Kasinathan Nadesan

2. Two Cases of Death Due to Plastic Bag Suffocation

Deaths due to plastic bag suffocation or plastic bag asphyxia are not reported in Malaysia. In the West many suicides by plastic bag asphyxia, particularly in the elderly and those who are chronically and terminally ill, have been reported. Accidental deaths too are not uncommon in the West, both among small children who play with shopping bags and adolescents who are solvent abusers. Another well-known but not so common form of accidental death from plastic bag asphyxia is sexual asphyxia, which is mostly seen among adult males. Homicide by plastic bag asphyxia too is reported in the West and the victims are invariably infants or adults who are frail or terminally ill and who cannot struggle. Two deaths due to plastic bag asphyxia are presented. Both the autopsies were performed at the University Hospital Mortuary, Kuala Lumpur. Both victims were 50-year old married Chinese males. One death was diagnosed as suicide and the other as sexual asphyxia. Sexual asphyxia is generally believed to be a problem associated exclusively with the West. Specific autopsy findings are often absent in deaths due to plastic bag asphyxia and therefore such deaths could be missed when some interested parties have altered the scene and most importantly have removed the plastic bag. A visit to the scene of death is invariably useful.

A fatal nail gun injury--an unusual ricochet?

An 18-year-old construction worker suddenly collapsed while handling a power-actuated nail gun and died shortly after. A neat, almost circular puncture wound was found on the front of his left chest. No fire-arm residues were detected on the surrounding skin. The police stated that it was an accidental injury, at a construction site, where a nail fired from a nail gun by the deceased had deflected off the wall and struck him on the front of the chest. Since the entry wound appeared to be a neat hole, and that too on the front of the left chest overlying the heart area, there was reluctance on the part of the pathologist to accept it as an accidental injury due to a ricochet. A visit to the scene, interrogation of witnesses, examination of the alleged tool and post-mortem X-ray of the deceased were undertaken prior to autopsy. A bent nail was found in the heart. The scene visit and the subsequent autopsy revealed that the nail took a roughly circular flightpath after it had struck the wall, all the while travelling with its pointed end directed forward. Within the body too, the nail maintained the same path. Various medicolegal issues are discussed pertaining to nail-gun injuries. The importance of a visit to the scene, examination of the alleged tool, interrogation of witnesses and the X-ray of the body, all prior to autopsy, are emphasized. The conclusion was: accidental death due to the unusual ricochet of a nail.

Investigation of suspicious deaths and deaths related to violence, a Malaysian perspective

Investigation of suspicious and violent deaths forms an important aspect of the administration of justice. In a routine medico-legal practice the need often arises to investigate various types of deaths. In some deaths the cause and manner of death are obvious and therefore an elaborate investigation may not be necessary. However, for some deaths owing to the nature and because of apparent suspicious circumstances surrounding the death a detailed investigation becomes important. Legal, law enforcement and medical personnel who are involved in the investigation of sudden, unnatural, violent and suspicious deaths, in addition to various knowledge should ideally have some background information regarding the historical evolution of the death investigation system. This paper explores the Malaysian perspective of routine death investigation.

Legal Implications in Routine Clinical Practice

Medico-legal management forms an important part of the total patient care. With the rapid progress of medical science and technology, the law and ethics pertaining to clinical practice have become more complicated in order to meet the various complex issues that have arisen. Medical ethics is a code of behavior accepted voluntarily within the profession, as opposed to statutes and regulations that are imposed by official legislation. Much of medical ethics consists of good manners and civilized behavior in the general sense, but there are certain matters, which are particular to the practice of the profession of medicine. Matters of immediate concern in routine clinical practice are pertaining to consent, confidentiality and negligence.