Pub Date : 2026-07-01Epub Date: 2026-09-10DOI: 10.1016/j.reml.2026.500519
Jordi León Caballero, Lucia Martínez Pariente
The management of patients with suicidal behavior raises significant legal challenges in healthcare, where respect for patient autonomy must be balanced against the duty to protect life and the risk of professional liability. In the Spanish legal system, suicide is not classified as a criminal offense; however, healthcare professionals may incur liability when a deviation from the lex artis or a relevant omission in the presence of a reasonably foreseeable risk is established. This article analyzes the legal framework applicable to suicidal behavior, focusing on the limits of informed consent, involuntary hospitalization, the use of coercive measures, and medical liability across different jurisdictions. Based on an analysis of current legislation and relevant case law, areas of legal uncertainty are identified that may encourage defensive medical practices, highlighting the need for clearer and more consistent regulatory and interpretative frameworks.
{"title":"Autonomía del paciente y responsabilidad médica ante la conducta suicida: análisis jurídico del ordenamiento español","authors":"Jordi León Caballero, Lucia Martínez Pariente","doi":"10.1016/j.reml.2026.500519","DOIUrl":"10.1016/j.reml.2026.500519","url":null,"abstract":"<div><div>The management of patients with suicidal behavior raises significant legal challenges in healthcare, where respect for patient autonomy must be balanced against the duty to protect life and the risk of professional liability. In the Spanish legal system, suicide is not classified as a criminal offense; however, healthcare professionals may incur liability when a deviation from the <em>lex artis</em> or a relevant omission in the presence of a reasonably foreseeable risk is established. This article analyzes the legal framework applicable to suicidal behavior, focusing on the limits of informed consent, involuntary hospitalization, the use of coercive measures, and medical liability across different jurisdictions. Based on an analysis of current legislation and relevant case law, areas of legal uncertainty are identified that may encourage defensive medical practices, highlighting the need for clearer and more consistent regulatory and interpretative frameworks.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500519"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-09-11DOI: 10.1016/j.reml.2026.500528
Sara González Vives, Rosa M. Molina Ruiz, Irene Serrano García, Antonio Sánchez Fernández, M. Dolores Morón Nozaleda, José Luis Carrasco Perera
Background
Judicially generated demand in mental healthcare remains an underexplored area in Spain despite its clinical and legal relevance. The aim of this study was to analyze the sociodemographic, psychopathological, and judicial profile of patients referred from courts and public prosecutor's offices to a Mental Health Center (MHC) in Madrid.
Methods
An epidemiological, descriptive, and retrospective study included 275 patients attended at a MHC in Madrid between 2019 and 2024 following judicial referral. Twenty-one sociodemographic, psychopathological, and judicial variables were analyzed using descriptive statistics.
Results
The sample was predominantly male (57.8%), with mean age 51.45 years. High labor inactivity was observed (89.5%). The most frequent primary diagnosis was schizophrenia (17.8%), followed by dementia (12.4%) and personality disorders (10.5%). Eighty-two percent of schizophrenia patients had previous psychiatric hospitalizations; 36% had substance use. The most common judicial request was a clinical status report (47.2%). Seventy-three percent did not require judicial support measures for the exercise of legal capacity. All patients with security measures for criminal offenses maintained mandatory outpatient follow-up at the MHC, yet none used psychosocial rehabilitation resources. A decrease in judicial referrals was observed between 2019 and 2022, associated with the COVID-19 pandemic.
Conclusions
The typical judicialized patient was predominantly a man with schizophrenia, marked clinical chronicity, and occupational vulnerability. Schizophrenia was the diagnosis most frequently observed among patients subjected to restrictive judicial measures. The principal finding was the association between judicially imposed security measures and absence of psychosocial rehabilitation resource use, suggesting a gap in specialized community mental healthcare.
{"title":"Perfil sociodemográfico y clínico de pacientes derivados judicialmente a un centro de salud mental: estudio descriptivo de 275 casos en Madrid","authors":"Sara González Vives, Rosa M. Molina Ruiz, Irene Serrano García, Antonio Sánchez Fernández, M. Dolores Morón Nozaleda, José Luis Carrasco Perera","doi":"10.1016/j.reml.2026.500528","DOIUrl":"10.1016/j.reml.2026.500528","url":null,"abstract":"<div><h3>Background</h3><div>Judicially generated demand in mental healthcare remains an underexplored area in Spain despite its clinical and legal relevance. The aim of this study was to analyze the sociodemographic, psychopathological, and judicial profile of patients referred from courts and public prosecutor's offices to a Mental Health Center (MHC) in Madrid.</div></div><div><h3>Methods</h3><div>An epidemiological, descriptive, and retrospective study included 275 patients attended at a MHC in Madrid between 2019 and 2024 following judicial referral. Twenty-one sociodemographic, psychopathological, and judicial variables were analyzed using descriptive statistics.</div></div><div><h3>Results</h3><div>The sample was predominantly male (57.8%), with mean age 51.45 years. High labor inactivity was observed (89.5%). The most frequent primary diagnosis was schizophrenia (17.8%), followed by dementia (12.4%) and personality disorders (10.5%). Eighty-two percent of schizophrenia patients had previous psychiatric hospitalizations; 36% had substance use. The most common judicial request was a clinical status report (47.2%). Seventy-three percent did not require judicial support measures for the exercise of legal capacity. All patients with security measures for criminal offenses maintained mandatory outpatient follow-up at the MHC, yet none used psychosocial rehabilitation resources. A decrease in judicial referrals was observed between 2019 and 2022, associated with the COVID-19 pandemic.</div></div><div><h3>Conclusions</h3><div>The typical judicialized patient was predominantly a man with schizophrenia, marked clinical chronicity, and occupational vulnerability. Schizophrenia was the diagnosis most frequently observed among patients subjected to restrictive judicial measures. The principal finding was the association between judicially imposed security measures and absence of psychosocial rehabilitation resource use, suggesting a gap in specialized community mental healthcare.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500528"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Assessing sex of individuals to create the biological profile is often difficult due to both forensic and bioarchaeological contexts tend to be complex, and incomplete skeletons and/or fragmented human remains are often found. Accordingly, the aim of this research was to analyze the metric differences of the scapula between sexes in the Mexican population, to calculate sectioning points and discriminant functions for sex estimation in those contexts.
Material and methods
Five scapular measurements were recorded on a sample of 124 skeletal remains (45 females and 79 males) from the osteological collection housed at the Department of Anatomy, School of Medicine of the Universidad Nacional Autónoma de México. And a Discriminant Function Analysis to obtain multivariate formulas and sectioning points.
Results
The results showed differences among sexes in all five measurements. The accuracy of sex estimation ranged from 80.6% to 89.5% with sectioning points and 87.9% al 93.5% based on the eleven discriminant functions.
Conclusions
In conclusion, the scapula is a great alternative for biological sex assessment in contexts where is not possible to locate or recover osseous structures like the pelvis; as well as in those in which isolated, fragmented, incomplete and/or commingled human remains are found.
由于法医和生物考古背景往往很复杂，并且经常发现不完整的骨骼和/或破碎的人类遗骸，因此评估个体性别以创建生物概况通常很困难。因此，本研究的目的是分析墨西哥人口中肩胛骨在性别之间的度量差异，计算在这些背景下性别估计的切点和判别函数。材料和方法对124具骨骼遗骸样本（45名女性和79名男性）进行了5次肩胛骨测量，这些骨骼标本来自国立大学Autónoma de m录影带西科医学院解剖学系的骨学收藏。并进行判别函数分析，得到多元公式和剖分点。结果五项测量结果均存在性别差异。基于11个判别函数的性别估计准确率为80.6% ~ 89.5%，基于11个判别函数的性别估计准确率为87.9% ~ 93.5%。结论：在骨盆等骨结构无法定位或恢复的情况下，肩胛骨是生物性别评估的一个很好的选择；以及在发现孤立的、破碎的、不完整的和/或混合的人类遗骸的地方。
{"title":"Estimación del sexo a partir de medidas de la escápula en una muestra mexicana contemporánea","authors":"Antinea Menéndez Garmendia, Enrique Ramírez Martínez, Gabriela Sánchez-Mejorada, Guillermo Torres, Jorge A. Gómez-Valdés","doi":"10.1016/j.reml.2026.500529","DOIUrl":"10.1016/j.reml.2026.500529","url":null,"abstract":"<div><h3>Introduction</h3><div>Assessing sex of individuals to create the biological profile is often difficult due to both forensic and bioarchaeological contexts tend to be complex, and incomplete skeletons and/or fragmented human remains are often found. Accordingly, the aim of this research was to analyze the metric differences of the scapula between sexes in the Mexican population, to calculate sectioning points and discriminant functions for sex estimation in those contexts.</div></div><div><h3>Material and methods</h3><div>Five scapular measurements were recorded on a sample of 124 skeletal remains (45 females and 79 males) from the osteological collection housed at the Department of Anatomy, School of Medicine of the Universidad Nacional Autónoma de México. And a Discriminant Function Analysis to obtain multivariate formulas and sectioning points.</div></div><div><h3>Results</h3><div>The results showed differences among sexes in all five measurements. The accuracy of sex estimation ranged from 80.6% to 89.5% with sectioning points and 87.9% al 93.5% based on the eleven discriminant functions.</div></div><div><h3>Conclusions</h3><div>In conclusion, the scapula is a great alternative for biological sex assessment in contexts where is not possible to locate or recover osseous structures like the pelvis; as well as in those in which isolated, fragmented, incomplete and/or commingled human remains are found.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500529"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suicide is one of the leading causes of preventable mortality and represents a major public health priority.
Objective
To analyse the clinical–forensic profile of suicide and their engagement with mental healthcare.
Materials and methods
A retrospective observational study was conducted on suicide deaths registered in Lleida between 2019 and 2024. A total of 189 autopsy reports and corresponding medical records from the public healthcare system were reviewed. Sociodemographic, temporal and spatial variables, suicide methods, toxicological results, and mental healthcare-related variables and activation of the Suicide Risk Code (CRS) were analysed. Descriptive and bivariate analysis were performed using Fisher's exact test.
Results
Most decedents were male (73.5%), with a mean age of 54.1 years (SD 17.8). The most common method of suicide was hanging (47.1%), followed by jumping from height (22.2%). Most suicides occurred at home (71.9%). Although 67.2% of relatives reported a history of psychiatric disorders, only 36.5% were clinically documented. Only 18% were engaged with mental healthcare, and 10.6% had an activated CRS. Medical risk factors were present in 25.9% of cases. Significant differences were observed by sex in mental health engagement (p = 0.013) and by age in medical comorbidity (p = 0.024).
Conclusions
Clinical-forensic profile is characterised by middle-aged and older males with low engagement with mental healthcare, and a high prevalence of medical illness. These findings highlight deficits in early detection and continuity of care and support the need for integrated preventive strategies involving mental health services, primary care, and community-based resources.
{"title":"Perfil clínico-forense y vinculación con salud mental en muertes por suicidio en Lleida (2019–2024)","authors":"Teresa Guilera, Montse Pedrico Serradell, Jordi Blanch Andreu, Eneko Barberia Marcalain","doi":"10.1016/j.reml.2026.500530","DOIUrl":"10.1016/j.reml.2026.500530","url":null,"abstract":"<div><h3>Introduction</h3><div>Suicide is one of the leading causes of preventable mortality and represents a major public health priority.</div></div><div><h3>Objective</h3><div>To analyse the clinical–forensic profile of suicide and their engagement with mental healthcare.</div></div><div><h3>Materials and methods</h3><div>A retrospective observational study was conducted on suicide deaths registered in Lleida between 2019 and 2024. A total of 189 autopsy reports and corresponding medical records from the public healthcare system were reviewed. Sociodemographic, temporal and spatial variables, suicide methods, toxicological results, and mental healthcare-related variables and activation of the Suicide Risk Code (CRS) were analysed. Descriptive and bivariate analysis were performed using Fisher's exact test.</div></div><div><h3>Results</h3><div>Most decedents were male (73.5%), with a mean age of 54.1 years (SD 17.8). The most common method of suicide was hanging (47.1%), followed by jumping from height (22.2%). Most suicides occurred at home (71.9%). Although 67.2% of relatives reported a history of psychiatric disorders, only 36.5% were clinically documented. Only 18% were engaged with mental healthcare, and 10.6% had an activated CRS. Medical risk factors were present in 25.9% of cases. Significant differences were observed by sex in mental health engagement (<em>p</em> = 0.013) and by age in medical comorbidity (<em>p</em> = 0.024).</div></div><div><h3>Conclusions</h3><div>Clinical-forensic profile is characterised by middle-aged and older males with low engagement with mental healthcare, and a high prevalence of medical illness. These findings highlight deficits in early detection and continuity of care and support the need for integrated preventive strategies involving mental health services, primary care, and community-based resources.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500530"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-09-25DOI: 10.1016/j.reml.2026.500532
Josep Arimany-Manso, Marta Grijalba-Mazo, Amadeo Pujol-Robinat
{"title":"La especialidad de Medicina Legal y Forense: el momento de culminar la transición","authors":"Josep Arimany-Manso, Marta Grijalba-Mazo, Amadeo Pujol-Robinat","doi":"10.1016/j.reml.2026.500532","DOIUrl":"10.1016/j.reml.2026.500532","url":null,"abstract":"","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500532"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-07-01Epub Date: 2026-04-08DOI: 10.1016/j.reml.2026.500516
Augusto Alfonso Rosales Meléndez
Introduction
Honduras reports one of the highest femicide rates. This study analyzed trends in the femicide rate between 2013 and 2022.
Methods
A descriptive study using femicide surveillance data from Honduras (2013–2022) was conducted. The age-standardized rate per 100,000 women was calculated, and trends were analyzed using Joinpoint regression.
Results
A total of 2,677 femicides were recorded. The age-standardized rate decreased from 10.1 per 100,000 women in 2013 to 3.9 in 2022, with an annual percent change (APC) of −7.6% (95% CI: −12.8 −2.6). Femicide associated with organized crime was the most frequent subtype (49.3%) and accounted for 55% of the overall reduction.
Conclusion
The decline in femicide was mainly driven by the reduction in cases related to organized crime, highlighting the need to prevent persistent forms of violence not associated with this context.
{"title":"Tendencias en las tasas de feminicidio en Honduras (2013–2022)","authors":"Augusto Alfonso Rosales Meléndez","doi":"10.1016/j.reml.2026.500516","DOIUrl":"10.1016/j.reml.2026.500516","url":null,"abstract":"<div><h3>Introduction</h3><div>Honduras reports one of the highest femicide rates. This study analyzed trends in the femicide rate between 2013 and 2022.</div></div><div><h3>Methods</h3><div>A descriptive study using femicide surveillance data from Honduras (2013–2022) was conducted. The age-standardized rate per 100,000 women was calculated, and trends were analyzed using Joinpoint regression.</div></div><div><h3>Results</h3><div>A total of 2,677 femicides were recorded. The age-standardized rate decreased from 10.1 per 100,000 women in 2013 to 3.9 in 2022, with an annual percent change (APC) of −7.6% (95% CI: −12.8 −2.6). Femicide associated with organized crime was the most frequent subtype (49.3%) and accounted for 55% of the overall reduction.</div></div><div><h3>Conclusion</h3><div>The decline in femicide was mainly driven by the reduction in cases related to organized crime, highlighting the need to prevent persistent forms of violence not associated with this context.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 3","pages":"Article 500516"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-06-09DOI: 10.1016/j.reml.2026.500526
Aina M. Gassó
{"title":"Violencia sexual digital en la infancia y adolescencia: una perspectiva médico-legal y victimológica","authors":"Aina M. Gassó","doi":"10.1016/j.reml.2026.500526","DOIUrl":"10.1016/j.reml.2026.500526","url":null,"abstract":"","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 2","pages":"Article 500526"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148555908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-05-29DOI: 10.1016/j.reml.2026.500518
Maria Luisa Soria
In recent years, forensic science has significantly strengthened its commitment to communication that is clearer, more precise, and verifiable, both in expert reports and in courtroom testimony. This article provides an integrated overview of the regulatory framework that governs such communication, encompassing the Ley de Enjuiciamiento Criminal (art. 478), UNE 197001:2019 standard for expert reports, ISO/IEC 17025:2017 of the International Organization for Standardization/International Electrotechnical Commission, the International Laboratory Accreditation Cooperation guideline ILAC G19:06/2022, and ISO 21043, forensic standards series, alongside the major international guidelines that shape best practices, including NIST SP 1500-28, OSAC, AAFS, and ENFSI. It also examines empirical evidence on how judges and juries interpret scientific findings and the factors that may enhance or hinder their understanding.
Building on this foundation, the article presents practical criteria applicable to disciplines such as toxicology, including cases involving new psychoactive substances (NPS), and forensic genetics, particularly DNA analysis and the use of the Likelihood Ratio (LR). These criteria aim to distinguish clearly between facts, interpretations, and opinions; to document assumptions, uncertainties, and error rates transparently; and to strengthen the expert's communicative effectiveness without sacrificing scientific rigor. Ultimately, the article seeks to contribute to a more robust, comprehensible, and methodologically transparent forensic practice that aligns with current expectations for quality and reliability, as reflected in the work of the National Research Council, NIST, ILAC, OSAC, and the AAFS Standards Board.
近年来，法医学在专家报告和法庭证词中都大大加强了对更清晰、更精确和可核实的交流的承诺。本文综合概述了管理这种交流的监管框架，其中包括《犯罪法》（第2条）。 478)，UNE 197001:2019专家报告标准，国际标准化组织/国际电工委员会的ISO/IEC 17025:2017，国际实验室认可合作指南ILAC G19:06/2022， ISO 21043，法医标准系列，以及形成最佳实践的主要国际指南，包括NIST SP 1500-28，OSAC， AAFS和ENFSI。它还审查了法官和陪审团如何解释科学发现以及可能加强或阻碍他们理解的因素的经验证据。在此基础上，本文提出了适用于毒理学等学科的实用标准，包括涉及新型精神活性物质（NPS）的案例，以及法医遗传学，特别是DNA分析和似然比（LR）的使用。这些标准旨在明确区分事实、解释和意见；透明地记录假设、不确定性和错误率；并在不牺牲科学严谨性的情况下加强专家的沟通效率。最后，本文试图促进一个更强大的、可理解的、方法上透明的法医实践，与当前对质量和可靠性的期望保持一致，正如国家研究委员会、NIST、ILAC、OSAC和AAFS标准委员会的工作所反映的那样。
{"title":"Comunicación de la prueba pericial: el informe y el testimonio en los procedimientos judiciales","authors":"Maria Luisa Soria","doi":"10.1016/j.reml.2026.500518","DOIUrl":"10.1016/j.reml.2026.500518","url":null,"abstract":"<div><div>In recent years, forensic science has significantly strengthened its commitment to communication that is clearer, more precise, and verifiable, both in expert reports and in courtroom testimony. This article provides an integrated overview of the regulatory framework that governs such communication, encompassing the Ley de Enjuiciamiento Criminal (art. 478), UNE 197001:2019 standard for expert reports, ISO/IEC 17025:2017 of the International Organization for Standardization/International Electrotechnical Commission, the International Laboratory Accreditation Cooperation guideline ILAC G19:06/2022, and ISO 21043, forensic standards series, alongside the major international guidelines that shape best practices, including NIST SP 1500-28, OSAC, AAFS, and ENFSI. It also examines empirical evidence on how judges and juries interpret scientific findings and the factors that may enhance or hinder their understanding.</div><div>Building on this foundation, the article presents practical criteria applicable to disciplines such as toxicology, including cases involving new psychoactive substances (NPS), and forensic genetics, particularly DNA analysis and the use of the Likelihood Ratio (LR). These criteria aim to distinguish clearly between facts, interpretations, and opinions; to document assumptions, uncertainties, and error rates transparently; and to strengthen the expert's communicative effectiveness without sacrificing scientific rigor. Ultimately, the article seeks to contribute to a more robust, comprehensible, and methodologically transparent forensic practice that aligns with current expectations for quality and reliability, as reflected in the work of the National Research Council, NIST, ILAC, OSAC, and the AAFS Standards Board.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 2","pages":"Article 500518"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148557197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-05-29DOI: 10.1016/j.reml.2026.500517
Sandra Puyal González , Marta Navas Tejedor
An 87-year-old woman with a history of chronic delusional disorder who attended the emergency services after a fall with a left subcapital femur fracture and subsequent anemia. The patient rejects the treatment despite the negative consequences that it entails. At the request of the medical team, two capacity assessments were performed to evaluate her competence in two consecutive decisions. Firstly, regarding the refusal of blood transfusion, and secondly, regarding the decision about surgical intervention.
{"title":"Valoración de la capacidad en decisiones clínicas complejas: un caso clínico","authors":"Sandra Puyal González , Marta Navas Tejedor","doi":"10.1016/j.reml.2026.500517","DOIUrl":"10.1016/j.reml.2026.500517","url":null,"abstract":"<div><div>An 87-year-old woman with a history of chronic delusional disorder who attended the emergency services after a fall with a left subcapital femur fracture and subsequent anemia. The patient rejects the treatment despite the negative consequences that it entails. At the request of the medical team, two capacity assessments were performed to evaluate her competence in two consecutive decisions. Firstly, regarding the refusal of blood transfusion, and secondly, regarding the decision about surgical intervention.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 2","pages":"Article 500517"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148380094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-02-05DOI: 10.1016/j.reml.2026.500504
Nahia Aia, Itsaso Bengoetxea, Benito Morentín, Inmaculada Arostegui, Luis F. Callado, Enara Garro
Introduction/objectives
Humanitarian release from prison on health grounds is a measure to preserve human dignity, recommended by international human rights bodies and enshrined in the legislation of many countries. A medical report is required for such a judicial decision. The objective of this study was to analyse the quality, content and variability of medical reports used for early release from prison on health grounds.
Methods
A retrospective observational descriptive study was conducted on 164 medical reports for the early release of persons deprived of liberty obtained in the Basque Autonomous Community (BAC) and Catalonia. Structural aspects, clinical content, compliance with the standards of clinical reports in the health system, and relevant medico-legal aspects were evaluated.
Results
The study revealed that there was a high degree of variability, that the importance of the temporary life prognosis for the granting of this type of measure was significant in Spain, and that the health baseline situation of the subjects studied was advanced. Analysis of the quality of the reports revealed significant technical deficiencies and the frequent absence of basic clinical elements. Barriers to accessing information sources limit research.
Conclusions
The absence of standardised guidelines or protocols at the national and international levels for the drafting of this type of report leads us to propose further advancement in this important area of human rights.
{"title":"Quality indicators for penitentiary medical reports supporting the adoption of alternative measures to imprisonment on health grounds","authors":"Nahia Aia, Itsaso Bengoetxea, Benito Morentín, Inmaculada Arostegui, Luis F. Callado, Enara Garro","doi":"10.1016/j.reml.2026.500504","DOIUrl":"10.1016/j.reml.2026.500504","url":null,"abstract":"<div><h3>Introduction/objectives</h3><div>Humanitarian release from prison on health grounds is a measure to preserve human dignity, recommended by international human rights bodies and enshrined in the legislation of many countries. A medical report is required for such a judicial decision. The objective of this study was to analyse the quality, content and variability of medical reports used for early release from prison on health grounds.</div></div><div><h3>Methods</h3><div>A retrospective observational descriptive study was conducted on 164 medical reports for the early release of persons deprived of liberty obtained in the Basque Autonomous Community (BAC) and Catalonia. Structural aspects, clinical content, compliance with the standards of clinical reports in the health system, and relevant medico-legal aspects were evaluated.</div></div><div><h3>Results</h3><div>The study revealed that there was a high degree of variability, that the importance of the temporary life prognosis for the granting of this type of measure was significant in Spain, and that the health baseline situation of the subjects studied was advanced. Analysis of the quality of the reports revealed significant technical deficiencies and the frequent absence of basic clinical elements. Barriers to accessing information sources limit research.</div></div><div><h3>Conclusions</h3><div>The absence of standardised guidelines or protocols at the national and international levels for the drafting of this type of report leads us to propose further advancement in this important area of human rights.</div></div>","PeriodicalId":35705,"journal":{"name":"Revista Espanola de Medicina Legal","volume":"52 2","pages":"Article 500504"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148557594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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