Legal Medicine o Under the fingernails / Scrapings from the

Abuse, Pregnancy, Abortion, Paternity, Impotence fingernails

March 6, 2019 o Fingertip bruising along the neck
Daniel Dy Lising, MD, LLM o Fingertip bruising along the arm
o Lip Bruising
ABUSE o Back of the patient
o Look for Defensive injuries
• A breast examination is done
EXAMINATION OF ABUSE VICTIM
o Hemispherical
• Should be done in a thorough and systematic manner o Conical
• Victims are encouraged not to: o Infantile / Flat sternal
o Bathe or shower o Pendulous
o Use the restroom • A detailed genito-anal examination is done
o Change clothes o Tools:
o Comb hair § Speculum
o Clean up the crime scene § Swab
o Move anything the offender may have touched § Colposcope
o Examination Position
INITIAL ASSESSMENT § Knee-Chest position (children)
• Get informed consent § Dorsal Decubitus (adults)
o Always tell them that they have the option not to
undergo the examination. They can refuse if they Determination of Virginity
don’t want to be examined because the exam is • Difficult to determine
invasive. Explain to them the consequences of not • A requisite in the criminal cases of:
doing the exam at the moment if they refuse o Qualified Seduction
• Get the Complete Medical History including gynecologic o Consented Abduction
history:
o Menarche – date of first menstruation • Types of virginity:
o LMP – last menstrual period o Moral Virginity
o Previous sexual history – to determine the o Physical Virginity
possibility of contamination of sample § True Physical Virginity
o To find out if it is possible that the patient is § False Physical Virginity
pregnant, or the pregnancy is attributable to the o Demi Virginity
assault o Virgo Intacta
• Collect all items of clothing or sanitary ware for further
examination Hymenal Configurations
o Should be stored in a sealed container for further • Annular (oval or circular) 32%
testing • Crescentic (Semilunar) 36%
o Clothing of assault victim • Redundant (Fimbriated or Denticular) 25%
• Septate 1%
• Improvised Rape Kit should include the following: • Slit like
o Bags and sheets for evidence collection
• Cribriform 0%
o Swabs
• Imperforate 2%
o Comb
§ Include the pubic hair, for DNA Analysis
o Envelopes for hair and fibers
o Blood collection devices
o Documentation forms

PHYSICAL EXAMINATION
• A “top to toe”
physical examination
should be done
• Physical Examination
Findings to be noted:
o Ligature marks

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Hymenal Laceration o The Long-Term Phase
• Superficial laceration – does not § Period of reorganization
go beyond one half of the § May be adaptive or maladaptive
thickness of the hymen § Phobias begin to appear in this phase
• Deep laceration – goes beyond - Acrophobia (fear of open spaces) is the
the half of the thickness but most common
does not go beyond the base § Victims initiate lifestyle changes
• Usually described using the faces § Sexual dysfunction begin to appear:
of the clock - Sexual aversion
• Compound laceration – - Vaginismus
continues all the way to the rectum; usually from - Flashbacks of the event during intercourse
assaults using foreign objects
BATTERED WOMAN SYNDROME
Timeline of Hymenal Laceration
• A series of abuse inflicted upon a victim
• Fresh, bleeding – recent origin • Requires at least 2 cycles of:
• Fresh healing with fibrin formation and edema of the o Battering
surrounding tissues – 4-10 days (aka recently healed o Remorse
laceration) o Reconciliation
• Healed laceration with sharp coaptible borders without • Recognized by Phil Courts as an exempting circumstance
congestion – 2-3 weeks (People v. Genosa)
• Healed laceration with rounded coaptible borders and o The woman experienced many cycles that when
retraction of the edges – more than 3 weeks they are in the reconciliation phase, she felt that
she will next experience battering, that she
Evidence Collection stabbed her husband preemptively
• Photography of all injuries o If a woman can prove that she experiences
o Needed for testification battered woman syndrome, she will not be held
o Can show the injury pattern liable for her actions while defending herself
• Swab all injuries that may have DNA transfers
o Bite marks
POST TRAUMATIC STRESS DISORDER
o Semen stains
o Vaginal/Rectal swabs • Usually manifested by victims of violent sexual assault
§ If the assault happened a while age, can use a and those perpetrated by strangers
speculum in doing a vaginal swab • Manifests as intrusions and avoidance
§ If recently assaulted, do a blind swab o Intrusions – reliving the event
§ 3 swabs needed: Endocervix, Ectocervix, and o Avoidance symptoms include:
the surrounding vaginal wall § Self-imposed isolation
§ Increase drug or alcohol use
§ Intellectualization of the event
CONDITIONS CONSISTENT WITH ABUSE
• Rape Trauma Syndrome
DUTIES OF THE PHYSICIAN
• Battered Woman Syndrome
• Post Traumatic Syndrome • Report all cases of abuse to the PNP or DSWD (R.A.
7610)
• Note for the following:
RAPE TRAUMA SYNDROME
o Skin imprints
• Stress response pattern of... a person who has o Multiple healing injuries
experienced sexual violence” o Repeated fractures
• Manifested in somatic, cognitive, psychological and/or o Trauma
behavioral symptoms o Malnourishment
• Usually consists of two phases:
o The Acute Phase PREGNANCY
§ Period of disorganization
§ Usually last for 2 -3 weeks
PROBLEMS
§ Victim presents with strong emotional reaction
• It is important to assess if the woman is pregnant or not
and may present with physical symptoms
• Pregnancy affects the disposition of the estate in
§ Rooted in fear of physical injury, mutilation or
death succession
§ Attackers are usually known to the victims o A child is considered an heir even inside the womb

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• In determination of certain crimes such as abortion and • Determines personality
infanticide o Conceived children shall be considered born for
• Evidentiary purposes in cases like adultery all purposes favorable to it
o Pregnancy is a prima facie evidence of adultery § For civil cases
especially is if there is a physical impossibility for o Examples
them to bear child. (Example is a woman with a § Succession (Art. 760 NCC) on legitimes
OFW husband) § Donation
§ Infanticide
DETERMINATION OF PREGNANCY
• Biochemical methods – 35 mIU of b-hCG in morning TYPES OF BIRTH
void has a high specificity (Limitation: certain • Stillbirth
conditions also increases hCG) o Immaturity
• Presumptive signs – Cessation of menses, changes in o Congenital Disease
the breast, discoloration of the vaginal mucosa, o General Debilitating Illness
increased skin pigmentation, and development of o Local Disease of the Reproductive System
abdominal striae o Accident in Delivery
• Probable signs – enlargement of the abdomen, o Violence
changes in the size, shape and consistency of the • Live Birth
uterus, anatomical changes in the cervix, and
Braxton-Hicks contractions ABORTION
• Positive signs – identification of the fetal heart tone, • Willful killing of the fetus in utero
perception of fetal movement by the examiner, • Violent expulsion of the fetus from the maternal
sonographic recognition of the fetus womb which results in the death of the fetus

PROBLEMS REGARDING LABOR CLINICAL TYPES OF ABORTION

• Dystocia • Missed abortion
• Repeat CS • Threatened abortion
• Abnormal presentation of the baby • Inevitable abortion
• Fetal Distress • Incomplete abortion
• Other problems like trauma, abruption placenta, • Complete abortion
placenta previa
• Cord Prolapse, and Cord coil INTENTIONAL ABORTION (ART 256 PRC)
• Ways of committing:
BIRTH o Using any violence upon the person of the
pregnant woman
• Medically means the entire delivery of a child from o By acting but without using violence without
the mother the consent of the woman
• Legally: o By acting with the consent of the woman
o The fetus is considered born if it is alive at the o It is imperative that it is known that the woman
time it is completely delivered from the mother’s is pregnant
womb
o Exception: • Elements:
§ If the newborn was born with a gestational o There is a pregnant woman
age of less than 210 days, then the child o Violence, drugs or beverages administered
must survive at least 24 hours to be o That as result the fetus dies
considered as born alive o That the abortion is intended
§ A baby born 209 days must survive for 24
hours for it to be considered born alive. • Difference from infanticide
§ A baby considered born alive, and if it dies o Infanticide – the baby can sustain independent
and you’re being accused of neglect, the life, if not it is considered abortion
case that will be filed against you is • Test to be used:
infanticide, which has a penalty of death or o If the fetus could sustain independent life and
reclusion perpetua the fetus is killed then it is infanticide
§ A baby not considered born alive, then the o Case: People v. Detaplan
case filed against you is impossible crime,
which has a lower punishment
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 UNINTENTIONAL ABORTIONA (ART 257) § Emmenagogues – substances which
• Elements: increase menstrual flow (Ergot Alkaloids)
o It is not known that the woman is pregnant § Ecbolic – stimulate uterine muscle
o There is a pregnant woman contraction (Prostaglandins, Ergot, RU 486
or Mifepristone (95% effective in
o Violence is used upon such pregnant woman
without intending an abortion terminating pregnancy))
§ Purgatives – primarily GI drugs with reflex
o Violence in intentionally exerted
o As a result of the violence, the fetus dies action causing uterine contraction
o Instrumentation
o Can be done thru imprudence and complexed
o Violence
with homicide and parricide
o Local Interference
ABORTION PRACTICED BY THE WOMAN/HER PARENTS
SPECIAL CASES
(ART. 258)
• Done to save face during the old times • Pregnancy reduction in multifetal pregnancies
o Terminate one pregnancy to make the rest
• Elements:
viable
o Pregnant woman has suffered an abortion
o Usually done in those artificially inseminated,
o Abortion is intended
where multiple embryos developed
o Caused by:
o Common complication: hemorrhage, Sepsis,
§ The pregnant woman
Shock, Retained products of conception
§ Any other parent with her consent
§ Any of her parents with her consent
BATTERED CHILD SYNDROME / CHILD ABUSE
ABORTION PRACTICED BY PHYSICIAN OR MIDWIFE AND • RA 7610
DISPENSING OF ABORTIVES • Maltreatment of the child, whether habitual or not,
which includes any of the following:
• Elements (Physician/Midwife):
o Psychological and Physical abuse, neglect, cruelty,
o Pregnant woman has suffered an abortion
sexual abuse, and emotional maltreatment
o Abortion is intended
o Any act by deeds or words which debases,
o Done by a physician or midwife
degrades, or demeans the intrinsic worth and
o Takes advantage of his/her scientific knowledge
dignity of a child as a human being
and skill
o Unreasonable deprivation of the basic needs for
• Elements (Pharmacist):
survival such as food and shelter
o Offender is a pharmacist
o Failure to immediately give medical treatment to
o No proper prescription has been made
an injured child resulting in serious impairment of
o Offender dispenses any abortifacient
his growth and development or permanent
o Charged together with RA 4729 which regulates
incapacity or death
the sale, dispensation and distribution of
§ Can be problematic, because what if the
contraceptive drugs
family does not have the means to seek for
medical help
Is there a way where you commit abortion but will not be
§ Poverty plays a big role
considered criminal? YES
• RA 9262 – Violence Against Women and their Children
For example, a patient is suffering from eclampsia, and in
o Physical violence
order to prevent the mother from dying, you delivered the
o Sexual violence – not only the children, this
baby. The delivery of the baby is considered abortion
includes the women, includes watching of obscene
practiced by a physician
publications and prostituting the child are
considered violation of VAWC
This abortion is known as a justified circumstances, or
o Psychological violence
avoiding greater evil. The mother will die if the baby was
o Mental and Emotional suffering of the victim such
not delivered
as intimidation, harassment, stalking, damage to
property, public ridicule, and humiliation
ILLEGAL ABORTION o Economic abuse
• Illegal abortion is performed in the following
manner: • Usually done by parents who are
o Use of Drugs o Immature
o Self Centered

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 o Impulsive o Malnourishment
o With poor control of aggression
o Teenage parents usually PATERNITY AND FILIATION
• Paternity – civil status of the father with respect to the
• Causes of abuse child begotten by him
o Unwanted Progeny
• Filiation – Civil status of the child in relation to its
o Disputed paternity mother and father
o Illegitimate
§ Out of wedlock
KINDS OF CHILDREN
§ Adultery
§ Rape
o Congenital / acquired deformity LEGITIMATE
o A belief that the child is the source of bad luck to • Born within a valid and subsisting marriage
the family • Those who were conceived before the marriage but
o Abusive Parents the parents got married before the child was born.
o Center of a triangle • Child born within a valid marriage but the marriage is
§ Nakikipag compete yung mother sa attention subsequently annulled
ng father • Separated parents
o A belief that the child is a hindrance to the socio- • Children born of Artificial Insemination
economic advancement of the parents o Is considered legitimate if the following
conditions are met:
• Kinds of abuse § Authorized and ratified in a written instrument
o Intermittent executed and signed by them before the birth
o One time of the child
o Constant § Recorded in the civil registry
o Ignorant § Insemination must be made on the wife
§ Worst kind of abuse
§ Akala ng parents that their actions are still ok, VALID MARRIAGE
but in reality is an act of abuse. Usually parents • At least 18 years old unless you belong to indigenous
are also from abusive families groups or a Muslim
§ Example: a father hit his child with a 2x2 wood • Must have a valid marriage license
as a form of discipline o Valid Birth Certificate
o Valid Certificate of No Marriage
SIGNS OF ABUSE • Undergo a seminar on Family Planning and
• Physical Counseling seminar
o Injury that cannot be explained (Shaken Baby • A marriage ceremony with at least 2 witnesses
syndrome, Fx) conducted by licensed officiating officers
• Sexual o Priests
o Fearful Behaviors o Ministers
o Abdominal Pain, Bed Wetting, UTI or STI, Genital o Mayor
Pain o Judges in their own jurisdiction
o Extreme Sexual Behavior inappropriate for age
• Emotional Surrogacy in the Philippines is not allowed. What will
o Sudden changes in self confidence happen is that the child will be the illegitimate child of the
o Headaches or stomachache with no medical cause surrogate mother, then the biologic parents needs to
o Abnormal fears, increased nightmares adopt the child
o Attempts to run away
ILLEGITIMATE
DUTIES OF THE PHYSICIAN • Those children born outside of the above
enumeration
• Report all cases of abuse to the PNP or DSWD (R.A.
• Rights of illegitimate children:
7610)
o Use the surname of the father by virtue of RA
• Note for the following:
9255
o Skin imprints
o Recognized by the father by acknowledgement in
o Multiple healing injuries
the back of the birth certificate and in an affidavit
o Repeated fractures
o Has a right to 1⁄2 of the share of a legitimate
o Trauma
child in the legitime (inheritance)
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 LEGITIMATED CHILDREN o Beta blockers can cause impotence
• These are children born out of wedlock but the parents • Disorders of the penis, prostate, and testes
were not disqualified to marry • Hormonal Disturbances
• They are legitimated by the subsequent valid marriage • Psychological problems
of their parents
• Brought about by The Family Code CAUSE OF STERILITY

PRESUMPTION OF LEGITIMACY MALES

• A child is always assumed legitimate in the Philippines • Azoospermia
• If a child is born within 300 days after dissolution of the o 2 reasons: talagang walang sperm, or due to
mumps orchitis
marriage if:
o There is a valid marriage • Anatomic obstruction of the male system
o Birth took place after 180 days after celebration o Vasectomy
of the marriage or within 300 days after its • Failure of Spermatogenesis
dissolution
o No physical impossibility of intercourse in the 1st FEMALES
120 days of the 300 days preceding the birth of • Physiologically anovulatory
the child • Lower Genital Tract
• Upper Genital Tract
IMPUGNING LEGITIMACY • Multifactorial Infertility
• Idiopathic Infertility
• Impotence of the husband
• Husband and wife living separately
MOST COMMON CAUSES OF STERILITY IN WOMEN
• Serious illness of the husband
• Tubal Occlusion
• DNA, HLA or other scientific basis
• Endometriosis
• Consent for artificial insemination obtained thru
• Hypothalamic-pituitary disorder
fraud, violence, intimidation or undue influence
• PCOS
• Early Menopause
PRESUMPTION OF ILLEGITIMACY DUE TO ETHNIC REASONS
• Elevated Prolactin levels
(ART 257 NCC)
• Positive anti-sperm antibody
• No longer a valid presumption

PREMATURE MARRIAGE
• Found in Art 351 of the Revised Penal Code
• Punishes a woman who shall marry within 301 days
from the death of her husband
• Arresto Mayor
• Fine of 500 pesos
• Decriminalized already by Pres. Ninoy Aquino
• Purpose: to prevent confusion in connection with
paternity
o Actual Cases
§ US v. Dulay
§ People v. Rosal

IMPOTENCE AND STERILITY

• Impotence – lack of copulative power in the male
• Sexual Arousal Disorder – Female impotence
• Sterility – inability to produce offspring

CAUSES OF IMPOTENCE
• Age *based on the handout given, ppt, and recordings
• Vascular Impairment *NO PROOFREADING was done
• Neurologic Disorders GOOD LUCK GUYS!! #roadtoclerkship
• Drugs

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