Necessary information included in the Bertillon System identification
a) Descriptive data: Color of the hair, eyes, 1. The probability of two fingerprints to be
complexion, shape of nose, ears, etc. identical is very slim at 1:64 billion
b) Body marks: Moles, scars, tattoo, deformities For context, total world population currently stands at
c) Anthropometrical measurements: 7.67 billion
1) Body measurements: Height, width of 2. Never interchangeable: Fingerprints are formed
outstretched arms, sitting height since fourth month AOG

3. Fingers may be wounded or burned but Fingerprint Anatomy
fingerprints reappear after wound heals.
4. Not much training is required to take, classify
and compare fingerprints
5. Cheap procedure, no expensive equipment is
required
6. Fingerprint filing for comparative purposes are
available
7. Errors can be checked
Definition of Terminologies in Fingerprinting

Dactylography
Art and study of recording fingerprints as means of
identification
Dactyloscopy Ridges: Dark lines in an imprint formed from the ventral
Art and study of identification by comparison and finger papillae
utilization of fingerprints Valley: Space between two ridges
Poroscopy Terminations: End of a ridge
Study of the pores found in papillary or friction ridges of Bifurcation: Branching out of a ridge into two
the skin for purposes of identification Core: Approximate center of the fingerprint impression
Island: A short ridge that stands alone
Methods of Fingerprint Imprinting Delta: Triangular, three-point, funnel-shaped ridge
Plain Print which diverge to flow around a whorl or a loop
Pressing of each fingers on its ventral surface on using
an ink pad or plate then is transferred and pressed on a
developing paper
Rolled
Medial to lateral rolling of each fingers on its ventral
surface using an ink pad or plate then is transferred on
a developing paper
Digital
Digital scanning of each fingers on its ventral surface
using a fingerprint capture device plate
Fingerprint Impressions (Imprint/Print) Dental Identification

Papillary ridges and valleys from the ventral surface of Odontologic Analysis/Forensic Odontology
the fingers that are transferred to paper or any surface. Factors of importance
Kinds of Fingerprint Impressions 1. The possibility of two persons having the same
1. Real impressions dentition (odontologic profile) is remote
Impression created by purposeful means of pressing, 2. The enamel of the teeth is hard and enough to
rolling or scanning of each fingers resist putrefaction
2. Chance impressions 3. Reliability of antemortem records depend
Impressions by mere chance without any intention to largely on the proximity to the time of death
produce it
a) Visible: Chance impressions that are Legal Basis of Forensic Odontology in the Philippines
observable without developing (Section 1, PD 1575 s. 1978)
b) Plastic: Chance impressions on a “The identification of persons is a necessary factor in
pliable, moldable material solving crimes and in settling certain disputes such as
c) Latent: Chance impressions that are not claims for damages, insurance, and inheritance.
observable and requires developing Now therefore…. It shall be obligatory upon all
practitioners of dentistry to keep and maintain an
accurate and complete record of the dentition of all
their patients which shall include a history and
description of the patient's dentition and the
treatments made thereon.”
Causes for Unreliability of Forensic Odontologic

Records
Dictum: “Antemortem dental records while available
can be insufficient or unreliable”

Factors for insufficiency and unreliability Legal Basis: Sec. 23, Rule 132, Rules of Court
1. Focus of dentist’s diagnosis (and subsequently, How can handwriting be proved?
the records) in aid of diagnosis and treatment 1. The witness testifying for the handwriting have
instead of recording accuracy of the entirety previously seen the person write
2. There is no agency mentioned in the law to be 2. The witness has knowledge on the handwriting
a records repository of odontologic records. of the person
3. Accuracy of the record based on the proximity 3. Corroborating proof is present proving the
from the time of death and investigation knowledge of the witness on a person’s
handwriting
Basis of Forensic Odontology Definitions
1. Teeth position Bibliotics
2. Teeth surface and positioning Science of handwriting analysis
3. Restorations Graphology
4. Prosthesis Study of handwriting for the purpose of determining the
5. Endodentia (Root canal treatments) writer’s personality, character and aptitude
Forensic Odontology Charts Identification of Skeletal Remains

Primary Baby Teeth Eruption Bones used to measure height
1. Femur
2. Humerus
3. Tibia
4. Radius
Bones used to determine sex
1. Pelvis
2. Skull
3. Sternum
4. Femur
5. Humerus
Pelvic Differences
Permanent Teeth Eruption
Cranium Differences
Other Basis in Forensic Odontology

1. Personal, occupational and cultural traits
2. Age
a) 9 y/o: 12 permanent teeth (8 incisors, 4
molars)
b) 11 y/o: 20 permanent teeth (8 incisors,
8 premolars, 4 molars)
c) 13 y/o: 28 permanent teeth, no
deciduous teeth
Racial Differences
d) 8-10 y/o: Calcification starting at the 3rd
molar
e) 25 y/o: Root ends of the 3rd molar
beginning to calcify
f) Beyond 25 y/o: Root ends and of the 3rd
molar have been completely calcified
g) After 30 y/o: Dental carries, gingival
recession
3. Sex: Examination of Barr bodies
Handwriting
Determination of the Duration from Death to Tests to Determine Sex
Interment (Libing)
• Period from the time of death up to the time of
examination may be determined by the nature
and presence of soft tissues and degree of
erosion of the bones
• General circumstance: All soft tissues in grave
usually disappear within a year
Bases of Duration from Death to Interment
1. Presence or absence of soft tissues adhering to
bones Levels of Evidence for Sexual Determination
2. Firmness, brittleness, weight, dryness of the
bones
3. The degree of erosion of the surface of the
bones
4. Changes in the clothing and coffin (container)
appearance
Determination of Sex
Importance
1. In aid of identification as inclusion or exclusion
criteria Legal Determination of Age
2. In determination whether an individual can May be determined by:
exercise obligations vested under one sex • Appearance of the ossification centers
a) In Article 176 of the Family Code, a child • Union of bones and epiphyses (and its closure)
is considered illegitimate if the child is • Dental Identification
born out of wedlock, and in such cases, • Obliteration of cranial sutures
the parental authority and custody of
the child fall on the mother (which is a Legal Determination of Age
female). Ossification Centers of the Cubital Joint
b) In Article 213 of the Family Code, the
so-called “tender-age presumption”
states that no child under seven (7)
years of age shall be separated from the
mother (which is a female) unless the
court finds compelling reasons to order
otherwise.
c) RA 9710 (The Magna Carta of Women)
specifically provides for women.
3. There are certain crimes wherein a specific sex
can only be an offender or a victim (the sexist
nature of the law) Legal Determination of Age
a) In Article 202, No. 5 of the Revised Importance
Penal Code it states “For the purposes 1. To aid in identification
of this article, women who, for money 2. Determination of criminal liability
or profit, habitually indulge in sexual Exception: A person under 9 years of age; a person over
intercourse or lascivious conduct are 9 years but under 15 unless he has acted with
deemed to be prostitutes.” discernment, in such case, the minor shall be proceeded
b) In defining adultery (Title Eleven, against
Chapter 1, Article 333 of the Revised 3. Determination of right to suffrage (18 years old)
Penal Code) it states: 4. Determination of the capacity to contract
“Adultery is committed by any married marriage (at least 21 years old without parental
woman…” consent)
c) In defining concubinage (Title Eleven, 5. As a requisite to certain civil rights
Chapter 1, Article 334 of the Revised
Penal Code) it states: Blood and Blood Stain Analysis
“Any husband…” Importance
d) In seduction (Art. 337 and 338 RPC), 1. Disputed parentage
abduction (Art 342 and 343) and, abuse 2. Circumstantial and corroborative evidence
against chastity (Art. 245), a woman is a against or in favor of the perpetrator of the
victim crime
3. Determination of the cause of death
4. Determination of the direction of escape of the
victim or assailant (tracking evidence)
5. Determination of the place of commission on
the crime (as corpus delicti evidence)

6. Determination of the presence of certain From fresh blood stains
diseases Oxyhemoglobin
Hemoglobin
Gross Macroscopic Examination of Blood Stain Reduced hematin
Summary of Procedure From older, dried blood stains
1. Determination of the material, composition, Methemoglobin
color of the article stained Alkaline hematin
2. Color of blood stain estimates the time of blood
splatter (recent being dark-red in color) Biologic Examination of Blood
3. The direction of the origin of the blood stain Precipitin Test (Ulenhuth Test)
Tail pointing at the direction OPPOSITE the • Antibody-antigen precipitin test
source in relation to the angle and velocity of • Human blood with immune serum from a
the blood splatter sensitized animal (usually rabbit) forms
Fall at 90 degrees gives a splash appearance in precipitate (called precipitin) of antigen-
relation to height of blood drop and the nature antibody complexes
of the surface where the blood drops Blood Typing
4. Determine the degree of soaking, size and • All human being belong to a specific blood type
intensity of color under several blood group systems (ABO and
Rh)
Physical Examination of Blood Stain • Value: Primary exclusion or inclusion criteria for
Solubility Test parentage.
• Recent blood droplet is soluble in saline and
imparts a bright red color (<12 hours, drying- Phenotypic and Genotypic Examination of Blood
dependent)
Heat Test
• Heating imparts a muddy brown precipitate
Chemical Examination of Blood Stain

Chemiluminescence Test (Luminol)
• Emission of bluish white luminescence due to
hematin containing iron in the blood
Guiacum Test (Van Deen and Isaac’s Method)
• Quinonemine dye formation (blue) after addition of Phenotypic and Genotypic Exclusion or Inclusion of
Guaiac reagent Blood
Leucomalachite Green Test
• Peroxidase-like activity of hemoglobin in
Leucomalachite Green and acetic acid produces
bluish-green coloration
Phenolphthalein (Kastle-Meyer Color) Test
• Phenolphthalein and Hydrogen Peroxide acts on the
hemoglobin of the blood with its peroxidase-like
activity forming deep pink coloration
Microscopic Examination of Blood Stain

(Confirmatory for Blood)
Hemochromogen crystal (Takayama Pyridine Absolute Exclusion in Parentage Using ABO Blood
Ferroprotoporphyrin) Test Group System
• Positive crystal test to any substance containing 1. Any of the claimant parent that is type O cannot
hemoglobin have a type AB child.
• Heated blood stain added with pyridine NaOH 2. Any of the claimant parent that is type AB
and reducing sugar (Takayama Reagent) cannot have a type O child.
produces Pyridine Ferroprotoporphyrin (pink 3. Both type A parents cannot have a type AB nor
feathery crystals) a type B child.
Hemin crystal (Teichmann Ferriprotoporphyrin 4. Both type B parents cannot have a type AB nor
Chloride) Test a type A child.
• Positive crystal test to any substance containing
iron porphyrin Age of Blood Stain
• KCl, KBr, KI in equal parts with Glacial Acetic • When blood is exposed to atmosphere,
acid when heated with suspected blood stain hemoglobin is converted to methemoglobin or
produces Ferriprotoporphyrin Chloride hematin changing the color from red to reddish
(rhombic, dark brown crystals) brown to brown to black in color.
• Coagulation and desiccation (drying) from the
rim of the blood drop to the center also gives
information to the age.
Spectroscopic Examination of Blood Stain

Differences of Naturally Shed versus Forcibly Extracted • Complete cessation of all life processes in every
Hair individual cell of an organism
Forcibly Extracted • Happens in approximately 6 hours after onset
Hair bulb is irregular with an undulating surface of brain and/or somatic death.
Naturally Shed Full Criteria: Impossible to ascertain clinically.
Hair bulb has a smooth external surface
Apparent Death or State of Suspended Animation
Medico-Legal Aspects of Human Death • Temporary (either short- or long-term) slowing
Definition of Terms or stopping of biological function in which
Life physiological capabilities are preserved.
Sum total of all functioning vital processes in which the • Either hypometabolic or ametabolic in nature, it
physical integrity of the body is maintained through may be induced by either endogenous, natural
homeostasis. or artificial, biological, chemical or physical
Homeostasis means.
Ability of all living organisms to maintain a relatively • Currently, this definition is not convening for
stable internal state that persists despite changes in the death in all jurisdictions and situations.
environment. Examples:
Death 1. Cryptobiosis in humans (in cases of application
Termination of life and the complete cessation of vital in Cryobiosis)
functions without the possibility of resuscitation. 2. Deep Hypothermic Circulatory Arrest (DHCA) for
Irreversible loss of the properties that define life. induced hypothermia
Legal Significance of Death Determination Signs of Somatic Death Determination

1. The civil personality of a person is extinguished Heart
by its death. (Article 42, Civil Code) 1. Absence of pulse on palpation
2. The property of a person is transmitted to his 2. Absence of heart sounds upon auscultation in
heirs at the time of death. (Art. 774, Civil Code) precordial areas
3. The death of a partner is one of the causes of 3. Asystole on ECG
legal dissolution of partnership agreement. (Art.
1830, Civil Code) Peripheral Circulation
4. The death of either the principal or agent is a 1. Magnus test: Application of ligature
mode of extinguishment of the agency. (Art. (tourniquet) on the base of the finger.
1919, Civil Code) a) Alive patient will have a bloodless zone
5. Criminal liability of a person is totally at the site of ligature.
extinguished by death of the offender before b) No change in a dead patient
judgement. (Art. 89, Revised Penal Code)
6. The civil case for claims prior to a final 2. Icards’ test: Subcutaneous administration of
judgement is dismissed upon the death of the fluorescein dye.
defendant. (Rule 3, Sec. 21, Rules of Court) a) In a live patient there is spread of the
dye from the site of administration
Defining Criteria for Death Determination b) Localization in a dead patient
Brain Death 3. Diaphanous Test: Fingers are spread wide and
• Deep, irreversible absence of electrical brain finger webs are viewed under a strong light
activity and complete cessation of vital a) In a live patient, finger webs appear
functions without the possibility of pinkish red
resuscitation. b) Yellowish in a dead patient
Full Criteria: 4. Blanching: Melted wax is applied on the chest
1. Unreceptive, unresponsive: Glasgow Coma a) In a live patient, there will be redness
Scale 3 on the site with edema
2. No chest movements of breathing for at least 1 b) No reaction in a dead patient
hour Respiration
3. Absence of reflexes upon excitation 1. Observation of chest and abdomen for
4. Flat electroencephalogram (EEG) or greater respiratory movements
confirmatory test such as Brain PET scan 2. Absence of respiratory sounds on auscultation
3. Examination for moistened respiratory air using
Somatic Death or Clinical Death a handheld mirror
• Complete, persistent and continuous cessation 4. Examination using feather or cotton fibers
of the vital functions of the heart and lungs 5. Winslow test: a flat, even surface is placed on
which maintains life. top of the chest or abdomen and water is
• “Patient Expired” applied
Full Criteria: a) Movement of reflected artificial light in
1. Absence of vital signs a live patient
2. Relaxation of sphincters b) No movement of reflected artificial light
3. Constant pupillary dilation in a dead patient
Molecular or Cellular Death

Cooling 5. Further details (such as age, gender, built,
Algor Mortis height, weight, actual time of death, time of
• After death, the metabolic processes in the reading of rectal temperature etc.) is noted
body ceases. down from the documents and history.
• Body loses heat to equilibrate the environment
by evaporation or conduction Hennsge Nomogram Plotting and Measurement
• Most prominent sign of death. 1. Line A: Between the rectal temperature and the
Post mortem caloricity difference to ambient temperature
• Transient rise of body temperature after death 2. Line B: Between the circle and the intersection
• Due to the rapid and early putrefactive changes of the standard line and Line A.
in the internal organs happening in the first 2 3. Time Since Death (TSD) is then read at Line B
hours of death value to the point corresponding to the weight
of the body after clothing and weight
Factors Influencing Delayed Cooling correction.
Somatic Factors
• High fever prior to death Skin Changes at Death
• Sudden death in good health 1. Pale coloration, dependent portions of the body
• Obesity will develop livid coloration (livor mortis)
• Death from asphyxia 2. Loss of elasticity and post mortem contact
• Death of middle age flattening
3. Opacity of the skin
Environmental Factors 4. Negative blanching test
• Clothing (thickness and degree of body covering
at death) Eye Changes at Death
• Small room 1. Loss of corneal reflexes
• Warm environment 2. Clouding of the cornea
3. Eyeball flaccidity and sinking to the orbital fossa
Factors Influencing Accelerated Cooling 4. Loss of pupillary reflex
Somatic Factors 5. Tache noir de la sclerotique: oval, round or
• Leanness of the body triangular discoloration of the sclera
• Extreme age (Geriatric patient)
• Long-standing illness causing death Ophthalmoscope Findings
Environmental Factors 1. Pale, atrophied optic disc
• Unclothed body 2. Fundus color changes from brownish-gray to
• Large room gray
• Wet cadaver or submerged in water 3. Pale retina
4. Segmented retinal veins due to intravascular
Time of Death Based on Cooling coagulation post-mortem
Generalized Guidelines
1. Normal temperature death (no pyrexia) at first Muscle Changes at Death
hour: Three Stages Post-Mortem
Rate of equilibrium = (Body temperature - Environment 1. Stage of Primary Flaccidity (Primary Relaxation)
temperature) / 2 2. Stage of Post-Mortem Rigidity (Rigor mortis)
2. Succeeding two hours (2nd and 3rd hour from 3. Stage of Secondary Flaccidity (Secondary
death): Relaxation)
“Half of the previous rate”
3. Succeeding two hours (4th and 5th hour from First Stage Muscle Change at Death
death): Stage of Primary Flaccidity (Primary Relaxation)
“Half of the previous rate” Time: Death to 3-6 hours; shorter in warmer localities
4. Absolute equilibrium to environmental Gross Characteristics:
temperature at 12-15 hours from the time of death “Flexed extremities, loosened lower jaw, no tension
on the eyeballs, sphincters are relaxed, incontinence
Hennsge Nomogram may be present”
1. Clothings were removed and rectal temperature Micro-biochemical Characteristics:
was recorded in supine position after spreading Alkaline myocyte, no putrefactive changes are
both legs apart exposing the perineal region. apparent.
2. Laboratory thermometer of length 32
centimetres with a temperature range of 0 to Second Stage Muscle Change at Death
50 degree Centigrade is inserted 10 centimeter Stage of Post-Mortem Rigidity (Rigor mortis)
deep in rectum of cadaver. Time: 3-6 hours to 24-48 hours post-mortem
3. The reading was noted down two minutes after Gross Characteristics:
keeping the thermometer inside the rectum. “Gradual stiffening of muscles starting from the
4. Simultaneously ambient temperature was also neck, lower jaw and spreads downwards. Complete
recorded with ambient temperature stiffening in 12 hours affecting both skeletal and
thermometer. smooth muscles.”
Micro-biochemical Characteristics:

Increased lactic acid and phosphoric contents of • Accumulation of blood in the most dependent
the myocyte. Acidic in nature and hence, basophilic portion of the body after death
staining. • Involves the superficial layer of the skin
• Does not appear elevated on the surface of the
Factors affecting the onset of Post-Mortem Rigidity skin
(Rigor mortis) • Uniform coloration
1. State of muscle health: Rigor appears later in • No injury on the skin
previous good muscle health Importance
2. Age: Rigor appears later in good health and 1. Signs of death
good muscular development in teenage and 2. Determines if the initial position of the cadaver
middle age population has been shifted after if formed
3. Nerve integrity: Rigor appears later in nerve 3. The color of lividity may indicate the cause of
transection patients death
4. Temperature: Rigor appears later in cold
environments Tardieu Spots
5. Moisture: Rigor appears rapid with short Dark pinpoint spots that are seen when capillaries
duration in moist air rupture due to increased pressure (like in the legs or in
the face of a hanged person or strangulation).
Conditions stimulating the onset of Post-Mortem
Rigidity Color of Lividity and Probable Cause of Death
1. Heat Stiffening: Exposure of the body to
temperatures >75 degrees Celsius will coagulate
the muscle in a “pugilistic attitude” (Clenched
fist, arms and legs are flexed); irreversible
COD usually are whole body scalding burns, burned to
death
2. Cold Stiffening: Exposure to freezing
environment causes solidification of fat;
reversible when re-exposed to warm Putrefaction
temperature Breaking down of complex, structural proteins into
COD usually are freezing to death, summit deaths in simpler components associated with bacterial
mountaineering enzymatic digestion with the evolution of foul smelling
3. Instantaneous Rigor: Rigidity occurring at the gases and accompanied by the change in the color of
instant moment of death due to extreme the cadaver
tension, exhaustion or, injury to the nervous
system Signs of Putrefaction
1. Changes in the color of the tissue
Third Stage Muscle Change at Death 2. Evolution of gases causing skin bullae,
Stage of Secondary Flaccidity or Secondary Relaxation abdominal distention and bloating
Time: Greater than 24-48 hours post-mortem 3. Liquefaction of soft tissues
Gross Characteristics:
“Post-rigor mortis, the muscles become soft and Factors Affecting Rate of Putrefaction
flaccid, unresponsive to electrical stimulation.” 1. Age: Newborns and infants putrefy faster
Micro-biochemical Characteristics: 2. Body composition: Obese person tend to
Putrefactive changes is evident with complete putrefy rapidly than skinny ones
loss of microscopic and ultramicroscopic structures. 3. Cause of Death: Death due to infection or
anasarca putrefy rapidly
Blood Changes at Death 4. Moisture: Increased moisture accelerates
Coagulation putrefaction
• Stasis of blood due to cessation of circulation 5. Soil: Dry absorbent soil retards decomposition
and factor activation enhances coagulation of 6. Water: Putrefaction hastens when wet
blood. 7. Clothing: Warmth hastens putrefaction but
• Complete systemic coagulation happens in impairs as insects will have less access on the
approximately 68 hours post-mortem cadaver
Ante-Mortem versus Post-Mortem Clots Order of Putrefaction in Water

Ante-mortem clots happen before death hence, firm, 1. Face, neck, breast
homogenous and uniform with presence of Lines of 2. Shoulders
Zahn. 3. Arms
Post-mortem clots happen after death hence, soft, 4. Abdomen
friable, disorganized with characteristic “chicken fat” 5. Legs
appearance.
Cadaveric Lividity (Post-mortem Suggilation or Livor Modification of Putrefaction

Mortis) Mummification
Dehydration of the body resulting to preservation
Saponification Autopsy done on a human body with the consent of the
Fatty tissues are transformed to waxy, soft-brownish nearest of kin to ascertain the cause of death (COD),
substance called adipocere clinical diagnosis, effects of therapy, educational study
Maceration on the cause of disease and/or, continued professional
Softening of the tissues in a fluid medium in the education for physicians and students
absence of putrefactive bacteria B. Medico-Legal or Official Autopsy
Autopsy done on a human body to determine cause of
Summary of Time-Based Post-Mortem Hallmarks death (COD); recovering, identifying and preserving
1. Rigor mortis: Starts 2-3 hours post-mortem, evidence for judicial use; to provide information,
fully at 12 hours, resolves in 24-48 hours interpretation and correlation of facts and
2. Livor mortis: Starts 3-6 hours post-mortem circumstances in relation to death; providing factual
3. Decomposition: 24-48 hours post-mortem and objective medical report and, to separate deaths
4. Entomology (insect): presence of maggots due to diseases and natural causes from death due to
means >24 hours post-mortem external causes
5. Digestion of last meal: 3-4 hours normally to
convert to feces a meal Persons Authorized to Perform Autopsies and
6. Post-mortem clotting: 6-8 hours post-mortem; Dissections
decoagulation at early stage of decomposition Health officers as referred by Chapter XXI, Section 95,
<24 hours post-mortem Subsection a, The Code of Sanitation of the Philippines
7. Soft tissue in skeletal remains: Complete (PD 856, 1976)
decomposition in 1-2 years post-mortem a) District Health Officer
b) Local Health Officer
Presumption of Death c) Medical Officers of law enforcement agencies
Absence of 7 years of unknown reason is to be (PNP, NBI)
presumed dead UNLESS if it is a legal matter of d) Members of the medical staff of accredited
succession which requires 10 years. hospitals
The following is presumed dead after 4 years of being
missing and unheard of: Manner of Death Requiring Medico-Legal Autopsy
a) On board on a lost sea vessel or 1. Death by violence
airplane 2. Accidental death
b) Person in the armed forces on a mission 3. Suicide
c) Mountain climber, cave explorer, miner 4. Sudden death of persons in apparent good
health
Medico-Legal Investigation of Death 5. Death unattended by physician
Officials Authorized To Conduct Death Investigations 6. Death occurring in unnatural manner
1. Provincial and City Fiscals
2. Judges of Regional Trial Courts and Municipal General Guidelines for Autopsies
Trial Courts 1. Examiner must be trained and properly guided
3. NBI Director 2. Autopsy should be comprehensive with
4. Chief of Police attention to detail
5. Solicitor General 3. Cadavers recovered as mutilated, decomposing
or burned are still suitable for autopsy
Stages of Medico-Legal Investigation 4. Autopsies must be conducted with complete
A. Crime Scene Investigation (CSI) respect to the cadaver.
Analysis of the place where the criminal act took place 5. Proper identification must be established
usually performed by criminologists who are trained as 6. A dead body must not be embalmed before the
Scene of the Crime Operatives (SOCO) autopsy; preferably done in a fresh state
7. The body should be autopsied in the
B. Autopsy approximate condition as found in the crime
Comprehensive study of a dead body, performed by a scene
trained physician employing recognized dissection
procedure and techniques Causes of Death
Cause of Death is the injury, disease or the combination
Autopsy versus Post-Mortem Examination of both responsible for initiating the trend of
A. Post-Mortem Examination physiological disturbance leading to fatal termination of
External examination of the dead body without internal life.
examination nor incision.
Can entail blood and/or other body fluid collection Types
B. Autopsy Immediate (Primary) Cause of Death:
Post-mortem examination with incision, internal An injury that directly caused death of the patient. No
examination, excision of important specimens of sequelae or complications developed but caused
interest and collection of blood and/or other body fluids instantaneous death
Proximate (Secondary) Cause of Death
Kinds of Autopsy An injury that was survived for a sufficient period of
A. Hospital or Non-Official time enough to lead to sequelae and complications
leading to death.

Definition of Terminologies Suicidal Death
a) Mechanism of Death • Self-inflicted harm that caused death
Physiologic derangement or biochemical disturbance • The law doesn’t punish the person who
that is incompatible with life commits suicide BUT the person who assists
Examples: hemorrhagic shock, metabolic disturbance, someone to the commission of suicide of
respiratory depression, cardiac tamponade another to the extent of doing the act of killing
b) Manner of Death himself shall suffer the penalty of reclusion
Explanation as to how the cause of death came into temporal
being or how the cause of death arose
Examples: Strangulation, Gunshot wound, Infection Acts Punishable for Assistance to Suicide (equates to
c) Medico-Legal Masquerade Murder)
Crime-related deaths with minimal or no external 1. Consummated suicide with the assistance of the
evidence of injury where signs of violence may be offender.
present. 2. Consummated suicide with the offender killing
d) Instantaneous physiologic death himself.
Sudden death occurring less than a minute after minor 3. Offender assisted another in the commission of
trauma suicide however, it is not consummated.
Can only be made as exclusion
Examples: Sudden Infant Death Syndrome (SIDS), Psychological Classification of Suicide
Sudden Unexplained Nocturnal Death (SUND) 1. First Degree: Deliberate, planned, pre-
meditated self-murder
Medico-Legal Classification on the Cause of Death 2. Second Degree: Impulsive, unplanned, under
Natural Death provocation
• Death caused by natural disease condition in 3. Third Degree: “Accidental suicide” when a
the body. person puts in own life in jeopardy and has
• If signs of violence is present, there is a two- been “unlucky” to have died
question test to determine criminal liability: 4. Lack of intentional capacity: Suicide due to
1. “Did the person die of natural cause and were psychosis, drugs or alcohol intoxication
the physical injuries afflicted after death?” 5. Self-destruction due to self-negligence: Self-
If yes, Impossible Crime. destructive behaviors due to chronic
2. “Did the victim died of natural causes alcoholism, drunk driving, reckless driving,
independent of the violence inflicted?” ignoring the realities of an infectious pandemic
If yes, the accused cannot be charged for the causing own death.
death but merely for the physical injuries Not presently classified as suicide in sense.
sustained by the victim. 6. Justifiable suicide: Self-destructive action that
is justifiable for being heroic or of unavoidable,
Violent Death impending death (euthanasia due to terminal
• Death due to the injuries inflicted in the body illness).
by some forms of outside force
• Physical injury must be the proximate cause of Evidences Inferring Death Due to Suicide
death 1. History of depression, unresolved personal
• May constitute a criminal act problem, metal disease
Full Qualifier for Violent Death 2. History of previous attempt of self-destruction
1. The victim is in normal health at the time when 3. Mortal wound causing death is usually solitary,
physical injuries were afflicted. accessible to the hand and is usually located in a
2. Death may be expected from the physical vital part of the person
injuries sustained 4. Effects of self-destruction is observed on the
3. Death ensued within reasonable time after victim
injury a) Blood-stained hand
b) Wounding and hand are compatible to
Penal Classification of Violent Deaths paraffin in gunshot wounds
Accidental Death c) Empty container of bottle in poisoning
• Death due to misadventure by an accident d) Absence of signs of struggle
• An accident is something that happened outside e) Presence of cadaveric spasm in the
one’s will and lies beyond bounds of human wounding hand holding the weapon
foreseeable consequences 5. Presence of suicide note
• In purely accidental death, no criminal liability is 6. Crime scene not in public view
to be imposed to the proximate person 7. Evidences will corroboratory rule-out other
circumstantial to the death manner of violent death
Parricide (Art. 246, RPC)
Negligent Death (Art. 365, RPC) Killing of one’s relative
• Death due to reckless imprudence, negligence, Requisites for Parricide (All must be present)
lack of skill or foresight 1. A person was killed by the offender
• Car accidents that caused death regardless of 2. The person killed is father, mother, or child
circumstance falls under this category whether legitimate or illegitimate, or any of his

ascendants or descendants, or the spouse of the In the commission of a homicide, it requires that the act
offender. intends to kill.
Killing of common law wife or an illegitimate relative Without proof of such intent, the felony may only be
other than the offender’s son or daughter does not serious physical injuries
constitute parricide.
Deaths Caused in a Tumultuous Affray
Infanticide (Art. 246, RPC) (Art. 251, RPC)
Killing of child less than three days old Requisites
Requisite for Infanticide 1. The person was killed in a confused or
A child less than 3 days old after birth is killed by the tumultuous affray (kaguluhan)
offender 2. That the actual killer is not known
3. That the person or persons who inflicted the
Condition variation for Infanticide serious physical injuries or violence are known
• If the offender is the mother, father or legitimate
ascendant, the penalty is of the same weight as Death or Physical Injuries Afflicted Under Exceptional
parricide Circumstances
• If the offender is not the parent nor a legitimate (Art. 247, RPC)
ascendant of the child, the penalty for murder Definition
shall be imposed • Any legally married husband who caught his
partner committing sexual intercourse, who
Murder (Art. 248, RPC) shall kill any or both of them in the act (in
Killing of a person with any of the following requisites flagrante delicto) or immediately thereafter, or
One would suffice as a Circumstance for Murder shall inflict upon them serious physical injury
1. With treachery, taking advantage of superior shall suffer the penalty of distierro (banishment
strength with an aid of armed men or employing from the place not more than 250 and not less
means to weaken the defense or means of than 25 kilometers for 6 months and one day to
persons to insure or afford immunity 6 years)
2. Killing of another person in consideration of a • If he shall inflict upon them physical injuries of
price, reward or promise any other kind, he shall be exempt from
3. By means of inundation, fire, poison, explosion or punishment.
with use of any other means involving great Requisites for two (2) condition variations
waste and ruin 1. Surprise of the spouse
4. On occasion of any calamities, earthquake, • There must be a valid marriage
epidemic or any other public calamity • The guilty spouse was caught by surprise in
5. With evident premeditation an act committing sexual intercourse with
6. With cruelty by deliberately and inhumanely another person
augmenting the suffering of the victim or • The killing or the injury was inflicted to
outraging or scoffing at his person or corpse. either or both at the very act or immediately
thereafter.
Requisites for Murder (All must be present) 2. Surprise of the daughter
1. The offender killed the victim • The daughter is below 18 years old
2. The killing is attended by any of the mentioned • The daughter is living with her parents
circumstances • Parents caught her by surprise committing
3. There was an intent by the offender to kill the sexual intercourse with the seducer
victim • Killing was done at the very act of sexual
4. The killing is not qualified for parricide nor intercourse or immediately thereafter.
infanticide.
Other Respective Penalties for Violent Deaths
Frustrated Murder (GR No. L-23133) 1. Parricide: Capital punishment of reclusion
The accused performs all of the acts which he believes perpetua (20 years and 1 day to 40 years
necessary to consummate the crime. Death, fails to imprisonment) to death penalty
follow for causes entirely apart from his will. 2. Infanticide: Capital punishment of reclusion
perpetua (20 years and 1 day to 40 years
Homicide (Art. 249, RPC) imprisonment) to death penalty
Killing of a person unfit with the requisites of parricide, 3. Murder: Capital punishment of reclusion
infanticide and, murder. perpetua (20 years and 1 day to 40 years
Requisite for homicide (All must be present) imprisonment) to death penalty
1. An act of the offender killed the victim 4. Frustrated murder: Prision mayor, maximum
2. The offender killed the victim WITHOUT any (10 years and 1 day) to reclusion temporal,
justification medium term (17 years and 4 months
3. There is no intention nor premeditation to kill the imprisonment)
victim. 5. Homicide: Reclusion temporal, full-term (12
4. Death that is beyond the definition of murder, years and one day to 20 years imprisonment)
parricide and infanticide 6. Frustrated homicide: Prision mayor, full term (6
years and one day to 12 years imprisonment)
Frustrated Homicide (GR No. 178512)

7. Death caused in a tumultuous affray: Prision • Sentiment on its practice is not legal (as there is
mayor, full term (6 years and one day to 12 no law explicit on the matter) but is against the
years imprisonment) principles:
• “No person has the right to end his own
Pathological Classification on the Causes of Death life”
1. Death from Syncope • Health practitioners “first, do no harm”
• Death due to the sudden and fatal cessation of (Primum non nocere)
the action of the heart with circulation included. • Can be termed as active (induced) or passive (to
withhold means that may prolong life)
2. Death from Asphyxia
• Death in which sudden supply of oxygen to the Euthanasia and “Do Not Resuscitate” (DNR) Orders
blood or to the tissues or to both has been Dictum Qualifier
reduced below normal working level. • A Do Not Resuscitate (DNR) order is one type of
Cause of death from asphyxia advance directive. This allows patients to decide
1. Strangulation, suffocation, hanging, drowning not to undergo cardiopulmonary resuscitation
2. Impaction of foreign bodies in the larynx (CPR) or other treatments which will try to
3. Compression of the larynx revive the patient if the heart stops or if the
4. Disease of the respiratory system patient stopped breathing.
“Passive euthanasia is exercised by withholding
3. Death from Coma advanced or basic life support and is most commonly
• Coma is the state of unconsciousness with undertaken in the form of DNR orders.
insensibility of the pupil and conjunctiva and the Writing a DNR order for a patient with an incurable
inability to swallow resulting from an arrest of condition who is not in an established death process is a
brain function form of passive euthanasia.”
• Death ensues from such arrest in brain function
and subsequently, the failure of the body to Performance of Euthanasia
thrive and survive in such condition. Patient:
Tantamount to committing suicide
Judicial Death Physician with or without patient’s consent:
Death as a result of penal application from any juridical • The physician is accountable and punishable in
ruling (death penalties). spite of patient’s consent (Assisting to Suicide).
1. Electrocution: Death due to shock, respiratory • If active euthanasia is performed (induced) by
failure due to bulbar paralysis or asphyxia due the physician without the patient’s knowledge,
to prolonged and violent convulsions it equates to murder.
2. Hanging: Death due to asphyxia or injury to the Death from Starvation
cervical spine Deliberate or consequential non-access to food for
3. Musketry (firing squad): Death due to bullet bodily nourishment and nutrition
injury after being fired in a trajectory Types of Starvation
4. Lethal injection: Most recent method • Acute Starvation: Necessary food has been
recognized by civil law (now defunct as death suddenly and completely withheld.
penalty has been repealed) • Chronic Starvation: Gradual or deficient supply
 Entails intravenous administration of one or of food.
more drugs into a person (typically a Causes of Starvation
barbiturate, paralytic, and potassium 1. Suicidal: Self-deprivation
solution) for the express purpose of causing 2. Homicidal: Depriving others
rapid death. 3. Accidental: Consequential, non-induced due to
calamity, shipwreck, entombment of miners or
Historical Methods of Death Penalty mountaineers
• Beheading Length of Survival in Starvation
• Crucifixion • Without food: Daily loss of 1/24th of weight;
• Beating 40% loss results to death
• Cutting/Tearing asunder • Without food and water: Survival approximately
• Precipitation from a height less than 10 days
• Destruction by a beast • Without food with water: Survival
• Flaying: being skinned alive approximately 50-60 days
• Impaling
• Stoning Disposal of Dead Body
• Strangling Legal Obligation (Sanitation Code of the Philippines PD
• Smothering 856 s. 1975 and Sec, 1103, Revised Administrative Code)
• Drowning • If the deceased is a married man or woman, the
duty of the burial shall devolve on the surviving
Euthanasia spouse
• Mercy killing • If the deceased is unmarried or is a child, the
• Deliberate and painless acceleration of death of duty shall devolve on the nearest kin
a person usually suffering from incurable or • If the deceased left no spouse or kindred
distressing disease. possession of sufficient means to defray the

necessary expenses, the duty shall devolve on • The body must be identified before cremation.
the municipal authorities (under the Parens • No cremation must be made unless there is a
patria doctrine). permit to do so.
Methods of Disposal of Dead Bodies Instances when Permission for Cremation must not be
Embalming granted:
• Artificial way of prolonging the body of the 1. If the deceased left an advance directive (a will)
dead by preservation that he/she must not be cremated
• Injection of 7 liters of 10% formalin, mercury 2. If the exact identity of the deceased has not
perchlorate or arsenic (last two not used due to been ascertained and further examination or
toxicity) inquiry may be needed.
• Access points used are femoral and/or carotid
arteries Use of Body for Scientific or Research Purposes
• The body of any deceased person which is to be
Burial or Inhumation (Sec. 1092, Revised Administrative buried at the public expense and which is
Code) unclaimed by relatives or friends for disposition
• The body must be buried within 48 hours after may be devoted to the purposes of medical
death except, science
a) When the body is subject for legal • Corpse of prisoners after judicial execution may
investigation be turned over to institutions of learning or
b) When specifically authorized by local scientific research
health authorities
c) Implied when the body is embalmed Exhumation and Disinterment
d) If with communicable disease, must be Exhumation
buried within 12 hours unless authorized • The deceased buried may be disinterred upon
by local health authorities the lawful order of proper authorities coming
• Specifically, in COVID-19 death, Wakes or any from the provincial or city fiscals, from the
form of public assemblies shall not be allowed. court, and from authorities to investigate (PNP
The procedures for burial and cremation shall and NBI)
be done within 12 hours after death however,
burial of remains should be in accordance with Conditions for exhumation or disinterment
the person’s religion and culturally-acceptable 1. After 3 years from burial: Granted to those who
norms, to the most possible extent (e.g. in died of non-communicable disease
Islamic rites, cremation is forbidden or “haram”) 2. After 5 years from burial: Granted to those who
DOH Department Memorandum No. 2020-0158 died of communicable disease
3. Special permit: Granted at any time upon order
• Death Certificate is necessary before burial as a from authorities for as long as the patient didn’t
Code of Sanitation requirement die of infectious diseases
a) Attending physician, municipal health
officer or if there is no physician in Consent for Exhumation
attendance, the municipal mayor, No human remains shall be retained, interred, disposed
municipal secretary or any councilor off or exhumed without consent of the following
may sign the Death Certificate. persons in order:
b) The signed Death Certificate shall be a) Spouse
forwarded to the municipal secretary b) Descendants of the nearest degree: Children of
within 48 hours after death the deceased
c) Permission granting clearance from the c) Ascendants of the nearest degree: Parents
fiscal or from the mayor is necessary if d) Siblings
death is due to violence or crime.
• Depth of the grave must be at least 1.5 meter Medico-Legal Aspects of Physical Injuries and Wound
Investigation
Burial or Inhumation Technical Critical Values Physical Injury
(Revised Administrative Code, Sec. 1092; PD 856, • Effect of harmful stimulus on the body either
Chapter 21, Sec. 3) appearing immediate or delayed
Physical Injury due to Physical Violence
 Distance to any dwelling house: 25 meters • Production of wound is the effect of the
 Drilling of a well or any source of potable application of physical violence
water supply: 50 meters • Wound is the natural result of continuing
 Minimum area for chapel/structure/building harmful stimulus; a disruption in the continuity
for public assembly: 50 sq. meters (5m x 10m) of any tissue of the living body
 Main road minimum width: 4 meters • Defense Wound is the result of the victim’s
 Cross road minimum width: 1 meter instinctive reaction for self protection
• If found on the victim, it may imply that
Cremation the injury or death is homicidal with
• The pulverization of the body into ashes by the someone intending harm or death and
application of heat
the victim had the chance to defend 2. Contre-coup: injuries sustained opposite to
him/herself. where the force is applied
3. Coup Contre-coup: injuries sustained from both
Vital Reaction to Physical Injury where the force is applied and opposite to the
Rubor site of application of force
Redness due to congestion of blood as a result of 4. Locus minoris resistencia: injuries located not
vasodilation on the site of application nor opposite to where
Calor the force is applied but to a body part offering
Warmth; increased heat sensation due to localized the least resistance to the force.
reaction to injury causing vasodilation and increased 5. Extensive: injuries to the great area of the body
blood flow as a result of generalized, massive application of
Dolor force.
Increased sensation of pain due to involvement of
sensory nerve stimulation Special Types
Tumor 1. Defense wound: sustained wound as a result of
Swelling due to localized reaction to injury causing a person’s instinctive reaction for self-
vasodilation, transudation and inflammatory response protection.
Functio laesa 2. Pattered wound: sustained wound forming a
Due to trauma that comes with physical injury, tissues pattern or shape on the skin as a result of the
may not be able to function normally. imprinting object or instrument causing it
3. Self-inflicted wound: Produced by one’s self in
Classification of Wounds hesitation to commit suicide.
Based on severity
1. Mortal wounds: caused by application of force Legal Classification of Physical Injuries
capable of causing immediate death after Mutilation
infliction Act of looping or cutting off any part or parts of the
2. Non-mortal wounds: caused by application of living body
force not capable of causing immediate death Mutilation punishable under Article 262 of the Revised
after infliction Penal Code
1. Intentionally depriving a person totally or
Based on kind of instrument used partially some of the organs for reproduction
1. Blunt instrument: causes contusion, 2. Intentionally depriving a person of any part of
hematoma, lacerated wound the body other than the organs for
2. Sharp-edged instrument: causes incised wound reproduction
3. Sharp-pointed instrument: causes puncture 3. Mayhem: unlawful and violent deprival of the
wound use of a body part of the body so as to render
4. Sharp-edged with sharp-pointed instrument: him less able in fighting
causes stab wound
5. Tearing force or shearing force: causes Serious Physical Injuries
lacerated wound Committed by anyone who shall wound, beat or assault
6. Change in atmospheric pressure: causes another and the offended party is incapacitated for
barotrauma labor for more than 30 days.
7. Extremes in temperature: causes frostbite, Acts that may constitute serious physical injuries
burns and scalding 1. Wounding
8. Chemical explosion: causes coagulation, 2. Beating
liquefaction from chemical burns 3. Assaulting
4. Administering injuries without the intent to kill
Based on depth of wound from the skin surface
1. Superficial: wounds limited only on the skin and Penalties for Serious Physical Injuries
its layers Prision Mayor (six years and one day to twelve years
2. Deep: wounds that goes beyond the layers of imprisonment)
the skin 1. If physical injury sustained caused imbecility
a) Penetrating: Wounding agent enters (injury during pre-adolescent age and injury
the body without exiting on another arrested mental development)
portion of the body other than the 2. If the physical injury sustained caused
entry wound OR remained pierced on a impotency (injury caused inability to grant to
solid organ or tissue the partner sexual gratification).
b) Perforating: Wounding agent enters the 3. If the physical injury sustained caused blindness
body and exits on another portion of to both eyes
the body producing communication
space between inner and outer portions Prision Correctional medium and maximum (2 years, 4
of organs months and 1 day to 6 years imprisonment)
Based on site of the application of force 1. Loss of the use of speech or the power to hear
1. Coup: localization of injury to where the force is or smell, loss of an eye, a hand, a foot, an arm
applied or a leg

2. Becomes incapacitated for work in which he A break in the bone
was therefore habitually engaged 5. Strain
Overstretching of a muscle or ligament
Prision Correctional minimum and medium (6 months
and 1 day to 4 years and 2 months imprisonment) Types of Fractures
1. Deformity not part of mentioned above a) Simple (Closed) Fracture
2. Becomes ill and incapacitated for the No break in the continuity of the skin with complete
performance of the work in which he was break of the underlying bone
habitually engaged for more than 90 days as a b) Compound (Open) Fracture
consequence of the sustained physical injuries Open wound in the skin with complete break of the
underlying bone
Arresto mayor (1 month and 1 day to 6 months c) Comminuted Fractures
imprisonment) Fragmentation of the bone
1. Becomes ill or incapacitated for labor for more d) Greenstick Fracture
than 30 days but less than 90 days Only one side is broken and the other side is bent
e) Linear Fracture
Less Serious Physical Injuries Forms a crack parallel on the substance of long bones
• Committed by anyone who shall wound, beat or f) Spiral Fracture
assault another and the offended party and is Break forms a spiral direction observed in long bones
incapacitated for labor for more than 10 days
but less than 30 days Internal Hemorrhage
• Penalty for less serious physical injuries is Rupture of the blood vessels in an organ enclosed in a
arresto mayor (1 month and 1 day to 6 months) body cavity causing pooling of blood through the
following mechanisms:
Slight Physical Injuries 1. Traumatic intracranial hemorrhage
• Committed by anyone who shall wound, beat or 2. Rupture of parenchymatous organs
assault another and the offended party and is 3. Laceration of other body parts enclosed in a
incapacitated for labor and would require cavity
medical attendance for nine (9) days or less
• Includes injuries which does not prevent the Cerebral concussion (Commotio Cerebri)
offended party in habitual work or any which • Jarring or stunning of the brain characterized by
that does not require medical attendance more or less complete suspension of its
• Penalty is arresto menor (1 day to 30 days function as a a result of injury to the head
imprisonment) • More severe when the moving or mobile head
struck a fixed, hard object.
Types of Injuries Signs and Symptoms
Closed Wounds (Contusions) 1. Unconsciousness
1. Petechiae (blood rash) 2. Relaxed and flaccid muscles
Circumscribed (less than 2mm) extravasation of blood in 3. Closed, unresponsive eyelids
the subcutaneous tissue or underneath the mucous 4. Slow and shallow respiration
membrane 5. Rapid and weal pulse; barely palpatory
2. Purpura 6. Hypothermic
Circumscribed (more than 2mm but less than 1cm) 7. Relaxed sphincters
extravasation of blood in the subcutaneous tissue or 8. Weak and sluggish reflexes
underneath the mucous membrane 9. Retrograde amnesia
3. Ecchymosis (typical bruise, “pasa”) Types of Injuries

Effusion of blood into the tissues underneath the skin Open Wounds
(more than 1cm) due to spontaneous rupture of blood 1. Abrasion (scratch, graze, “gasgas”)
vessels, platelet disorders or a result of application of Removal of the superficial epithelial layer of the skin
blunt force trauma (not always due to traumatic injury) caused by friction against a rough surface
4. Hematoma (Blood tumor, “bukol”) 2. Incised Wound (“hiwa”)
Extravasation or effusion of blood forming a cavity Cut in the continuity of the tissue from a sharp-edged
underneath the skin; causes the skin to elevate (almost instrument forming clean-cut edges, straight wounds
always due to traumatic injury) and gaping external communication. Wider than deep
3. Stab wound (“saksak”)
Musculoskeletal Injuries Cut in the continuity of the tissue from thrusting a
1. Sprain sharp-edged, sharp-pointed instrument forming clean-
Partial or complete disruption in the continuity of a cut edges of wide, deep character highly dependent on
muscular or ligamentous support of a joint the nature of the penetrating instrument. Deeper than
2. Dislocation wide
Complete displacement of the articular surfaces of 4. Punctured wound (“tusok”)
bones in a joint Small, focused, point-like external injury with deep
3. Subluxation character resulting from a thrust of a sharp pointed
Incomplete or partial dislocation linear instrument.
4. Fracture 5. Lacerated wound (“punit”, “pumutok”)

Irregular, jagged tear in the skin and/or underlying 5. Photography, sketching, or accurate description
tissues due to forcible contact with a blunt instrument. of the crime scene.
Fatal Effects of Wounds B. Examinations of the wounded body

Direct Fatal Effect 1. Examinations that are applicable to the living or
The wound sustained and the subsequent mechanism is dead victim
the direct cause of death 2. Examination of wounds and injuries sustained
• Hemorrhage • Character
• Mechanical injuries to vital organs impairing its • Location
function • Depth
• Shock • Condition of the surroundings
• Extent of the Wound
Indirect Fatal Effect • Direction
The wound causes sequelae and events leading to • Number
morbidity which may subsequently contribute to death
• Secondary hemorrhage following sepsis C. Examinations of the locality
• Bacterial infection 1. Presence or absence and degree of hemorrhage
• Stricture and adhesion formation 2. Evidence of struggle
3. Information on the position and posture of the
Healing of Wounds body
Regeneration 4. Presence of letter or suicide note
Replacement of newly formed tissues mobilized by 5. Condition of the weapon
repair response from tissue damage.
Kinds of Wound Healing Clinical Distinction of Ante-Mortem versus Post-

1. Wound healing by primary intention Mortem Wound
Wound closure performed to approximate the edges of
clean, incised wounds.
2.Wound healing by secondary intention
Wound healing relying on the body’s natural ability to
heal itself. Used if primary intention would prove less
valuable when a wound that cannot be stitched causes
a large amount of tissue loss in cases of body
movements impairing wound approximation, risk of
infection and contamination and, increased wound size.
3.Tertiary wound healing (Healing by delayed
primary closure) Points of Consideration in Determination of Wound as
Occurs when there is a need to delay the wound-closing to Intent (Homicidal, Suicidal or, Accidental)
process due to the risk of anaerobic infection in a closed 1. External signs and circumstances related to the
wound. Process allows the wound to drain or wait for position and altitude of the body when found
the effects of other therapies to take place before 2. Location of the weapon or manner in which it
wound approximation and closing. was held or located
3. The motive underlying the commission of the
crime
4. The possibility that the perpetrator tampered
Medico-Legal Investigation of Wounds on the crime scene and on the evidences
General Procedure 5. Other pertinent information that may give more
1. All injuries must be described enlightenment on the case
2. Description of wounds must be comprehensive,
measured in detail and if possible, a sketch or Other Information of Concern
photograph must be taken
3. Examination must not be influenced by any
other information obtained from others in
making a report or conclusion.
A. General Investigation of the Surroundings

(Crime Scene Investigation)
1. Examination of the place where the crime is
committed
2. Examination of the clothing, stain, cuts, hair and Death or Physical Injuries Caused by Explosions
other foreign body. Explosion is defined as sudden release of potential
3. Investigation of those persons who may be energy producing an injurious force
witnesses to the incident or those who can give
testimonies for the case Classification of Explosion as to the Source of Energy
4. Examination of the wounding instrument 1. Mechanical: Pressure inside a container
exceeds the structural holding strength
2. Electrical: Development of electrical arcs when Firearms of Medico-Legal Interest
2 objects of different electrical potential are 1. Revolver: A firearm with cylindrical magazine
connected to one another situated at the rear of the barrel. Bullet velocity
3. Nuclear: Release of significant amount of is at 600ft/sec.
energy either from atomic fusion or fission 2. Automatic Pistol: A self-loading firearm which
4. Chemical: Occurs when a chemical reaction automatically ejects an empty shell when a
produces heat and gas at a rate faster than cartridge is fired and a new cartridge is slipped
what the environment can dissipate into the breech automatically as a result of
recoil. Bullet velocity is at 1,200ft/sec.
Mechanism of Death may include: 3. Rifle: A self-loading firearm which has a
1. Direct contact with the explosives: proximity is characteristic long muzzle and butt. A typical
directly proportional to the sustained injury and military-grade rifle has a muzzle velocity of
may cause death 2,500ft/sec with a range of 3,000 feet.
2. Peppering injuries: shrapnel and broken pieces 4. Shotgun: A firearm with a variety of projectile
of metal or glass may cause death depending on (or pellets) depending on the type of cartridge
the injured organ applied.
3. High pressure wave causing sonic boom: may
cause laceration in fluid-filled hollowed cavities Parts
4. Burns: Degree of burns depend on the intensity Cartridge or Ammunition (Ammo, “bala”)
and duration of exposure 1. Cartridge case or shell (“basyo ng bala”):
5. Asphyxia: Explosion transiently decreases the Cylindrical structure with a base which houses
atmospheric oxygen available the propelling gunpowder, the primer at its
6. Poisoning: Inhalation of carbon monoxide, base with the bullet as the projectile attached
nitrous oxide, hydrogen sulfide, sulfur dioxide on its tip.
2. Primer (detonating fuse): lining at the base of
Atomic Bomb Explosion the cartridge shell with the function of
Generalized Effects transforming the mechanical energy from the
Causes acute generalized erythema, disorientation hilt of the firing pin on the percussion cap to the
followed by coma and death potential chemical energy stored in the
Lesser dose of radiation may induce chronicity causing gunpowder releasing it through rapid
nausea, vomiting followed by leukemia and/or cancers. combustion
3. Gunpowder or propellant (“pulbura”): The
Localized Effects primary chemical component of an ammunition
1. Retardation of cell division, microstructural storing the potential energy that when
changes in tissues, loss of supporting triggered, will explode causing the bullet to be
parenchymal cells driven forward towards the gun muzzle.
2. Radiation dermatitis with patchy keratitis and 4. Bullet (“bala”, missile, projectile): The metallic
ulceration foci with patched hyper-and object attached to the free end of the
depigmentation. cylindrical tip of the cartridge case propelled by
3. Endothelial necrosis in vessels and thrombosis the expansive force of the propellant explosion.
4. Eye cataracts Main part of the ammunition responsible in the
5. Sterility, abortion and stillbirths production of damages to the target
Factors Responsible for Radiation Injury Firearm

1. Trigger hammer with the firing pin: firing
mechanism of the gun
2. Barrel: chamber that builds the momentum of
the bullet
3. Handle or the grip: handling and for magazine
placement
4. Firing Chamber: Place where the cartridge is
held in place before firing
5. Breech Block: Steel block that closes the rear
Definition of a Firearm against the force of the charge
Technical Definition 6. Trigger Guard: Protective loop surrounding the
Instrument used for the propulsion of a projectile by the trigger
expansive force of gases coming from abrupt burning of 7. Front and Rear Sight: Aiming guides of the gun
gunpowder. 8. Safety lock: A clipping mechanism to secure the
gun from firing
Legal Definition 9. Gun sling: Used to tether the gun from the
Deadly weapons such as rifles, muskets, shotguns, shooter
revolvers, pistols, and others utilizing a bullet, ball, shot,
shell or other missile that are discharged by means of
gunpowder and other explosives

Material Movements From the Muzzle After a Gun • Results from the burning of hair and clothing
Fire material from the heated air or flame from the
1. Bullet: moving projectile that causes injury muzzle after gunshot fire.
a) Forward Distance from the muzzle: less than 15cm (less than
b) Spinning 6 inches or ½ foot) depending on the cartridge used
c) Tumbling
d) Wobbling 4. Abrasion Collar: (contusion-abraded collar,
e) Gravitational pull marginal abrasion)
2. Flame: propellant ignition after combustion of • The pressure of the bullet on the skin will cause
the gunpowder it to depress as the bullet lacerates to the skin.
3. Heated, compressed and expanded gas: • The depressed portion will be rubbed with the
forceful heated air as a result of gunpowder rough surface of the bullet creating an abrasion
ignition
4. Smoke or Soot: By-products from the ignition of Perpendicular bullet approach: even width of the collar
the gunpowder on all sides
5. Powder grains: Unburned, burning and partially Acute angle bullet approach: abrasion collar is wider on
burned powder the acute angle approach
Significance of Material Movements From the Gunshot Wound Entrance (Inshoot) Defect
Muzzle
1. Bullet: Entry and exit wound determination,
size and shape of entry, trajectory, source
tracing
2. Flame: gunshot-related burns (tattooing)
3. Heated, compressed and expanded gas:
gunshot-related burns (tattooing)
4. Smoke or Soot: smudging from gunpowder
residue
5. Powder grains: smudging from gunpowder Exit (Outshoot) Gunshot Wound
residue • Larger than entry wound in soft tissue, usually
stellate, jagged and gaping (protruding)
Definition of Terminologies • Does not show characteristic shape unlike
1. Tattooing or peppering: results from the grains wound of entrance
of gunpowder being driven into the skin.
• Tattooing is seen on the skin as small, discrete, Distinction Between Gunshot Inshoot and Outshoot
black specks which cannot be wiped off. Wounds
• The extent of tattooing will depend on the
caliber of the weapon, the type of powder used
and the range. The same may be absent if the
firing has taken place through clothing.
• Distance from the muzzle: less than 100 cm
(less than 36-40 inches) depending on the
cartridge used
2. Blackening or smudging: results from a

superficial deposit of smoke on the skin.
• Carbon particle deposition over the skin and Souvenir Bullet
can be easily wiped off with a wet sponge. The Bullet has been lodged and remained in the body.
intensity of the smudging will depend on the Determination of Souvenir Bullet
caliber of the weapon, the type of powder used “Odd and Even Rule”
and the range. • Add the number of entrance and exit wounds.
• The greater the caliber of the weapon, wider • Even sum means no bullet is lodged as a
the area of blackening and vice versa. Smudging souvenir bullet.
may also be absent on the skin, if firing has • Odd sum means one or more bullet is lodged as
taken place through clothing. a souvenir bullet.
• The presence of blackening, especially if a
smokeless powder is used, may not be clearly Sequelae of Souvenir Bullet
visible to the naked eye. In such cases infrared 1. Encapsulation of a dense, fibrous tissue may
or ultraviolet photography will help to visualize cause no untoward effect
it. 2. Bullet migration causing further damage: Bullet
• Distance from the muzzle: less than 30cm (less that is not lodged when it was previously
than 12 inches or 1 foot) depending on the located
cartridge used. • Fragmentation upon entry or after
hitting a hard bone
3. Burning or singeing of hair and clothes: • Ricochet effect (tumalbog)

• Bullet embolism: blockage of a bullet or 2. Heat Exhaustion
its fragment in a blood vessel • Heart failure caused by heat and
3. Infection precipitated muscular exertion and
warm clothing
Medico-Legal Reporting of Gunshot Wound 3. Heat Stroke (Sunstroke, Thermic Fever)
1. Complete description of inshoot (entry) and • Caused by body overheating, usually as
outshoot (exit) gunshot wound a result of prolonged exposure to or
2. Location of the wounds physical exertion in high temperatures.
a) Parts of the body involved Can occur if body temperature rises to
b) Distance of the wound from the midline 104 F (40 C) or higher.
c) Distance of the wound from the heel or 4. Burns
the buttocks
3. Direction and length of the bullet tract Death or Injury from Heat
4. Organs and tissues involved in its course. Post-mortem Findings
1. Early onset cadaveric rigidity with faster
Determination of Presence of Gunpowder and Primer resolution
Components 2. Early putrefaction
1. Gross examination using hand held lens: (+) 3. Marked lividity
black powder residues of varying particle sizes 4. Petechial hemorrhages seen on the brain and in
at the dorsum of the hands of the shooter or in the heart
the gunshot wound 5. Congestion of internal organs
2. Chemical Tests:
a) Dermal Nitrate Test (Paraffin-Diphenylamine Local Effects of Heat
Test, Gonzales Test) Burns can be either:
Detects the presence of nitrates on GSW and hands. A. Scalding (caused by hot liquids or moist heat)
Applying melted paraffin allows opening the pores and • Geographic lesion by virtue of gravity
extraction of gunpowder residues. Blue specks upon • NO singeing (burning) of hair nor
addition of DPA reagent is the positive result carbonaceous material on skin
b) Walker’s Test on Clothes • First to third degree burns except for
Detection of nitrates in the partially burnt and unburnt molten metal burns
propellants. • Redness of skin and blister formation
20% Acetic acid pretreatment of clothes is then added B. Thermal burns (dry heat burns)
on paper with 5% 2-napthylamine- 4 ,8-disulphonic acid. • Gravity does not play a factor in pattern
Dark red or orange brown specks as positive result. formation
• Singeing of hair and carbonaceous
Thermal Injuries deposit on skin is apparent
• Injuries Thermal death is death specifically • First to fifth degree burns
caused by thermal injuries. • Produced by fire, radiant heat, solid
• caused by deviation from physiologic substances, friction or, electricity.
temperature capable of producing cellular or
thermal changes in the body
Death or Injury from Cold

Frostbite Classification of Burns by Degree (Dupuytren’s
Degrees of Frostbite
First: blanching and paleness of skin due to vascular
spasm
Second: erythema, edema and swelling due to vascular
dilation and capillary permeability
Third: blister formation
Fourth: necrosis, vascular occlusion, thrombosis leading
to “chipping off” or organ affected.
Systemic Injury: decreased respiration, heart rate and Classification of Burns by Severity
metabolic processes leading to cerebral anoxia (American Burn Association Severity Classification)
Cold stiffening, blister and gangrene formation
Death or Injury from Heat

1. Heat Cramps (Miner cramps, Fireman cramps,
Stoker’s cramps)
• Involuntary, spasmodic, painful
contraction of muscles due to
dehydration and excessive loss of
chlorides due to sweating

Burned Body Surface Area (BSA) Estimation:
(Wallace Rule of Nines) Electrical Burns
1. Contact Burn
Due to close contact with an electrically-live object
2. Spark burn
Due to poor contact and resistance of dry skin shows a
prickled appearance with a central white zone and
surrounding hyperemia
3. Flash Burn
Appearance varies from tree-like pattern of lightning
burns to crocodile skin appearance at high voltage
Mechanisms of Death from Electrical Shock

1. Ventricular fibrillation
2. Respiratory failure
3. Mechanical asphyxia
Death by electrocution is most likely accidental rather
Prognosticator and Mortality Predictor in Burn than homicidal
Patients: (Modified Baux Score) =
BSA + Age + II Factor Radiation Burns
*Inhalational Injury Factor (II Factor), if present: 17 1. Burn from X-ray
Depends on the intensity and length of time of
Interpretation: exposure.
The score is a comparative indicator of burn severity, a) Slight exposure produces reddening and
with a Modified Baux Score over 140 considered as inflammation of skin
being unsurvivable, depending on the available b) High intensity long exposure may produce
treatment resources. blisters and atropy of the superficial tissue
Causes of Death in Burns and Scalds 2. Burns from ultraviolet light

A. Immediate Death Severe and persistent dermatitis; intensity and length of
1. Death from shock time of exposure dependent
2. Death from concomitant physical
injuries with burns Death or Physical Injuries Due To Barotrauma
3. Suffocation Atmospheric changes as a result of quick ascending into
B. Delayed the atmosphere, quick descent in bodies of water or
1. Exhaustion abrupt changes from an atmospheric state to another.
2. Dehydration with hemoconcentration Two types:
3. Secondary shock 1. Hyperbarism: Abrupt increase of atmospheric
4. Hypothermia pressure
5. Complications 2. Hypobarism: Abrupt decrease of atmospheric
a) Septicemia pressure
b) Pneumonia
c) Nephritis Hyperbarism Symptoms:
d) Inflammation 1. Feeling of euphoria
6. Changes in the blood due to heat 2. Nitrogen narcosis
Ante-mortem versus Post-mortem Burns 3. Cerebral anoxia
4. Muscle cramping
5. Physical injuries
6. Bends: air emboli during rapid decompression
that may lodge into capillaries
Hypobarism Symptoms:
1. Bends
2. Chokes: respiratory distress and non-productive
coughing
3. Substernal emphysema: accumulation of
Thermal versus Chemical Burns bubbles underneath the skin
4. Trapped gas: doubling in the size of hollowed
viscus
5. Anoxia: progression from hypoxia at 8,000 to
15,000 feet above sea level.
Aircraft Injury and Fatality

Causes:
1. Hypobarism at high altitudes
2. Spatial disorientation and vertigo

3. Toxicity via noxious gases in an aircraft capsule 1. Redness and ecchymosis at the site of ligature
(carbon dioxide, carbon monoxide) 2. Ecchymosis at the pharynx and epiglottis
4. Hypothermia 3. Trauma or rupture in the intima of carotid
5. Fatal crash injury artery
Death by Asphyxia Hanging versus Strangulation with Ligature

Asphyxia is violent death which results primarily from • Strangulation with ligature is the compression
the interference with the process of respiration or the of the neck by means of tightened force instead
condition in which the supply of oxygen has been of the weight of the body.
reduced below normal levels. • Murder instead of suicidal in nature
Types
1. Anoxic Death
2. Anemic anoxic death
3. Stagnant Anoxic Death
4. Histotoxic Anoxic Death
Manual Strangulation or Throttling (Sinakal)
Anoxic Death Constricting force applied in the neck is by the hand
Failure of the arterial blood to be come normally • Homicidal, typical of infanticide
saturated with oxygen
a) Breathing in an atmosphere without or with Smothering
insufficient oxygen Caused by the closing or blockade of external
b) Obstruction in the air passage respiratory orifices either by the use of hand or by some
c) Paralysis of the respiratory centers other means
d) Mechanical interference with the passage of air Necessitates complete blockade of BOTH nasal and oral
e) Shunting of blood from the right side of the orifices
heart to the left side of the heart. • Commonly homicidal
• Not possible in suicide
Anemic Anoxic Death • May occur accidentally in victims who are under
Due to decreased capacity of blood to carry oxygen the influence of alcohol, epilepsy or helpless
a) Severe hemorrhage state
b) Poisoning (like carbon monoxide poisoning)
c) Low blood hemoglobin level Types of Smothering
d) Severe iron deficiency related to severe 1. Overlaying: Pressure from bedding or pillows
malnutrition (most common)
2. Accidental: Epileptic patients may be buried in
Stagnant Anoxic Death pillows and bedding during an attack
Failure of circulation causing tissue and organ anoxia 3. Gagging: Covering of nasal and oral orifices by
a) Shock hand (homicidal)
b) Cardiac arrest 4. Plastic bag suffocation (can be homicidal,
c) Circulatory failure suicidal, accidental)
d) Fatal hypotension
Choking
Histotoxic Anoxic Death Impaction of foreign body in the respiratory passages
Failure of cellular oxidative process • Most of suffocation by choking are accidental
a) Cyanide poisoning • Most common occurrence in geriatric, stroke
b) Severe alcoholism patients and newborn (population with
c) Sodium azide poisoning impaired swallowing reflex) but may occur in all
d) Hydrogen sulphide poisoning ages
e) Hydrozoic acid poisoning
Asphyxia by Submersion (Drowning)
Asphyxia By Hanging Suffocation induced by the submersion or immersion of
Classifications the mouth and nose in a liquid.
As to the location of ligature or knot • Most commonly accidental but can be
a) Typical: ligature runs from the midline above homicidal or suicidal.
the thyroid cartilage • Fatal in 1-2 minutes; about 2-5 minutes
b) Atypical: imbalanced tied on one side of the required for death in drowning
neck, in front or behind the ear or on the chin Phases of Drowning
As to the amount of constricting force 1. Respiration de surprise: One full, deep
a) Complete: Body is completely suspended inspiration while submerged in water
without support other than the hanging line 2. Phase of resistance: Short apneic phase
b) Partial: Body is partially suspended either 3. Dyspneic phase: Forceful respiratory movement
partially sitting, kneeling, leaning, reclining 4. Second apneic phase
5. Terminal respiration: One full inspiration and
Determination of Ante-mortem Hanging after which, complete cessation of breathing
Presence of the following confirms ante-mortem nature
of hanging:

Gettler Test in Drowning Death or Physical Injuries Due to Automotive Crash
Quantitative determination of chloride content in blood Collision
in the right and left ventricle of the heart. Impact on the passenger after forceful contact causing
Results: exchange in energy or momentum
Cut-off shift in value: 25mg/dL
Saltwater drowning: Chloride difference of 25mg/dL is Types Based on Chronology and Effects In a Crash
greater than left ventricle than in right ventricle 1. First Collision: Impact of the moving vehicle
Freshwater drowning: Chloride difference of 25mg/dL is with another vehicle or fixed object
greater in right ventricle than in left ventricle Force of impact is highly dependent on car mass and
acceleration on collision
Compression Asphyxia 2. Second Collision: Impact of the unrestrained
The free exchange of air in the lungs is prevented by the passengers with the interior of the vehicle
immobility of the chest and abdomen during external Occupants move in the same direction and at the same
pressure or crush velocity towards the point of impact
• Can be homicidal in case an assailant kneeling
or putting weight on the chest of the victim and Types Depending on the Location of Impact Crash
squeezing the victim between the arms and legs 1. Front Impact Crash
• Rarely suicidal • Driver and front passenger seat at the
• The body may be pinned between two big dangerous areas with risk of mortality
objects in a collapsed building or due to any • Skull fractures are often observed from
object falling on the chest or abdomen in an passengers
accident. • If the car is at high velocity before the impact,
the front portion of the car may be shortened
Asphyxia by Breathing Irrespirable Gases and cramped causing severe facial and chest
1. Carbon monoxide injuries
Colorless, insoluble in water and alcohol • Rear sear occupants may strike at the back of
Tests: Kunkel’s Test, Potassium Ferrocyanide, Gas the front seat or may be propelled over at the
chromatograph front seat.
2. Carbon dioxide 2. Side Impact Crash
Colorless, heavy gas often mixed with carbon monoxide • Common impact in street intersections
and hydrogen sulfide • Injuries sustained are more severe than front
Tests: Barium nitrate and Silver nitrate test, Gas impact crashes
chromatograph • Passengers move toward the side of impact
3. Hydrogen sulfide with the passenger near to the side of impact
Colorless, transparent gas, sweetish taste and emitting sustaining the most injuries
a characteristic odor of rotten eggs 3. Rear Impact Crash
Test: Litmus paper with lead acetate turns black • Impact most prone to explosion due to
4. Hydrogen cyanide proximity to the gas tank
Most toxic and rapid acting gas, usually used in suicide • Most common injury sustained is “whiplash” or
Test: Gas chromatography-mass spectrometry acceleration-deceleration injury
• Spasm, sprain and cervical dislocation injuries
War Gases are common
Gaseous agents that have been historically used during 4. Roll Over Crash
wars to inflict casualties • Happens when the center of gravity is shifted
1. Lacrimator or tear gas from either side, front or back of the car.
a) CAP (Chloracetonephenone): powder with • Depending on the side where the car is rolled
fruity sour odor over, the height of fall and the number of times
b) BBC (Bromobenzylcyanide): heavy, oily, heavy the car is rolled over, passengers may or may
brown liquid with penetrating bittersweet not sustain severe injuries
odor
c) KSK (Ethyliodoacetate): A dark brown, oily Vehicle versus Pedestrian Collision
liquid with a smell resembling that of 1. Primary Impact: First injurious contact between
"peardrops." the pedestrian and the motor vehicle
2. Vesicant or blistering gas • Depending on the location of center of
Contact with the skin may cause blebs or blistering gravity of the pedestrian on primary impact,
a) Mustard Gas (bis(2-chloroethyl) sulfide) it may determine if pedestrian will sustain
b) Lewisite: an organoarsenic compound, highly- windshield secondary impact (high center of
irritating to both the skin and lungs gravity) or possibility of run over injuries
3. Lung irritants from the ground (low center of gravity)
Causes dyspnea, chest tightness, coughing, conjunctival • Bumper fracture is the fracture of the leg
irritation, vomiting, coma and death after first impact
a) Chlorine 2. Secondary Impact
b) Phosgene • Subsequent impact of the pedestrian either
c) Chloropicrine on the windshield or on to the ground after
d) Diphosgene primary impact.

• May result in multiple abrasions, contusions Violence and Abuse Against Women and Children
soft tissue injuries and/or fractures (RA 7610, RA 9262)
3. Run Over Injuries Physical Abuse
• Car wheel passing over the body after a • Involves the use of instrument, fist blow or any
primary impact bodily injury to a child or woman causing
• May result in a variety of injuries including physical, emotional and psychological harm.
fractures, lacerations, rupture of internal • May include the act of physical or emotional
organs persuasion that forces or places the child or
• Usually, the victim dies of shock woman in a potentially dangerous situation
instantaneously.
Evidences in Vehicular Crashes Physical Neglect of the Child
• Failure to provide the child with necessities to
life.
• Failure to provide for the child must be willful.
Types of Child Abuser

1. Intermittent Child Abuser
Anyone who periodically batter a child with periods of
proper care between battering
2. One-time Child Abuser
Anyone who manhandle the child but never repeats the
act.
Motorcycle and Bicycle Crash 3. Constant Child Abuser
1. Velocity of the motorcycle or the bicycle affects Anyone who actually hates a child and callously,
largely on the injuries sustained deliberately beats and maltreats it.
2. Car and truck drivers may have a hard time 4. Ignorant Abuser
seeing motorcycles and bicycles because of Anyone who means well but in attempts of rearing the
blind spots while driving child results in permanent injury or death of their
3. At high speeds and unfavorable road children.
conditions, cyclist may lose control of the
motorcycle or bicycle. Sex Crimes, Impotency, Sterility
4. Protective equipment like helmet and guards Medico-Legal Aspects of Pregnancy, Birth, Abortion
may offer some protection from mortal injuries and Infanticide
but may not totally prevent injuries from being
sustained. Virginity and Defloration
The Constant Struggle: Defining Virginity
Contact Sport Injuries • State of a female who has not experienced
Common Injuries in Boxing, Muay Thai, Taekwondo, sexual intercourse and whose genital organ
MMA, Handheld and Other Fist-Fighting or Foot- have not been altered by carnal connection.
Striking Combat Sports
1. Facial lacerations especially in the eyebrows, Limitation of Various Offered Definition
lips and cheeks • Human sex experience, sexuality and practices
2. Serous effusion on the loose tissue around the continues to evolve over time hence, fixed
eyeballs definitions are often lacking and
3. Trauma on the pinna of the ear misrepresentative.
4. Fracture of the nasal septum • Offered definition is fixated on morality and
5. Retinal detachment non-encompassing
6. Muscle cramps, sprain, dislocation • No consensus, vague definition
7. Soft-tissue injuries of the internal organs • Archaic, non-realistic
8. Intracranial injuries
Hymen: An Unsatisfactory Determinant of Virginity
Common Injuries in Wrestling, Judo, Jujutsu, Jiu-jitsu, • Thin fold of mucus membrane at the external
Sambo and other Grappling and Takedown-Type orifice of the vagina.
Combat Sports • Commonly used as the physical determinant of
1. Injuries to the spine, most commonly to the virginity
cervical spine
2. Knee injury Why Hymen is Unsatisfactory to Be a Virginity
3. Shoulder and rotator cuff injuries Determinant
4. Facial trauma 1. Hymen and its normal anatomic appearance
5. Internal bleeding and abdominal hemorrhage exists in different variations.
due to rupture of internal organs from a violent 2. Absence or presence of hymen does not accept
fall nor exclude sexual virginity
• Presence of hymen does not guarantee
non-carnal connection
• Hymen laceration does not always
corroborate carnal connection (like in

cyclists, gymnasts, equestrians, tennis b) When the offended party is deprived of reason or
players, track and field athletes etc.) otherwise unconscious;
c) By means of fraudulent machination or grave abuse
Variations in Defining Virginity of authority; and
d) When the offended party is under twelve (12) years
of age or is demented, even though none of the
circumstances mentioned above be present.
2. By any person who, under any of the
circumstances mentioned in paragraph 1
hereof, shall commit an act of sexual assault by
inserting his penis into another person’s mouth
or anal orifice, or any instrument or object, into
the genital or anal orifice of another person.
3. Punishment is reclusion perpetua for rape of
Virginity and Defloration females (20 years and 1 day to 40 years
Defloration imprisonment), for rape of males prision mayor
• Laceration or rupture of the hymen as a result (6 years and 1 day to 12 years)
of sexual intercourse.
• All other lacerations of the hymen which are Test for Carnal Knowledge
not proximally caused by sexual act is not 1. Act of a man having sexual bodily connection
defloration. with a woman
2. Presence of carnal knowledge is there if there is
Hymenal Lacerations the slightest penetration in the sexual organ of
A. Superficial: Does not go beyond half of the the female or instrument manipulated by the
width of the hymen tissue man (by clearer definition, of anyone acting as a
B. Deep: Goes beyond half of the width of the man)
hymen but not reaching the base
Instances When Rape is Punishable by Capital
Death Associated to Sexual Intercourse Punishment
Death of the Male Partner (Death or highest equivalent; Reclusion perpetua)
A. Death due to natural causes 1. When by reason or on the occasion of rape, the
During the act of sexual intercourse, the man may die as victim becomes insane
a result of the following natural causes: 2. When the rape is attempted or frustrated and a
1. Cardiac arrest by hypertension and homicide is committed by reason or on the
tachycardia occasion thereof
2. Respiratory failure as a result of
underlying pulmonary pathology Examination of Seminal Fluid and Spermatozoa
(asthma, COPD) triggered by 1. Gross Examination
hyperventilation and hypoxia while on • Examination by means of naked eye or
sexual act with use of hand-held lens.
B. Death due to defensive act of a woman (in • Color, volume, consistency, liquefaction
rape) 2. Chemical Examination
Victim may inflict injuries to the defender as self- • Florence Test (determination of
defense for rape choline): Florence reagent (Potassium
iodide, Iodine and water) is added on
Death of the Female Partner the specimen and viewed
A. Death by accident microscopically. Positive test is dark
1. Accidental strangulation by heat of intercourse brown crystals of Choline periodide
2. Partial or total airway obstruction due to fellatio • Barbiero’s Test (determination of
3. In cunnilingus, the male partner may induce air spermine): Barbiero’s reagent is added
embolism on the specimen and viewed
4. In BDSM practices, sadists inflicting pain as part microscopically. Positive test is needle-
of sexual play may inflict mortal injuries leading shaped rhombic crystals of picrate
to death • Determination of Seminal Acid
5. Hemorrhage and infection Phosphatase by spectrophotometric
B. Death due to murder analysis is the most conclusive
• Deliberately done to conceal the crime of rape 3. Microscopic examination
• Sample is fixed on a slide and viewed
Sex Crimes microscopically after applying stains
Rape (Article 266, Revised Penal Code) usually hematoxylin and eosin (H and E
Requisites (must have both): staining) or methylene blue and eosin.
1. Committed by a man who shall have carnal 4. Biological Test
knowledge of a woman under any of the • Precipitin Test (Biological Test of
following circumstances: Farnum) utilizes immune serum
a) Through force, threat, or intimidation; sensitized from rabbits to determine if
the sample is sperm of human origin

Sex Crimes b) Depriving her of her reasons or
Seduction (Article 337 ad 338, Revised Penal Code) otherwise is unconscious
1. Qualified Seduction (prision correctional in c) When a woman is under 12
minimum and medium periods: 6 months to 4 years of age
years and 2 months imprisonment) c) The offended party must be a person of
Requisites (must have both): either sex.
a) Seduction of a virgin over 12 and under 2. Acts of Lasciviousness With Consent (prision
18 years of age correctional: imprisonment of 6 months and 1
b) Committed by a person in public day to 6 years)
authority, priests, house servants, Elements:
guardian or any person who in any a) The offender commits any from the
capacity shall be entrusted with the lascivious acts
woman seduced b) The offended woman must be over 12
2. Simple Seduction (arresto mayor: 1 month and but under 18 except if the victim is the
1 day to 6 months imprisonment) sister or descendant of the offender
Requisites: c) The offender commits the act by abuse
Seduction of a woman who is single or widow of authority, confidence, relationship or
with good reputation over 12 but under 18 years old deceit
committed by deceit (panloloko) d) The victim must be a woman, virgin,
• Must have sexual intercourse with a single or widow of good reputation.
woman within the qualifier
• Sexual act is accomplished by deceitful Adultery and Concubinage
means. (Art 333 and 334, RPC respectively)
Definitions
Types of Qualified Seduction Concubinage
1. Ordinary: Committed by any person who in any Any husband who shall keep a mistress in the conjugal
capacity shall be entrusted with the woman dwelling, or shall have sexual intercourse under
seduced scandalous circumstances with a woman not his wife or
(*same elements as stated previously) shall cohabit with her in any place
2. Incestuous: Seduction wherein there is a blood
relationship of the seducer to the seduced Elements of Concubinage
In incestuous qualified seduction the seduced a) Perpetrator is a husband
need not be a virgin or may be more than 18 years of b) The husband kept a mistress who is not his wife
age in his conjugal dwelling
Additional qualifier from qualified seduction: c) The husband had sexual intercourse under
a) Sexual act between the offender and the scandalous circumstances with a mistress
offended party d) The husband and his mistress is cohabiting
b) Ascendant who seduces his ascendant
• Adultery: Prision correcional in its medium and
Acts of Lasciviousness maximum period (2 years, 4 months and 1 day
(Art. 336, RPC) to 6 years imprisonment)
Acts which tends to excite lust, conduct which is • Concubinage: Prision correcional in its minimum
wanton, lewd and voluptuous of lewd emotion. and medium period (6 months and 1 day to 4
years and 2 months imprisonment)
Acts Considered as Lascivious
1. Embracing, kissing and holding a woman’s Prostitution
breast (Art 202, RPC)
2. Placing a man’s private organ over a girl’s Women who for money or profit habitually indulge
genitals (in case of tribadism) in sexual intercourse or lascivious conduct
3. Compelling the woman to take off her clothes • Prision mayor in its medium and maximum term
and dance before the offended (8 years and 1 day to 12 years imprisonment)
4. Insertion of fingers in the private part of the
victim Types of Prostitutes
1. Call girl: Telephone call sex service
Acts of Lasciviousness 2. Hustler: Bar or tavern pick-up girl, street walker
Two types: 3. Door Knocker: Hotel door-knocking to sell sex
1. Ordinary Acts of Lasciviousness (prision service
correctional: imprisonment of 6 months and 1 4. Factory Girl: Sex brothel worker
day to 6 years)
Elements:
a) The offender commits any from the Grave Scandal
lascivious acts (Art 200, RPC)
b) The lascivious act is done under any of Offending against decency or good customs by any
the following circumstances highly scandalous conduct.
a) Using force or intimidation • Arresto mayor full term (1 month and 1 day to 6
months imprisonment)

Requisites 2. Under Sex
a) The offender perform acts or acts
b) Such act or acts is/are highly scandalous and Sexual Anesthesia: absence of sexual desire or arousal
offending against decency and good customs Dyspareunia: Painful sexual act in women
c) It is also necessary that the act or acts be Vaginismus: Painful spasm of the vagina
committed in a public place or within the view Old Age: dryness, increased friction, low stamina
and knowledge of the public. Persistent Genital Arousal Syndrome (PGAD)
Immoral Doctrines, Obscene Publications and Paraphilia

Exhibitions (Sexual Perversion, Sexual Deviation)
(Art 201, RPC) Paraphilia as to Sexual Expression or Way of Sexual
• Doctrines, publications, books, materials and Satisfaction
exhibitions contrary to public morals 1. Oralism: Use of mouth as a way of sexual
• Prision mayor (6 years and one day to 12 years gratification
imprisonment), fines and confiscation of Fellatio: The female receives the penis of the man in
materials to be destroyed her mouth
Cunnilingus: The man licking and sucking the female
Inclusions genitalia
a) Publicly proclaim doctrines openly contrary to Anilingus: a person deriving pleasure by licking the anus
public morals of another person of either sex
b) Authors of obscene literatures published in 2. Sado-masochism: Pain or cruel act as a factor
their knowledge for gratification
c) Those who in theater or plays who shall exhibit 3. Fetishism: The real or fantasized presence of an
indecent or immoral scenes or plays object or bodily part is necessary for sexual
d) Those who shall sell, give away,exhibit prints stimulation and or gratification
who are offensive to the morals
Paraphilia Focused to the Part of the Body
Crimes of Abuse Against Chastity 1. Sodomy: Sexual act through the anus of
1. Adultery (Art. 333) another human being
2. Concubinage (Art. 334) 2. Uranism: Sexual gratification attained by
3. Rape (Art. 335) fingering, fondling with the breast, licking parts
4. White slave trade and Corruption of minors of the body
(Art. 341 and 340, respectively) 3. Frottage: Characterized by compulsive desire of
5. Simple seduction and Qualified seduction (Art. a person to rub sex organ against some parts of
338 and 337, respectively) the body of another
6. Acts of lasciviousness (Art. 336) 4. Partialism: The person has a special affinity to a
certain part of the female body
Paraphilia As To Visual Stimulus
Crimes Against Decency and Good Customs 1. Voyeurism: Characterized by compulsion to
1. Grave scandal (Art. 200) peep to see a person undress or perform
2. Immoral doctrines, obscene publications, personal activities
exhibitions and indecent shows (Art. 201) 2. Mixoscopia (Scoptophilia): Sexual pleasure is
3. Prostitution (Art. 202) attained by watching couples undress or during
sexual activity
Paraphilia (Sexual Perversion, Sexual Deviation)
Abnormal sexual preferences and experience Paraphilia As To Number of Sexual Partners
characterized by intense sexual arousal to atypical 1. Trolism: three persons (threesome)
objects, situations, fantasies, behaviors, or individuals. 2. Pluralism: Group of people participating in
sexual orgies
Paraphilia as to Choice of Sexual Partner
1. Infantosexual (Pedophilia) Others
Sexual desire towards an immature person 1. Coprolalia: Need to use obscene language
2. Bestosexual (Beastiality, Zoophilia) 2. Don Juanism: Promiscuity and seduction of
Sexual desire towards animals many women a part of career
3. Gerontophilia 3. Exhibitionism (Indecent Exposure): Willful
Sexual desire with an elderly exposure to public places of one’s genitals
4. Necrophilia
Sexual desire with a cadaver or corpse Pregnancy
5. Incest Legal Importance
Sexual desire to persons related by blood 1. Ground for suspension of the execution of
death as capital punishment in a woman
Paraphilia as to Extremes of Sexual Urge 2. A conceived child is capable of receiving
1. Over Sex donation
Satyriasis: excessive desire of men to intercourse 3. A conceived child may exercise civil rights
Nymphomania: excessive desire of women to
intercourse

4. Concealment of the woman that she is pregnant a) Therapeutic (medical) abortion: purposely done
at the time of marriage is a ground for in aid to protect the life of the mother
annulment b) Criminal abortion: done without any
therapeutic indication but with criminal intent
Delivery punishable by law.
Legal Importance
1. Legitimacy Post-mortem Abortion
2. Abortion Expulsion of the product of conception brought about
3. Infanticide by intrauterine demise as aided by the uterine muscle;
4. Concealment of Birth either spontaneous or induced by therapeutic means.
5. In a case of slander or libel; in ascertaining
truths Therapeutic Abortion
Allowed by law under specific qualifiers.
Abortion a) The harm sought to be avoided actually exists
Ending of a pregnancy by removal or expulsion of an b) That the injury feared to be greater than that
embryo or fetus. done to avoid it
Types and Differentiating Elements c) That there are not other practical and less
1. Intentional Abortion harmful means of preventing it
Elements:
a) That the woman is pregnant Grounds for Therapeutic Abortion
b) That violence was applied, drug was 1. Cardiovascular conditions such as CHF
administered, or a person acts upon such 2. Renal conditions
pregnant woman 3. Pulmonary conditions such as advanced TB
c) That the effects of such violence, drugs or acts 4. Blood conditions such as severe anemia
of the offender results in the fetus to die and be 5. Gynecologic conditions
expelled 6. Miscellaneous conditions like diabetes
d) That the offender has the intention to abort the 7. Hereditary conditions such as insanity
pregnancy
2. Unintentional Abortion Birth
Elements: Legal Importance on the Study of Birth
a) That the woman is pregnant 1. Determination of personality
b) That violence was applied on such pregnant 2. Proof of live birth must first be shown before
woman without the intention of aborting the the death of the child by the prosecution in case
pregnancy of infanticide.
c) That the effects of such violence of the offender
results in the fetus to die and be expelled Stillbirth versus Live Birth
• Stillbirth is when a child has not breathed or has
3. Abortion Practiced by the Woman Herself Or By not shown any sign of life after being born
Her Parent • Live birth is when the child exhibited clear sign
Elements: of vitality and viability. (however, such
a) That the woman is pregnant definition is not legally necessary)
b) Abortion was intended to be commited In law, a newborn child found dead was born dead.
c) That abortion is induced by
a) The pregnant woman herself Proof of Live Birth
b) Other persons with consent of the 1. Presence of well-developed signs of breathing
pregnant woman 2. Presence of air or food in the stomach
c) The parents of the woman or either of 3. Changes have taken place in the region of the
them for the purpose of concealing her umbilicus
dishonor and with the consent of the
woman herself. Tests for Live Birth versus Stillbirth
4. Abortion Practiced by a Physician or Midwife and 1. Hydrostatic Test (Fodere’s Lung Float Test)
Dispensing Abortives “Lungs that float when submerged in water has been
Elements: aerated” and hence, breathed.
a) The woman must be pregnant 2. Stomach Bowel Test (Breslau’s Second Life
b) The physician induced or assisted in causing Test)
abortion with the use of scientific knowledge Air is swallowed during respiration in a live born child
c) The acts done by the physician and/or midwife and detecting the presence of this air in these viscera
was intended to cause the abortion. constitutes the basis for this test.
Kinds of Abortion Paternity and Filliation

1. Spontaneous Natural Abortion Paternity is the civil status of the father with respect to
Occurs without any form of inducement or intervention the child begotten to him.
2. Induced Abortion Answers the question “Is he the father to the child?”
Abortion that took place because of intervention and Filiation is the civil status of the child in relation to a
inducement supposed mother or father.

Answers the questions “Is he the son?”, “Is she the Illegitimate and Natural Children
daughter?”, “By biological or by legal merits?”, Illegitimate Children
“Legitimate or illegitimate?” Those who are born out of lawful wedlock or after a
competent time after its dissolution.
Proper Legitimate Children
Those who were born in lawful wedlock within 300 days Natural Children
after the dissolution of marriage. 1. Natural Children Proper
Born outside lawful wedlock in which during the
Requisites for the Presumption of Legitimacy time of conception the parents were not
1. There is a valid marriage disqualified for marriage.
2. The birth of the child took place 180 days 2. Natural Children by legal fiction
following the celebration of marriage or within Children born of of void or voidable marriages
300 days following the dissolution 3. Natural Children by presumption
3. There is no physical impossibility of the Acknowledged natural children of two legally
husband having access to the wife during the competent parents during the time of conception
first 120 days of the 300 days preceding the 4. Spurious Children
birth of the child. Illegitimate children who are not considered natural
in sense
Legitimated Children Adulterous
Legitimation is defined as the remedy or process by Sacrilegious
which a child born out of lawful wedlock are by fiction Incestuous
of law considered legitimate by subsequent valid Manceres
marriage of the person.
Paternity and Filiation
Requisites for Legitimation of Natural Child Legal Evidence for Paternity and Filiation
1. Child must be natural born (from conception of 1. Parental likeness and corroborative tracing
parents) 2. Blood Grouping
2. Child must be acknowledged by both parents 3. Non-Medical Evidences such as Birth Certificate
before marriage as documentary evidence
3. There must be subsequent marriage of the
parents Non-Conventional Methods of Procreation
1. Artificial Insemination: semen is introduced in
Adopted Children the vagina other than natural copulation
Adoption is defined as the act of proceeding by 2. In-vitro fertilization: “test tube baby”;
which relations of paternity and filiation are fertilization of ovum by a sperm using artificial
recognized as legally existing between persons not medium
so related by nature. 3. Artificial Inovulation: removal of unfertilized
egg and transferred in another woman
Persons who may be adopted 4. Embryo Transplantation: removal of zygote
1. The natural child by the natural mother or from the womb and being transferred to
father another
2. Other illegitimate children by the father or 5. Parthenogenesis: stimulation of the unfertilized
mother ovum to convert from haploid to diploid cell
3. A step-child, by the step-mother or step-father 6. Cloning: multiplication of genetically-identical
4. Any person, even if of age provided the adopter cell from progenitor cell
is sixteen years older
Legal Aspects of Marriage
Persons who cannot be adopted Requisites of a “Valid Marriage”
1. A married person, without the written consent 1. Legal capacity of contracting parties
of the other spouse 2. Freely given consent of both parties
2. An alien with whose government the 3. Authority of person performing the marriage as
Philippines has broken diplomatic relations cited by the law
3. A person who has already been adopted. 4. Marriage license as proof of marriage
Persons who cannot adopt Age

1. Those who have legitimate, legitimated, Male: If above 20 but under 25, obliged to seek for
acknowledged natural children parental consent
2. The guardian with respect to the ward before Female: If above 18 but under 23, obliged to seek for
final approval of his accounts parental consent
3. A married person without consent of the other
spouse. Annulment is a legal procedure that declares a marriage
4. Non-resident aliens as null from its inception.
5. Resident aliens with whose government the • A marriage may be annulled for any of the
Philippines has broken diplomatic relations. following causes existing at the time of
6. Any person who has been convicted to a crime marriage

1. That either of the party were under the age of “Delusion Rule”
18 and no parental consent is given A person is not responsible for his acts if he is suffering
2. That either party is of unsound mind from delusion although he knows that his actions were
3. That the consent of either party was fraudulent wrong.
4. That either party was, at the time of marriage is
physically incapable of entering into the Disturbance of Mentality
married state Mental Deficiency
Below-normal intellectual functioning which originates
Legal Separation is a court-ordered arrangement from the arrest or incomplete development of the
whereby a married couple lives apart leading separate mind.
lives but are not “single” being a focal difference from
divorce. Classification of Mental Deficiency
Conditions to be legally separated:
1. Adultery of the wife
2. Concubinage of the husband
3. Homicidal attempt of one’s spouse against the
other
Impotence and Sterility

Impotency is the physical incapacity of either sex to
allow or grant the spouse’s legitimate sexual
gratification.
Sterility on the other hand is the loss of power of Rules in Determining Criminal Liability in Insanity
procreation and is absolutely independent of whether Defense
or not impotence is present. “Wild Beast Rule”
A person is exempted of criminal liability if he is totally
Legal Aspects of Impotence deprived of his understanding and memory and knows
1. May overthrow the presumption of legitimacy no more than an infant, a brute, or a wild beast of what
in parentage claims he is doing.
2. May be a ground for annulment of marriage
3. May be a defense for rape
4. May be a cause to develop abnormal sexual “Delusion Rule”
behaviors (cause of paraphilia; unsuitable A person is not responsible for his acts if he is suffering
defense to any crime) from delusion although he knows that his actions were
5. May be a cause to develop suicidal tendencies wrong.
Disturbance of Mentality Malingering

Insanity Feigning or stimulation of a disease or injury
Sociological Ground characterized by ostentation, exaggeration and
“Persistent inability through mental causes to adapt inconsistencies.
oneself to the ordinary environment.”
Medical Ground Usual Reasons for Malingering
“Prolonged departure of the individual from his natural 1. To avoid military or naval training exercises as
mental state arising from bodily diseases.” required
Legal Ground 2. To avoid court summons
“The relation of a person from a particular act which is 3. As a defense to criminal prosecution
the subject of any judicial investigation.” 4. To increase civil liability
5. To gather sympathy
Legal Importance of Determining Insanity 6. To evade legal obligations (like taxation)
Grounds in Civil Code
a) Restriction in the capacity of the person to act Other Conditions in Relation with Mental Disturbance
b) In determining ground for annulment Somnambulism
c) Testator must be of sound mind at the time of An abnormal condition whereby a person is performing
execution of will an act while in a state of natural sleep (sleep walking,
d) Witness to a will must be of sound mind sleep eating)
e) An insane cannot give consent to a contract Semisomnolence or Somnolencia
f) The insane himself will be liable for damages if A state when someone is half asleep or in a condition
there is no parent or guardian between sleeping and waking.
Hypnotism
Rules in Determining Criminal Liability in Insanity A person is made unconscious by the suggestive
Defense influence of the hypnotist
“Wild Beast Rule” Delirium
A person is exempted of criminal liability if he is totally State of confusion of the mind characterized by
deprived of his understanding and memory and knows incoherent speech hallucination, illusions, delusions
no more than an infant, a brute, or a wild beast of what restlessness and apparently purposeless motions.
he is doing.

Drug Dependence Opium Use and Administration
Drug Symptoms
Any substance used in composition or as preparation of 1. Excitement
medicine or any substance used as medicine. 2. Stupor
3. Narcosis
Dangerous Drugs Signs
Drug whose use is attended by risks and are therefor 1. Main Liner: Multiple pigmented punctured
unsafe, perilous, hazardous to people or to the society. marks along the course of the superficial veins
2. Skin popper: Scars of previous subcutaneous
Drug Dependence abscess also alomg the course of superficial
State of psychic or physical dependence or both on veins.
dangerous drug arising in a person following
administration or use of drug in a periodic or Sedatives
continuous basis. Barbiturates
Drug Addiction
A state of periodic or chronic intoxication produced by
repeated consumption of a drug whether synthetic or
natural.
Features of Drug Addiction

1. Addicts have an overpowering desire or need to
continue taking the drug or to obtain it by any
means Methalqualone
2. Having a tendency to increase the dose A sedative drug in smaller dosage and hypnotic in larger
3. Addicts have psychological or physical dos.
dependence on the effects of the drug Combination of the drug is more toxic compared when
4. Detrimental effects to the society and individual methalqualone alone.
is observed. Mondrax is an example of combination drug with 250
methalqualone and 25mg diphenhydramine.
Prohibited versus Regulated Drugs
Prohibited Drugs Hallucinogens or Psychomimetic Drugs
1. Opium and its active component and
derivatives such as heroine and morphine
2. Coca leaf and its derivatives principally cocaine
3. Alpha and beta eucaine hallucinogenics such as
mescaline, lysergic acid diethylamide (LSD) and
other substances producing similar effects
4. Indian hemp and its derivatives
5. All preparations made from any of the list
Stimulants
6. Other drugs whether natural or synthetic with
Amphetamines
the psychological effects of a narcotic drug
Synthetic drug created to mimic the effects if
epinephrine
Regulated Drugs
Cocaine
1. Sedatives such as secobarbital, phenobarbital,
Alkaloid from the leaf of Coca shrub
pentobarbital, and other drug which contains
Caffeine
salt or derivative of Barbituric acid.
A methylxanthine alkaloid from coffee beans and
2. Any salt isomer or salt of isomer of
chocolate
amphetamine such as Benzedrine, or any drug
The most consumed, abused and a legally available
which produces physiologic action similar to
stimulant drug
amphetamine.
3. Hypnotic drugs such as methaqualone or any
Comprehensive Dangerous Drugs Act 2002
other compound producing similar physiologic
(RA 9165, amending RA 6425)
effects.
Pertinent Penal Provisions:
Drugs Classification
Article II, Section 4: Importation of Dangerous Drugs
Hypnotics
and/or Controlled Precursors and Essential Chemicals
Opiates and its Derivatives
 Importer of Dangerous Drugs, use of diplomatic
Derived from the milky sap of the incised unripe seed
facilities for importation and “financier”: Life
capsules of the poppy plant (Papaver somniferum).
imprisonment to death and a ranging from Five
hundred thousand pesos (P500,000.00) to Ten
million pesos (P10,000,000.00)
 Importer of Controlled Drug Precursor:
Imprisonment ranging from twelve (12) years and
one (1) day to twenty (20) years and a fine ranging

from One hundred thousand pesos (P100,000.00) to  10 grams or more of cocaine or cocaine
Five hundred thousand pesos (P500,000.00). hydrochloride;
 50 grams or more of methamphetamine
Article II, Section 5: Sale, Trading, Administration, hydrochloride or "shabu";
Dispensation, Delivery, Distribution and Transportation  10 grams or more of marijuana resin or marijuana
of Dangerous Drugs and/or Controlled Precursors and resin oil;
Essential Chemicals.  500 grams or more of marijuana; and
 Sell, trade, administer, dispense, deliver, give away  10 grams or more of other dangerous drugs such as,
to another, distribute dispatch in transit or but not limited to,
transport any dangerous drug: Life imprisonment methylenedioxymethamphetamine (MDA) or
to death and a fine ranging from Five hundred "ecstasy", paramethoxyamphetamine (PMA),
thousand pesos (P500,000.00) to Ten million pesos trimethoxyamphetamine (TMA), lysergic acid
(P10,000,000.00) diethylamine (LSD), gamma hydroxyamphetamine
 Sell, trade, administer, dispense, deliver, give away (GHB)
to another, distribute, dispatch in transit or
transport any controlled precursor and essential If with lesser amount:
chemical: Imprisonment ranging from twelve (12)  Life imprisonment and a fine ranging from Four
years and one (1) day to twenty (20) years and a hundred thousand pesos (P400,000.00) to Five
fine ranging from One hundred thousand pesos hundred thousand pesos (P500,000.00): 10 grams
(P100,000.00) to Five hundred thousand pesos to less than 50 grams of methamphetamine
(P500,000.00) hydrochloride or "shabu“
 “Protector/Coddler": Twelve (12) years and one (1)  Imprisonment of twenty (20) years and one (1) day
day to twenty (20) years of imprisonment and a fine to life imprisonment and a fine ranging from Four
ranging from One hundred thousand pesos hundred thousand pesos (P400,000.00) to Five
(P100,000.00) to Five hundred thousand pesos hundred thousand pesos (P500,000.00): 5 grams to
(P500,000.00) less than 10 grams of opium, morphine, heroin,
cocaine or cocaine hydrochloride, marijuana resin
Article II, Section 6: Maintenance of a Drug Den, Dive or or marijuana resin oil, methamphetamine
Resort hydrochloride or "shabu”, MDMA or "ecstasy",
 Drugs are sold: Life imprisonment to death and a PMA, TMA, LSD, GHB
fine ranging from Five hundred thousand pesos  Imprisonment of twelve (12) years and one (1) day
(P500,000.00) to Ten million pesos (P10,000,000.00) to twenty (20) years and a fine ranging from Three
 Controlled drug precursor are sold: Imprisonment hundred thousand pesos (P300,000.00) to Four
ranging from twelve (12) years and one (1) day to hundred thousand pesos (P400,000.00): Less than
twenty (20) years and a fine ranging from One 5 grams of opium, morphine, heroin, cocaine or
hundred thousand pesos (P100,000.00) to Five cocaine hydrochloride, marijuana resin or marijuana
hundred thousand pesos (P500,000.00) resin oil, methamphetamine hydrochloride or
"shabu", or other dangerous drugs such as, but not
Article II, Section 7: Employees and Visitors of a Den, limited to, MDMA or "ecstasy", PMA, TMA, LSD,
Dive or Resort: GHB
 Imprisonment ranging from twelve (12) years and o Less than three hundred (300) grams of
one (1) day to twenty (20) years and a fine ranging marijuana is punishable of to the same
from One hundred thousand pesos (P100,000.00) to degree.
Five hundred thousand pesos (P500,000.00)
Alcoholism
Article II, Section 8: Manufacture of Dangerous Drugs Alcoholic Beverage
and/or Controlled Precursors and Essential Chemicals. Mixture of water, flavorings and ethyl alcohol which
 Manufacturer, Financier: Life imprisonment to imparts a characteristic odor and taste.
death and a fine ranging Five hundred thousand Legal Provisions
pesos (P500,000.00) to Ten million pesos 1. Intoxication is an alternative circumstance to
(P10,000,000.00) criminal liability
 “Protector/Coddler“ of a Drug Manufacturer or 2. Public scandal and other crimes committed by a
Financier: Twelve (12) years and one (1) day to person while drunk is punishable
twenty (20) years of imprisonment and a fine 3. Contracts agreed in a state of drunkenness are
ranging from One hundred thousand pesos voidable
(P100,000.00) to Five hundred thousand pesos 4. Law penalizing manufacturer of such liquor
(P500,000.00) without license is valid
5. The State may prevent some people from
Article II, Section 11: Possession of Dangerous Drugs. drinking highly-spirited beverages or pass
Penalty of life imprisonment to death and a fine ranging regulations and bans regarding liquor
from Five hundred thousand pesos (P500,000.00) to Ten consumption.
million pesos (P10,000,000.00) if in possession of such
quantities of: Factors Affecting the Rate and Absorption of Alcohol
 10 grams or more of opium; 1. Concentration of the total alcohol taken
 10 grams or more of morphine; 2. Nature of food in the stomach or intestine
 10 grams or more of heroin; during consumption
3. Volume of gastric contents 3. Delirium
4. Disease condition of the stomach or intestine • Probable poisoning due to Belladonna,
5. Length of time the gastric content is held in the hyoscyamus, cannabis, alcohol, camphor,
stomach methamphetamine
6. Optimum concentration of alcohol to be rapidly • Rule Out: Pneumonia, brain injury, other
absorbed is 10-20%. infectious disease
4. Paralysis
Blood Alcohol Level and Degree of Intoxication • Probable poisoning due to heavy metals,
aconite, gelsemium, eserine
• Rule Out: Injury to spinal cord or brain
5. Convulsions
• Probable poisoning due to nux vomica, arsenic,
antimony
• Rule Out: tetany, epilepsy, fever
6. Cyanosis
• Probable poisoning due to analine, antefibrin
Causes of Death in Alcoholism • Rule Out: Valvular heart disease, pulmonary
1. Acute Alcohol Intoxication diseases
2. Trauma in vino 7. Enlarged pupil
3. Unexpected aspiration of food • Probable poisoning due to atropine,
4. Poisoning by contaminants of alcoholic hyoscyamus, aconite, alcohol, conium,
beverage (methanol) chloroform
5. Chronic disease associated with alcoholic • Rule Out: Brain disease, cranial nerve
beverage consumption involvement, sympathetic NS paralysis
8. Vomiting
Methods Used in Alcohol Detection • Probable poisoning due to corrosives and GI
1. Chemical Method irritants
2. Enzymatic Method • Rule Out: Gastric ulcer, acute gastritis, GIT
3. Gas Chromatographic Method obstruction
4. Infrared Absorption Spectrophotometry 9. Diarrhea
• Probable poisoning due to Gi irritants, digitalis,
Poisoning cholichium
Poison • Rule Out: Dysentery, cholera, typhoid fever,
Anything other than physical agents which is capable of other GI-related infectious process
death either by chemical action to the tissues of the 10. Gastric colic and cramping
body or by physiological action by absorption and • Probable poisoning due to lead, copper, arsenic,
interfering with living systems. antimony
Legal Aspect • Rule Out: volvulus, obstruction, constipation
• A poison is a substance that is applied or
administered in the intention to kill or do harm Food Poisoning
• Intent is essential in legal implication; not State of ill-health or disease resulting from food which
quality nor quantity of the poison have abnormal or noxious contents.
• Determine intention of handler, food quality
Circumstances Affecting Action of Poison and food source to rule-out homicide.
1. Method of administration
2. Idiosyncrasy: sensitivity to certain foods or Medical Jurisprudence
drugs Medical Jurisprudence
3. Age • Latin: “juris” meaning “of law”; “prudentia”
4. Habit: Tolerance formation due to repetitive, meaning “foresight”
chronic intake of some substances • “Foresight of Medical Law”
5. Dose: The medical sense of poisoning is dosage- • Branch of Law
dependent • Knowledge of the law in the study and practice
of medicine.
Symptom-Based Poisoning Differential Diagnosis and • Rights, duties, obligations of a medical
Ruling-Out Diseases practitioner, among others
1. Coma • Latin: “juris” meaning “of law”; “prudentia”
• Probable poisoning due to opium (and based meaning “foresight”
derivatives) or alcohol • “Foresight of Medical Law”
• Rule Out: Apoplexy, Brain injury, Uremia, • Branch of Law
Diabetes, Epilepsy, Fever • Knowledge of the law in the study and practice
2. Collapse of medicine.
• Probable poisoning due to heavy metals, • Rights, duties, obligations of a medical
aconite, tobacco, antipyrine practitioner, among others
• Rule Out: Diphtheria, Cholera, other infectious
disease

Differentiation Rules and regulations that govern the relationship of
Legal Medicine individuals as a “private matter” not concerning the
Practice of medical science → Legal procedures and society at large.
enforcement
Medical Legislation:
Medical Jurisprudence Sources of Laws in the Philippines
Legal provisions, procedures, and enforcement → (*Refer to the same notes on the Legal Medicine Proper
Practice of Medicine of the same topic)
Medical Ethics Medical Education in the Philippines

Definitions • Only schools, colleges and universities that are
1. Medical ethics duly authorized by CHED shall be allowed to
“Medical etiquette”, moral principles governing the operate medical education programs.
conduct of physicians in relationship with patients, CHED Memorandum Order No. 36 s. 2001, Art. 1,
colleagues, the medical profession, other allied subsection 1
professions and the public. • All curricular programs in education must have
2. Torts proper authorization from the CHED prior
Civil (not criminal) wrongs committed by a person offering of such programs.
against another person or property CHED Memorandum Order No. 36 s. 2001, Art. 1,
3. Deposition subsection 2
Oral investigation done under oath and taken in writing. • CHED is the regulatory agency of medical
4. Bioethics education.
Ethical principles concerning life and life sciences;
applied specifically in medical education, medical
research and therapeutic practices
5. Code of Ethics Board of Medical Education
Provision of means which professional standards of To determine and prescribe:
practice are established, maintained and improved a) Requirement for admission to a recognized
College of Medicine
Medical Law b) Requirements for minimum physical facilities
Concerns the rights and duties of the medical c) Minimum number and qualifications of teaching
profession and the rights of the patients. personnel
Three main areas within medical law: d) Minimum required curriculum
1. Laws on Confidentiality
2. Laws on Negligence, torts in relation to medical Composition of the Board of Medical Education
treatment and procedures (Administrative and (updated as per revisions and amendments)
Civil) a) Chairman: CHED Chairperson
3. Criminal Law in relation to medical practice and b) Members
treatment. a) DOH Secretary
b) Director of APMC
Laws Not Enforced by the State c) Chairperson of the Board of Medicine
(PRC)
d) PMA representative
e) Dean, College of Medicine, University of
the Philippines
f) Representative of the Council of Deans
of Philippine Medical Schools
g) Representative of Philippine Medical
Colleges
Laws Enforced by the State Admission Requirements in a Medical School

As to purpose Philippine Medical Act of 1959 (RA 2382 as amended by
1. Substantive Law RA 5946)
Prescribes the rights and obligations of persons in daily 1. Student must have completed bachelor’s
relation with each other and society. degree in science or arts
2. Procedural Law 2. Student must not been convicted by any court
Mechanical rules that govern the means by which rights of any offense involving moral turpitude
and duties are enforced. 3. Student must take the National Medical
Admission Test (NMAT) and have a score above
As to nature of subject matter the percentile cut-off set by the school
1. Public Law Tablarin v. Gutierrez, GR No. 78164, July 31, 1987
Rules and regulations that govern the relationship 4. A certificate of eligibility for entrance to a
between the state and its subjects (state and people medical school from the Higher Educational
laws) Institutions (HEI); the referral letter from the
2. Private Law undergraduate school or university
CHED Memorandum Order No. 3, s. 2003

5. RA 2382 and its amended does not bar medical 1. Medical student enrolled in a medical school or
schools to add more qualifications to what is graduate under training and supervision of a
provided by the law. registered Physician
Basis of additional exams and panel interviews prior 2. Legally registered dentist
admission 3. Registered masseur or physiotherapist
providing massage or physical therapy upon
Practice of Medicine written order by a licensed Physician provided
Philippine Medical Act of 1959 (RA 2382 as amended by that it is for muscular development
RA 5946) 4. Legally registered Optometrist
• The states obligation and right to regulate the 5. Any person rendering service in cases of
practice of Medicine as a profession is based on medical emergency
the police power of the state. 6. Any person who administers household remedy
• Police power of the state is defined as the as per classification of existing Pharmacy Laws
inherent power of the state to promulgate rules 7. Legally registered Psychologist
and regulations for the interest of welfare, 8. Prosthetists who fits artificial limbs under
health, morale and safety of its constituents in supervision of a licensed physician
its jurisdiction. 9. Anyone taking BP and announcing its result
without giving medical advice and treatment
Licensure and Regulatory Laws 10. Anyone who uses electric vibrator and sun ray
• Licensure is the process of physician lamps
accreditation to practice the profession taking 11. Use of electric machine by barbers to sought
at the national level in accordance with the law. beatification rather than treating a disease or
• Physician Licensure Examination is given by the deformity
Professional Regulation Commission every
March and September of the year in major Prerequisites to Practice Medicine
cities of the country. Philippine Medical Act of 1959 (RA 2382 as amended by
RA 5946)
Nature of the Practice of Medicine 1. At least 21 years of age
• Privilege or franchise granted by the state to 2. With proper education background, as stated
any person to perform the medical acts upon 3. Completed and passed the Physician Licensure
compliance with law. Examination
• Consists of judging the nature character and Requirements for PLE:
symptoms of a disease in determining the 1. At least 19 years old
proper remedy 2. With good moral character
• Practices the means of diagnosis and use of 3. Citizen of the Philippines or
medicines like drugs and procedures for curing, naturalized
mitigating or relieving bodily diseases and 4. Citizen of foreign country that
conditions. practices foreign reciprocity
4. Must be a holder of Certificate of Registration
Acts that Constitute Practice of Medicine
1. Physically examine a person, diagnose, treat, The Regulatory Agency:
operate or prescribe and remedy for human Professional Regulation Commission
disease, injury or deformity for compensation, Function
fee, salary or reward paid directly or indirectly. • General regulation and supervision of all
2. Who shall by means of signs, cards professions constituting the highly-skilled
advertisement either offer or undertake by any manpower of the country
means or method to diagnose • Administering and conducting licensure
3. Who shall use the title (Doctor of Medicine) MD examinations in various regulatory boards.
after his name • Under the Commission are the forty-three (43)
Professional Regulatory Boards which exercise
The legal right to use the title “MD” is vested upon administrative, quasi-legislative, and quasi-
board passers of the Physician Licensure Examination. judicial powers over their respective
professions.
“Graduates may use the title “M.D.” after their names, Full-time Commissioner: appointed by the President
only after they have been issued the license to practice with 9 years term
medicine by the Professional Regulations Commission. Associate Commissioners: appointed by the President
The degree of Doctor of Medicine is the primary with 6 years term or 3 years
educational qualification for the Physicians’ Licensure
Examination (PLE) in the Philippines which is equivalent The Physician-Patient Relationship
to Level and of the Philippine Qualifications Framework Nature of Physician-Patient Relationship
(PQF) and International Standard Classification of • Contractual (meeting of the minds between 2
Education (ISCEd).” person) in nature
CHED Memo No. 18 s 2016 • Consensual (based on mutual consent of both
physician and patient)
Acts that Does Not Constitute Practice of Medicine • Fiduciary (based on mutual trust and
confidence)

Forms of Contractual Relations Between Physician and Termination of Contract
Patient • Maybe terminated by the physician or the
1. Expressed: orally stated and documented in patient
writing • Physician terminating the contract:
2. Implied: unstated, circumstantial in nature, Patient must be given ample notice so that the patient
inferred from the acts of contracting parties may secure the service of another physician
Happens in emergency room settings in treating • Patient terminating the contract
emergency cases of unconscious patients The termination of contract and the nature of
circumstances should be well-documented
NO Physician-Patient Relationship
1. Pre-employment Physical Examination Rights of Physician
2. PE for determination of eligibility for insurance Inherent Rights
3. Physicians appointed by the court to examine 1. To choose patients unless in emergency cases
the accused and evidences for whatever reason where the patient should respond
(as expert witness) 2. Limit the practice
4. Physicians performing autopsy and witnessing a) As to field of specialty
for such cases b) As to setting (clinic or hospital)
5. Casual questions asked in unordinary c) Within a certain locality
circumstances (group chats, gatherings, “Doc, d) Number of days per week and number
may tanong ako…”) of hours
e) By dictates of conscience
3. Determine appropriate management
procedures
Duties and Obligations Imposed on a Physician 4. Avail of hospital services
1. A physician should possess the knowledge and
skill of which an average physician is expected Incidental Rights
within the standard peers. 1. Right of way when responding to call of
“A practicing GP should maintain at least within the emergency
average skill as required of a GP OR be better than a 2. Right of exemption from execution of
specialist BUT a practicing specialist should always be instruments and library
better than the average practicing GP in terms of 3. To hold certain public or private offices
clinical management skill.” 4. Right to compensation
2. A physician should use such skill and knowledge 5. Right to membership in medical societies.
with ordinary care and diligence.
3. A physician should exercise “Best Judgement” Kinds of Medical Fees
4. He has duty to observe utmost good faith Simple Contractual Fee
• Contract stipulates the nature of procedure
Terms NOT INCLUDED In Doctor-Patient Relationship • Specifically states the value of medical service
1. Promise or guarantee of treatment success. either orally or in writing
2. Does not imply any promise that the treatment • Most common form of professional fee in
will benefit the patient. medicine practice
3. Does not imply any promise that treatment will • Ethical in the practice of Medicine
produce certain results.
4. Does not promise that the treatment will not Retainer Fee
harm the patient. • Measured by the space and time and not by the
5. Does not promise that the physician will not quality or quantity of medical services rendered
commit any errors. • Ethical in the practice of Medicine
Patient Obligations In Doctor-Patient Relationship Contingent Fee

1. The patient is to give honest and complete • Fee is depends on the success or failure of the
medical history treatment instituted
2. The patient must cooperate and follow • No fee will be received for efforts until a result
instructions, medical orders and suggestions of is obtained.
the physician. • Unethical in the practice of Medicine
3. Patient must inform physicians in any progress,
development and occurrences during the Dichotomous Fee (Fee Splitting)
course of treatment. • Sharing a fee with another physician, laboratory
4. Patients must state whether they understood or drug company not based on service
the contemplated course of action as set by the performed
physician • Doctors as agents for other services
5. The patient is expected of the same prudence • Unethical in the practice of Medicine
of an ordinary patient under the same
circumstances. Straight Fee or “Pakyaw”
• The amount of medical fee is dependent on the
remaining balance when all expenses are been
paid

• Unethical in the practice of Medicine certain task and medical procedures in a
hospital setting
Factors Influencing the Amount of Medical Fees
1. Nature and character of the services rendered Captain of the Ship Doctrine
2. Labor, time and trouble involved • Physicians are tasked to be at helm and be on
3. Importance and responsibility in a case the top of all responsibility in certain conditions
4. Professional character and standing of the MD • Surgeons are likened to be the “captain of the
5. Results secured ship” that whatever happens in the four corners
6. Financial ability of the patient of the operating room, the surgeon is to be held
7. Purchasing power of the peso (being indirectly responsible.
proportional to fee)
8. Local customs Doctrines Applied in Medical Malpractice Cases
Res Ipsa Loquitur Doctrine
Obligation to Pay Medical Fees • The apparent grave nature of the wrongful act
In Order of Obligation is highly suggestive of malpractice due to
1. The patient negligence
2. The spouse • Surgical Never Events
3. The descendants a) Operating on the wrong patient
4. Ascendants b) Performing surgery on the wrong body
5. Siblings of the patient part
c) Implanting the wrong prosthesis during
Rights of the Patient surgery
1. To give informed consent on diagnostic d) Administering improper doses of
treatment and procedures anesthesia or high-risk medications
2. Right to religious belief e) Failing to properly complete or
3. Right to privacy administer a caesarean section
4. Right to disclosure of information f) Accidentally damaging a patient’s
5. Right to confidentiality internal organs, tissues, and/or nerves
6. Right to choose a physician g) Transfusing incompatible blood or
7. Right to treatment organs.
8. Right to refuse necessary treatment (right to h) Using contaminated surgical
self-determination) instruments
i) Administering medications that are
Other Rights of the Patient known to be fatal allergens
(coinciding on medical treatment) j) Leaving foreign objects inside a patient
1. Right to receive visitors
2. Right for unrestricted access to correspondence Doctrine of Contributory Negligence
3. Right to be free from mechanical restraints • Also known as Doctrine of Common Fault
(unless for justifiable reasons) • The patient may contribute to end harm done
4. Right to be released of care (if the condition by practices of the physician if patient
which justifies hospitalization no longer exist) obligations are not met.
Doctrines Applied in Medical Malpractice Cases Doctrine of Superior Knowledge

Doctrine of Vicarious Liability • The doctor is presumed to have superior
• Doctrine of respondent superior knowledge over his patient on their medical
• Responsibility of a person who is not negligent matters
for the wrongful conduct or negligence of • It is such for this doctrine that contributory
another negligence is not always a viable defense.
• The liability of employee is a liability of the
employer Doctrine of Continuing Negligence
• Medical consultants are NOT employees of the • When a physician fails to investigate a non-
hospital. response of a patient on medical treatment
supposed to alleviate the patient of medical
Doctrine of Ostensible Agent condition.
• Some physicians are both employees and • In a CKD patient on lifelong dialysis who died
independent contractors depending on practice due to Iron Deficiency Anemia secondary to
and how their fees are paid by the hospital in dialysis, the Nephrologist can be sued.
exercise of profession. • In treatment of unresolved hypogastric pain in a
• Pathologist, Radiologists and Anesthesiologists female, an IM resident gave pain medication
and discharged the patient subsequently which
Borrowed Servant Doctrine then followed up only to die with ectopic
• Some physicians being employees of the pregnancy. The IM resident can be sued.
hospital are borrowed and temporary under the
control and supervision of another. Doctrine of Assumption of Risk
• Residents (as hospital employee) when asked by • When informed consent is given by a party
the consultants (as non-employees) to do despite knowing the risks involved as

adequately explained by the physician, the Hospital Admission
consenting party cannot recover damages for Justifiable Grounds to Refuse Admission of Patients
injuries resulting from inherent, ordinary risks 1. All accommodations are filled
informed of them in the procedure and in the 2. The patient is chronically ill and would not
signed waivers. benefit (or may cause more harm) to be
• Relatives cannot recover damages due to admitted
inherent surgical risk in a surgical procedure 3. The patient needs only convalescent care
they provided informed consent. 4. There is no accommodation for the clinical
service required for what the patient is
Last Clear Chance Doctrine suffering (capability limitation of a hospital)
• A physician who recognized and had a last clear 5. The patient’s condition is contagious and a risk
chance to avoid damage or injury to a patient to other patients
but negligently fails to so is liable.
• In doing a preventive maintenance to a LASIK Liabilities of a Hospital
machine, a doctor noticed that the laser lens of 1. Corporate Liabilities
the machine is damaged but still continues with Arising from the failure to furnish accommodation and
the procedure causing total blindness. The facilities necessary to carry out its purpose.
doctor may be liable. 2. Vicarious liabilities
Arising due to the acts of hospital employees in relation
Doctrine of Foreseeability to medical care.
• A physician should recognize events that may
proceed following the inherent condition of the Medical Records
patient. If an injury is sustained due to proven Records
lack of foresight and advice from such incidents, • Compilation of pertinent facts of the patient’s
the physician may be held liable. life his history, illness, course in the ward,
• In-hospital patient fall event causing concussion treatment and disposition as performed in an
in a pediatric, epileptic case. institution by a physician.
• Consummated suicide of an admitted patient • The HOSPITAL is the guardian and owner of
with a working diagnosis of schizophrenia with hospital medical records and the PHYSICIAN are
suicidal features. considered owners of medical information and
records gathered and maintained by them in
Fellow Servant Doctrine their respective clinics.
• If a servant was injured on the account of
negligence from his fellow servant, the Disclosure of Medical Records
employer cannot be held liable. 1. When requested by the patient upon the
• In needlestick injury of a MedTech and approval of the legal guardian of medical
subsequent contraction of HIV following poor records.
needle disposal of the laboratory aide despite 2. When the law requires such disclosure
protocols, policies and facilities in place, the a) Certification of Live Birth
hospital cannot be sued. b) Death Certification
c) Certificate of Immunization
Rescue Doctrine (Good Samaritan Doctrine) d) Information and reporting of
• If a physician went to rescue someone needing communicable diseases, as required
medical attention and in the process, sustained 3. Upon the order of the court via a subpoena
injuries, it should not be the liability of the
physician. Ethics, Medical Ethics and, Bioethics
• If a physician in exercise of being Good Ethics
Samaritan rescued someone who was hit by a Thoughts, judgement and actions on issues that have a
car, cervical fracture sustained is not to be held greater implication of moral “right” and “wrong”.
against the physician and cannot be sued Medical Ethics
Moral principles which should guide members of the
Criminal Law and the Physician medical profession in their dealings with one another,
(*Refer to the same notes on the Legal Medicine Proper with their patients and with the state.
of the same topic) Bioethics
Moral principles in life sciences involving but not to be
Evidences limited to handling life, life science education, research
(*Refer to the same notes on the Legal Medicine Proper using live subjects and application of methods for the
of the same topic) purpose of promoting life and not merely to prevent
death.
Hospital
• An institution maintained for reception, care Ethical Principles of Medical and Bioethics
and treatment of those in need of medical and 1. Autonomy
surgical attention. A patient’s right to self-determination without outside
• Admission: The manner in which patients will control nor forcible influence.
be catered by a hospital for their medical needs 2. Beneficence
by availing in-patient medical services. Duty to actively do good for patients

3. Nonmaleficence
Duty to prevent or avoid doing harm whether
intentional or unintentional
4. Distributive Justice
Duty to treat all patients fairly without regard to age,
socioeconomic status, or other variables.
5. Fidelity*
Duty to be faithful to commitment
6. Veracity
Duty to tell the truth
7. Confidentiality*
Duty to keep the entrusted information and cannot be
revealed without due consideration
Ethical Declarations and Conventions of the World

Medical Association and Convening Commissions
Versions of Physician’s Code of Ethics

1. The Law and Oath of Hippocrates
2. PMA Code of Ethics of the Medical Profession
(2008)
3. PRC Board of Medicine Code of Ethics (1965)
“And the line where the sky meets the sea, it calls me
and no one knows how far it goes.
If the wind in my sail on the sea stays behind me, one
day I'll know how far I'll go.”
-Jeline Athena, daughter of the author singing “How

Far I’ll Go”
Congratulations and claim it, doctors!

Welcome to the profession.


Board Review Legal Medicine Brex

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Examination and Reporting of Physical Injuries

“The attending physician of any hospital, medical clinic,

1 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Medical Jurists as Specialists Ordinance Power of the President

3 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

4 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

5 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Psycho-Physiological Responses Standardized Polygraph Phase 3

6 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

7 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Legal Provisions on the Admissibility of Evidence Judicial Confession (Plea bargain)

8 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

9 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Definition of Terminologies in Fingerprinting

Fingerprint Impressions (Imprint/Print) Dental Identification

Causes for Unreliability of Forensic Odontologic

10 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Forensic Odontology Charts Identification of Skeletal Remains

Other Basis in Forensic Odontology

12 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Chemical Examination of Blood Stain

Microscopic Examination of Blood Stain

Spectroscopic Examination of Blood Stain

13 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Legal Significance of Death Determination Signs of Somatic Death Determination

Molecular or Cellular Death

14 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

15 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Ante-Mortem versus Post-Mortem Clots Order of Putrefaction in Water

Cadaveric Lividity (Post-mortem Suggilation or Livor Modification of Putrefaction

17 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

18 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

19 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

20 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

22 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

3. Ecchymosis (typical bruise, “pasa”) Types of Injuries

23 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Fatal Effects of Wounds B. Examinations of the wounded body

Kinds of Wound Healing Clinical Distinction of Ante-Mortem versus Post-

A. General Investigation of the Surroundings

Factors Responsible for Radiation Injury Firearm

25 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

2. Blackening or smudging: results from a

26 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Death or Injury from Cold

Death or Injury from Heat

27 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Mechanisms of Death from Electrical Shock

Causes of Death in Burns and Scalds 2. Burns from ultraviolet light

Aircraft Injury and Fatality

28 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Death by Asphyxia Hanging versus Strangulation with Ligature

29 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

30 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Types of Child Abuser

31 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

32 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

33 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Immoral Doctrines, Obscene Publications and Paraphilia

34 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics

Kinds of Abortion Paternity and Filliation

35 | Legal Medicine, Medical Jurisprudence, Medical Ethics and Bioethics