CURRENT-EVENTS

OPINION: Why we need an independent, science-based medicolegal death investigation system

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Proper medicolegal death investigation requires a science-first, multidisciplinary approach that employs a cadre of vetted, qualified, and impartial experts and focuses on fact-finding surrounding the death event. Illustration by JL JAVIER

Editor’s note: Dr. Matthew Go is a forensic anthropologist currently working at the U.S. Department of Defense agency tasked with identifying and repatriating the remains of all missing military personnel from past armed conflicts. His scholarly focus has been developing both the research and professional practice of forensic anthropology in the Philippines as a means to improve the outcomes of medicolegal death investigations. The opinions expressed in this commentary are his.

Death does not bring peace for many in the Philippines. Recent controversies surrounding the cause and manner of death of flight attendant Christine Dacera are reminiscent of similar procedural and analytical failures in the handling of the Kian Delos Santos slay, Dengvaxia autopsies, and the cremation of inmate Jaybee Sebastian, to cite only a few examples of high-profile cases. The blunders of these cases are pathognomonic, or specifically indicative, of a larger affliction in the Philippine medicolegal death investigation system; namely, blatant conflicts of interest, a lack of clear jurisdictional boundaries, misrepresentation of forensic examiner qualifications, and weak legislative backing.

Medicolegal death investigation (MLDI) is a fact-finding process whereby the who, when, where, and what questions surrounding any violent, suspicious, unexplained, unexpected, unnatural, or unattended death are answered. Who died, when did the death occur, where did it happened, and what were the cause, manner, and circumstances surrounding the death? Accurate answers to these questions are vital to ensuring public health and safety. While any finding may be presented as evidence in civil or criminal proceedings, the purpose of MLDIs is not to determine civil or criminal liability. That is the domain of the courts and judges. MLDI is also separate from criminal investigation — the domain of law enforcement — whose purpose is to determine if a crime has been committed and obtain evidence to identify the persons responsible for the crime.

The Philippines employs a police-led MLDI system, whereby the police initiate, lead, and define the scope of both the criminal investigation and death investigation. In this set-up, the fine line that separates the two can easily be blurred. While it is not uncommon to find both these investigation services under the umbrella of a single state agency, the Philippine situation has often posed a gross conflict of interest in many instances. Most notably relating to the war on drugs, police officers are accused of leading many extrajudicial killings while also wielding the nearly exclusive power to investigate themselves. Witness tampering, planted evidence, and inconsistent forensic reports are just some of the indicators this conflict has laid bare.

Related to conflicts of interest, the jurisdictional boundaries of who is in charge over a case are also unclear. The Philippine National Police (PNP), with its large workforce and wide geographic spread, conducts the majority of “day-to-day” MLDIs in the country, while the National Bureau of Investigation (NBI) under the Department of Justice (DOJ) takes on high-profile cases as it sees fit. However, it is unclear what “high-profile” even means, and how a case is determined to be as such. The boundary has never been clearly drawn except in the context of mass fatality incidents. Likewise, the Public Attorney’s Office, also under the DOJ, has established its own forensic laboratory and taken upon itself to conduct its own MLDIs as it sees fit. Furthermore, the Commission on Human Rights is constitutionally mandated to investigate abuses of power by the state and has its own small contingent of medicolegal officers, but has faced economic censorship and strong stonewalling when attempting to address state-sanctioned violence. The result is often a chaotic power grab and insular operation that produces opaque, questionable science and mistrust among the general public in these institutions.

Proper MLDI requires a science-first, multidisciplinary approach that employs a cadre of vetted, qualified, and impartial experts and focuses on fact-finding surrounding the death event. Currently, initial employment as a medicolegal officer in the Philippines only requires passing the general physician licensure exam. Once hired, they are internally trained in MLDI, including conducting autopsies and collecting biological samples. However, autopsy is a complex procedure that requires years of formalized study and training. Autopsies and the conclusions drawn thereof should only be conducted by a pathologist that is board-certified by an accredited specialty board (such as the Philippine Society of Pathologists) after completing a multi-year residency in the subspecialties of anatomical and clinical pathology and passing diplomate examination. Ideally, board-certified pathologists also undergo at least one additional year of fellowship in forensic pathology before they can claim to be a forensic pathologist, although the Philippines has no such formal fellowship program currently.

The blunders in recent high-profile cases are pathognomonic, or specifically indicative, of a larger affliction in the Philippine medicolegal death investigation system; namely, blatant conflicts of interest, a lack of clear jurisdictional boundaries, misrepresentation of forensic examiner qualifications, and weak legislative backing.

Just as a general practitioner or internist or surgeon cannot and should not perform the procedures done by a forensic pathologist, the forensic pathologist must rely on the expertise of other allied forensic science practitioners. Forensic anthropologists (experts on the human skeleton and archaeological recovery), odontologists (experts on dental examination and bite marks), toxicologists (experts on the detection of alcohol, drugs, poisons, and other chemicals in biological fluids and tissues), geneticists (experts on extracting and analyzing DNA), and entomologists (experts on carrion insects), to name a few other specialists, work in concert with the forensic pathologist in answering the who, when, where, and what of a case and have undergone their own extensive educational, training, and certification requirements. In the Philippines, the number of individuals misrepresenting themselves as subject matter experts far outnumbers the individuals that are true qualified experts in their field.

The basis for our current MLDI system is rooted in a Marcos-era presidential decree — the 1975 Code on Sanitation — that has only been sparsely clarified by Department of Health memoranda and administrative orders in 1996, 2010, and 2020. Proposed bills in the Legislature to improve the system include two different mandatory autopsy bills that clarify instances in which an autopsy is required, a bill that requires the collection of information about the decedent to include photographs, fingerprints, dental impressions, and DNA samples prior to any cremation, a bill that requires local health officers to undergo training in disaster victim identification, and a bill that establishes a national Forensic Science Institute within the University of the Philippines, but all of these have been stalled for years. Likewise, the Judiciary must demand the prosecution to present physical evidence and expert opinion over eyewitness accounts, a stark departure from the current situation where upwards of 90% of cases in the country are tried solely on witness testimony.

Death investigation professionals in our country do essential work, and to the best of their abilities. This is not a criticism of individuals, but rather of a larger, complex system. Botched death investigations that reach the level of public ire like that of Christine Dacera, Kian Delos Santos, and so many others can be described as a comedy of errors: a series of events made ridiculous by bungling and incompetence. Except, there is nothing amusing about the consequences of our broken system: disjointed and prolonged grief of family members, impunity and lack of accountability of perpetrators, or continued danger to public health and safety. One can only wonder how many other cases are mishandled in a similar vein, yet fail to reach media sensationalism and are thus left unscrutinized. Truly, a complete dismantling of the current PNP/NBI-directed MLDI system must be done in favor of an autonomous, apolitical, and well-funded government agency that is clearly separate from, but cooperates with, law enforcement whose sole purpose is to produce high quality, independent, accurate, timely, and complete information regarding all qualifying deaths in the country.