Forensic clinical appraisal serves as a crucial link between medical facts and judicial judgments. Its core mission is to precisely define the causal relationship between the injurious act and harmful outcomes from a medical perspective. In judicial practice, the objective reconstruction of factual causation and the normative judgment of legal causation are invariably intertwined. The application of the legal concept of causative potency in the field of forensic appraisal further highlights the deep integration of technical judgment and legal thinking. Factual causality and legal causality differ essentially in the judging subject, criteria, and objectives. In scenarios such as single causality and multiple-cause-single-effect causality, practitioners confront difficulties in distinction, including the conflict between technical boundaries and legal demands, and the cross-border application of causal potency.This paper systematically reviews the theoretical differences between factual causation and legal causation, analyzes their specific manifestations in forensic clinical appraisal, and focuses on the evolutionary trajectory and practical challenges of the distinction pathway. According to the current application status of causative potency assessment, it proposes a balancing strategy between technical rationality and legal thinking in appraisal, providing theoretical support and practical reference for enhancing the scientific robustness and legal applicability of forensic clinical appraisal opinions.
Objective To evaluate the potential of stable isotope analysis for determining the geographic provenance of aged human remains, and to assess its effectiveness as a screening tool in forensic identification when prior information is limited. Methods Enamel samples from twelve aged human remains were analyzed for strontium isotopes (87Sr/86Sr) and stable carbon and oxygen isotopes (u03B413C, u03B418O). Geographic assignment was conducted using the assignR package by integrating isotopic data with global isoscapes to generate probabilistic provenance maps. Results The 87Sr/86Sr ratios of enamel samples ranged from 0.708 647 to 0.717 172, while u03B413C and u03B418O values indicated substantial inter-individual variation in diet and environmental conditions. Isotopic assignment effectively excluded incompatible regions and significantly narrowed the range of possible origins. Among the twelve individuals, eight showed concordance between isotopic predictions and known places of origin, demonstrating the method's relatively high accuracy. Conclusion Multi-isotope analysis provides an effective approach for determining the geographic provenance of aged human remains, particularly in cases where DNA evidence is unavailable or limited. The reliability of isotopic assignments depends on the quality of isoscapes, individual life history, the preservation state of samples, and rigorous laboratory quality control. Future work should focus on improving baseline datasets, standardizing analytical protocols, and integrating multidisciplinary data to enhance the precision and applicability of isotope-based provenance methods.
The reform of China’s forensic appraisal management system is facing the contradiction between an increasingly growing demand for standardized and unified management and the unordered and decentralized management supply. Over the past ten years of the “delegation of powers, improvement of regulation, and optimization of services” reform, the decentralization of forensic appraisal management power has, to a certain extent, solved the drawback of insufficient management supply in the old management system. However, in the reform, problems have emerged, such as the absence of an ability assessment for the main bodies undertaking administrative licensing rights, the lack of a legal basis for the delegation of administrative penalty powers, inconsistent contents of the decentralized management power, and non-unified ways of decentralizing the management power. There is an urgent need for unified management rules for forensic appraisal to make effective regulation. Therefore, when formulating the “Forensic Appraisal Law”, it is necessary to consider four aspects: constructing a pre-entrustment evaluation and demonstration procedure, supplementing the legal basis for delegation, clarifying the content of the decentralized management power, and unifying the ways of decentralizing the management power. This is expected to absorb the practical effects of the local decentralization reform and improve the quality and efficiency of forensic appraisal management.
Medical damage appraisal, one of the crucial links in medical disputes, serves as the scientific basis for resolving such disputes and is also one of the major issues in medical dispute complaints. This paper focuses on the dual structure of medical damage appraisal entities, namely the coexistence of medical associations and judicial appraisal institutions, and delves into its formation background, operational drawbacks, and core issues. The study reveals that the dual structure suffers from problems such as unequal legal status, inefficient resource allocation, intensified doctor-patient confrontation, and frequent conflicts in conclusions, leading to practical predicaments such as the lack of neutrality, absence of uniformity, procedural obstacles, and deficiencies in quality assurance mechanisms. Therefore, taking the medical damage appraisal work in Shanghai as a sample, and combining judicial practice with theoretical research, this paper proposes an optimization path oriented towards neutrality, uniformity, and professionalization. It aims to establish a scientific and reasonable system for medical damage appraisal entities, provide theoretical support and practical solutions for resolving the predicament of “difficult and disorderly appraisal”, and facilitate the efficient resolution of medical disputes and the improvement of doctor-patient relationships.
Due to the diversity and complexity of the objects and content involved in forensic appraisal, appraisers face greater difficulties in understanding the appraisal issues and conducting the assessment. In particular, under the influence of appraisal standards with legal attributes and related legal factors, there is a substantial gap between the reality of forensic appraisal and the ideal goals presupposed by the institutional framework. Forensic appraisal not only requires the use of forensic medical knowledge to communicate objective facts and legal facts, but also needs the results of communication between forensic medicine and law to meet the requirements of legal facts. Furthermore, the facts established through forensic knowledge and judgment must be subject to scrutiny by non-experts under legal standards. Given the differences in the nature of criminal and civil cases, forensic appraisal in ambiguous areas or within ranges of discretion should not only consider the exogenous, endogenous, and intervening factors of existing facts, but also make value choices based on different concepts of rule of law. This realizes the goal of incorporating forensic knowledge cognitive judgment into legal value judgment, thereby giving full play to the functions of forensic medicine in cognitive judgment of objective facts and interpreting specialized issues as evidence, and providing key opinion evidence for the determination of legal facts of cases.
