Questions posed to expert witnesses by the legal community and the courts are expanding to include not just those relating to source level (i.e. ‘who is the donor of the trace?’) but also those relating to activitity level (i.e. ‘how did the DNA get there?’). The answers to these questions are usually formulated as the probability of the evidence under alternative scenarios. As activity level questions are part of investigative and legal considerations it is of paramount importance that expert witnesses are provided with knowledge and tools to address these questions.

To answer such questions within a probabilistic framework, empirical data is needed to estimate probabilities of transfer, persistence and recovery of DNA as well as background levels of DNA on everyday objects. There is a paucity of empirical data on these topics, but the number of studies is increasing both through in-house experiments and experimental data published in international scientific journals.

Laboratories that conduct such studies all use different experimental setups, trace recovery strategies and techniques and DNA analysis systems and equipment. It is essential for the forensic genetics community in general to establish whether the data generated by different labs are in concordance, and can therefore be readily used by the forensic community.

Moreover, if existing data and data generated from future experiments are made available to the (forensic) community, knowledge is needed on the key factors that underlie potential interlaboratory variation.

The aims and objectives of this ENFSI Monopoly 2013 project are to conduct a study of methodologies and data from different laboratories and to assess the comparability of the scientific data on transfer, persistence and recovery of DNA. This comparison will allow us to identify key factors that underlie potential variation. This information will be used to setup guidelines to enable sharing and database-storage of relevant scientific

data. This will improve the ability of forensic scientists and other professionals of the Criminal Justice System to give evidence-based answers to questions that relate to the activity level of the crime under investigation.

Forensic molecular autopsies have emerged as a tool for medical examiners to establish the cause of death. It is particularly useful in sudden unexplained deaths where the cause of death cannot be determined with a regular medical autopsy. We provide the first study of exome data from formalin-fixed paraffin-embedded samples (FFPE) paired with data from high-quality blood samples in forensic applications. The approach allows exploration of the potential to use FFPE samples for molecular autopsies and identify variants in extensive exome data. We leverage the high uniformity of the hybridization capture approach provided by Twist Bioscience to target the complete exome and sequence the libraries on a NextSeq 550. Our findings suggest that exome sequencing is feasible for 24 out of a total of 35 included FFPE samples. When successful, the coverage across the exome is comparatively high (> 90% covered to 20X) and uniform (fold80 below 1.5). Detailed variant comparisons for matched FFPE and blood samples show high concordance with few false variants (positive predictive value of 0.98 and a sensitivity of 0.97) with no distinct FFPE artefacts. Ultimately, we apply carefully constructed forensic gene panels in a stepwise manner to find genetic variants associated with the clinical phenotype and with relevance to the sudden unexplained death.

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.

In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).

We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. 

In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention. 

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

Deaths by exsanguination among various underlying causes of death were analyzed in order to expand the knowledge on the relation of extravasated blood volume to other documented parameters.

A consecutive series of 193 cases of ruptured thoracic aortic aneurysm (n=13), gunshot wounds (n=63), stab wounds (n=28), rib fractures (n=5), and blunt injury to thoracic aorta (n=84) were investigated.

The amount of internal bleeding into pleural cavities only varied greatly (200-3,400 ml) with a mean value of 1,174 ml, slightly higher among males. Age, body weight, cause and manner of death, external bleeding, alcohol inebriation, multiplicity of injuries, and degree of coronary heart disease did not significantly affect the amount of internal (pleural) bleeding. Also, post-mortem delay to autopsy did not correlated to the amount of extravasated blood, indicating that post-mortem bleeding is of no importance in these days.

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated.

METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests.

RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers.

CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

OBJECTIVES: Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families.

STUDY DESIGN: The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001.

METHODS: An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail.

RESULTS: Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims.

CONCLUSIONS: The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

Suicides by drowning have received limited attention by researchers. A recent finding that almost onethird of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

Background: Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. Methods: This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. Results: Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p amp;lt; 0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p amp;lt; 0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p amp;lt; 0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p amp;lt; 0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. Conclusions: This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Background: Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions. Aim: To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations. Methods: 1407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS [hyperosmolar hyperglycaemic state], acidosis NOS [not otherwise specified], or hypothermia. Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded. Results: Cases of AKA and DKA were most numerous (184 and 156, respectively). In DKA and in its male subgroup, cases with severe ketosis (BHB &gt; 1000 mu g/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250-1000 mu g/g) and controls (P &lt; 0.001). In DKA and in its female subgroup, cases with moderate ketosis cases were older (P = 0.0218 and P = 0.0083) than controls. In AKA and in its male subgroup, cases with severe ketosis had a lower BMI than those with moderate ketosis (P = 0.0391 and P = 0.0469) and controls (P &lt; 0.001). Cases with moderate ketosis had a lower BMI than controls (P &lt; 0.001). Conclusions: BHB concentration is associated with BMI in DKA and AKA, and with both BMI and age in DKA. Constitutional factors should, therefore, be considered in potential AKA and DKA cases. (c) 2021 The Authors. Published by Elsevier B.V. CC_BY_4.0

Background

Post-mortem biochemistry, including the analysis of beta-hydroxybutyrate (BHB), is increasingly employed in forensic medicine, especially in conditions such as diabetes and chronic alcoholism. However, not much is known about the associations between age, body mass index (BMI), and sex and BHB concentrations in ketoacidotic conditions.

Aim

To retrospectively study the association between age, BMI and sex in several conditions, such as diabetic ketoacidosis (DKA), alcoholic ketoacidosis (AKA), and elevated post-mortem BHB concentrations.

Methods

1407 forensic autopsy cases analysed for BHB were grouped by diagnosis: DKA, AKA, HHS [hyperosmolar hyperglycaemic state], acidosis NOS [not otherwise specified], or hypothermia. Age, sex, BMI and the concentrations of blood alcohol, vitreous glucose and blood BHB were recorded.

Results

Cases of AKA and DKA were most numerous (184 and 156, respectively). In DKA and in its male subgroup, cases with severe ketosis (BHB>1000 µg/g) were younger and had a lower BMI than those with moderate ketosis (BHB 250–1000 µg/g) and controls (P<0.001). In DKA and in its female subgroup, cases with moderate ketosis cases were older (P = 0.0218 and P = 0.0083) than controls. In AKA and in its male subgroup, cases with severe ketosis had a lower BMI than those with moderate ketosis (P = 0.0391 and P = 0.0469) and controls (P<0.001). Cases with moderate ketosis had a lower BMI than controls (P<0.001).

Conclusions

BHB concentration is associated with BMI in DKA and AKA, and with both BMI and age in DKA. Constitutional factors should, therefore, be considered in potential AKA and DKA cases.

Mosaicism and chimerism in individuals can complicate the interpretation and even lead to misinterpretation of DNA profiles in forensic casework. If a person has different DNA profiles in different tissue types, i.e. a true chimaera, wrongful exclusions can be made. Additionally, mixed chimaeras can have DNA profiles that may be mistaken for mixtures. We have set-up automatic DNA databasing processes to handle atypical single-donor DNA profiles, i.e. profiles having one or several “extra” alleles.

Studying all reference samples analysed at NFC from 2006 until spring 2014, 2‰ of the samples showed atypical DNA profiles. To be able to set routines for handling these DNA profiles, each one was manually searched in CODIS with adjusted settings, to evaluate the frequency of false-positive hits. To tag these profiles in LIMS a new result status was implemented. Additionally, all such DNA profiles must be confirmed by analysing at least two discrete samples. In LIMS, the results are manually recorded to compose of all alleles from the samples from a suspect, i.e. containing most possible genetic information. LIMS automatically categorises the atypical DNA profiles with a special CODIS index, called “Multi-allelic offender”. The first time an atypical profile is searched, the matches are manually investigated. If a match is false, its disposition will be set to “no match” to prevent this from occurring in future searches. Automatic searches will then be performed in every day routine with moderate stringency, allowing the atypical DNA profile to match either a genotype or a mixture. If the match is true, a match-report will be created and sent to the police from the LIMS.

Archaeological theories and methods are developed to reconstruct past human behavior from fragmentary material remains. The interrelated discipline of physical anthropology addresses questions related to skeletal remains while acknowledging taphonomic parameters. The benefit of integrating these disciplines in forensic investigations has gained increasing acknowledgement over the last decades, but the use of forensic archaeology and anthropology (FAA) remains limited in Sweden. The aim of this study is to analyze the field of FAA in Sweden in relation to outdoor and fire crime scenes where human remains are encountered. Based on qualitative interviews, the state and potential developments of FAA within the Swedish police and the National Board of Forensic Medicine are discussed. The results show that for ensic investigations and analysis of human fragmentary remains are not standardized in Sweden. A great responsibility is placed on the individual crime scene investigator who elects how to investigate these sites and who to contract for the analysis of osteological remains. This can endanger evidence collection and interpretation. This study shows that investigations of buried or fragmentary human remains in Sweden could be aided by a development of FAA. Key steps to further development of FAA within Swedish police involve 1) quantifying cases that could benefit from FAA, 2) establish FAA as an independent subject, 3) develop a national infrastructure, 4) offer professional education in the subject(s), and 4) develop best practice to advance evidence collection and legal security in investigations involving fragmentary human remains. An ongoing ISO accreditation of outdoor crime scene investigations within the Swedish police will hopefully benefit FAA development and collaborations with external partners.

This paper presents a quantitative retrospective study of gross human decomposition in central and southeastern Sweden. The applicability of methods developed abroad for postmortem interval (PMI) estimation from decomposition morphology and temperature are is evaluated. Ninety‐four cases were analyzed (43 terrestrial and 51 aquatic) with a median PMI of 48 days. The results revealed differences in decomposition patterns between aquatic, surface, hanging, and buried remains. While partial saponification and desiccation occurred in cases of surface remains, complete skeletonization was observed in all cases with a PMI over two years. Aquatic skeletonization was slower due to extensive saponification in cases with PMI higher than one year. Formulae for assessing accumulated degree‐days (ADD) from the original methods did not fit the study material. However, a regression analysis demonstrated that 80% of decomposition variance in surface remains could be explained by ADD, suggesting that a geographically adapted equation holds promise for assessing PMI. In contrast, the model fit was poor for aquatic cases (43%). While this may be explained by problems in obtaining reliant aquatic temperature data or an insufficient scoring system, aquatic decomposition may be highly dependent on factors other than ADD alone. This study evaluates the applicability of current PMI methods on an outdoor sample from a previously unpublished region, and represents the first scientific publication of human outdoor decomposition patterns in Sweden. Suggestions for future research are provided, including that scoring methods should incorporate saponification to fit forensic taphonomy in Swedish environments.

Microarray-based single nucleotide polymorphism (SNP) genotyping enables simultaneous and rapid detection of a large number of markers and is thus an attractive method for forensic individual acid identification. This assay relies on a one-color detection system and minisequencing in solution before hybridization to universal tag arrays. The minisequencing reaction is based on incorporation of a fluorescent dideoxynucleotide to a primer containing a tag-sequence flanking the position to be interrogated. This one-color system detects C and T polymorphisms in separate reactions on multiple polymerase chain reaction targets with the fluorophore TAMRA coupled to the respective dideoxynucleotide. After incorporation, tagged primer sequences are hybridized through their complementary sequence on the array, and positive signals are detected by a confocal laser-scanner.

Två svenska pojkar, Texas Linderot och Kevin Hjalmarsson, var båda fyra år gamla med en tydlig sak gemensam. Båda är döda. När det är ett barn som blivit dödat/mördat vill vi inte tro att det är sant.  

I de båda fallen med pojkarna var det inte en vuxen person eller en pedofil som var gärningsmännen, det var barn. Kevin Hjalmarssons mördare var två syskon som var fem respektive sju år gamla. Texas Linderoths mördare var en pojke som var tio år gammal.

Vad är det som har hänt de båda mördade pojkarna är frågor som vi ställer oss.

Var det lekar som gått snett?

Nu i efterhand vet vi svaren på frågorna och vi vet med säkerhet att det inte var en lek som gick snett. Det var barn som med avsikt mördade andra barn. I båda fallen var det rättsläkarna på Rättsmedicinalverket som kunde konstatera att dödsorsaken var strypning och dödsättet inte skett genom en olycka  utan troligt orsakats av någon utomstående.

När massmedia berättade den hemska sanningen bakom dessa två mord var vi många som inte trodde det var sant. Vi vill nog tro att barn är goda och inte benägna att utföra hemska våldshandlingar.

We demonstrate how the Bayesian framework for forensic interpretation can be adapted for casework involving postmortem intervals (PMI) utilizing taphonomic data as well as how to overcome some of the limitations of current approaches for estimating and communicating uncertainty. A model is implemented for indoor cases based on partial body scores from three different anatomical regions as correlated functions of accumulated temperature (AT). The multivariate model enables estimation of PMI for human remains also when one or two local body scores are missing or undetermined, e.g. as a result of burns, scars or covered body parts. The model was trained using the expectation maximization algorithm, enabling us to account for uncertainty of PMI and/or ambient temperature in the training data. Alternative approaches reporting the results are presented, including the likelihood curve, likelihood ratios for competing hypotheses and posterior probability distributions and credibility intervals for PMI. The applicability or the approaches in different forensic scenarios is discussed.

The Nuffield Report is well-written, clear, extensive and up to date, and it covers most of the major ethical issues in the field of forensic DNA analysis and database searching. The ethical analysis is thorough and based on solid theoretical ground.

Evidence contaminated with DNA from staff, police, and other individuals can have a dramaticimpact on an investigation and can mislead police inquiries. Forensic DNA elimination databases(EDB) are used to minimize the risks associated with DNA contamination. Central issues withmaintaining such databases include the basis for sample collection, sample, and profile integrity, aswell as retention times, database access, and procedures when a database match occurs. Followingyears of discussion, debate, and the use of an “in house” EDB at the Swedish National ForensicCentre (NFC), these issues have now been resolved by passing legislation on DNA EDB. According tothe legislation, sampling for EDB purposes is mandatory for certain forensic professionals, as well asfor other individuals who need access to the premises handling DNA evidence. In the event of adatabase match, the match can only be reviewed and evaluated for quality purposes and the nameof the donor cannot be disclosed to the crime inquiry. Thus, as a consequence, if a contaminationevent is not the probable cause the legal limitation opens for impunity for individuals included inthe database.KEYWORDSContamination; DNA;elimination database;forensic science; legislationIntroduction

Aim: Gamma-hydroxybutyrate (GHB) is a common drug of abuse with an elimination half-life of 20-45 min. However, there is some evidence that GHB might exhibit saturation kinetics after ingesting high recreational doses. The aim of this study was to investigate the elimination kinetics of GHB from blood in people apprehended by the police for impaired driving and secondary to describe concentrations in all GHB-positive drivers. Methods: Two consecutive blood samples were taken about 30-40 min apart from N =16 apprehended drivers in Norway. GHB was determined in blood by an Ultra High-Performance Liquid ChromatographyTandem Mass Spectrometry (UHPLC-MS/MS) method. The changes in GHB between the two consecutive blood samples allowed estimating GHBs elimination half-life, assuming first-order and zero-order elimination kinetics. GHB concentrations are also reported for N =1276 apprehended drivers with GHB in blood. Results: The median time interval between collecting the two blood samples was 36 min (range 20 56 min). The median concentration of GHB in the first blood sample was 56.5 mg/L (range 14.1 142 mg/L) compared with 47.8 mg/L in the second sample (range 9.75 113 mg/L). The median elimination half-life was 103 min (range 21 187 min), and GHBs median zero-order elimination rate constant was 21.0 mg/L/h (range 6.71-45A mg/L/h). Back-calculation to the time of driving resulted in GHB concentrations up to 820 mg/L assuming first-order kinetics and up to 242 ma assuming zeroorder kinetics. In all drivers (N 1276), the median GHB concentration was 73.7 ma and highest was 484 mg/L. Conclusion: The elimination half-life of GHB in blood samples from apprehended drivers was longer than expected compared with results of controlled dosing studies. Zero-order kinetics seems a more appropriate model for GHB when concentrations are back-calculated. and the median elimination rate was 21 mg/L/h. (C) 2020 The Authors. Published by Elsevier B.V.

Fram till den 1 januari 1988 saknade Sverige rättsregler som angav när en människa skulle anses vara död. Innan år 1984 hade inte heller frågan om dödsbegreppet lyfts till analys. I medicinsk przis hade emellertid döden sedan länge ansetts träda in vid det tillfälle då en människas hjärt- och andningsverksamhet varaktigt upphört. Under intensivsvårdens växande framsteg på sextio-, sjuttio- och åttiotalen utvecklades dock ett behov av att både ändra den allmänt vedertagna definitionen av dödens inträdande och av att införa en juridiskt bindande definition om när döden ansågs ha inträffat. Efter en omfattande utredning beslutades till sist att lagstadga dödsbegreppet och döden definierades ha inträffat när hjärnans samtliga funktioner totalt och oåterkalleligt fallit bort. Frågan som ställs i denna uppsats är hur dagens definition av döden lyder. Uppsatsen undersöker därav skälen som föranlett den nuvarande definitionen och hur den rent praktiskt går till när döden ska fastställas.

Vissa typer av brott kräver stora insatser och kunskap för att hitta en gärningsman. Sådana situationer uppstår när ett offer är död och/eller när man har ett seriemord eller till och med när ett offer har svåra skador med är medvetslöst. I vissa fall kan det vara att offret inte vet vem gärningsman är. Man bör inte heller glömma ett levande offer som skadat sig själv.

   Just skadorna som återfinns hos ett offer indikerar en hel del om en gärningsman. Till skillnad från det juridiska begreppet – en skada, som används i brottsrubriceringssyfte[1], så används skadorna som finns på ett offer i utredningsarbetet för att hitta en gärningsman och återskapa ett händelseförlopp. Med andra ord försöker man svara på frågor: vem har begått ett brott, hur och när brottet har begåtts och varför det har begåtts.[2] Själva utredningsarbetet som omfattar gärningsmannaidentifiering kan i vissa komplicerade, allvarliga fall även inkludera en gärningsmannaprofilering. Syftet är att hitta en gärningsman, dvs. även verifiera om det är just den person som begått visst brott – bevissyfte.

   Skadorna bedöms utifrån art, ålder, grad och antal, t.ex. vilken karaktär en skada har, hur den kunde uppkomma osv. Man försöker bedöma utifrån skadornas art eller andra förhållanden om det kan tyda på ett bestämt motiv, planering av brott eller om det handlar om en impulshandling.[3]

[1] Thomsen, s. 85.

[2] Ainsworth, s. 17.

[3] Thomsen, s. 148-153.

Relevant for various areas of human genetics, Y-chromosomal short tandem repeats (Y-STRs) are commonly used for testing close paternal relationships among individuals and populations, and for male lineage identification. However, even the widely used 17-loci Yfiler set cannot resolve individuals and populations completely. Here, 52 centers generated quality-controlled data of 13 rapidly mutating (RM) Y-STRs in 14,644 related and unrelated males from 111 worldwide populations. Strikingly, greater than99% of the 12,272 unrelated males were completely individualized. Haplotype diversity was extremely high (global: 0.9999985, regional: 0.99836-0.9999988). Haplotype sharing between populations was almost absent except for six (0.05%) of the 12,156 haplotypes. Haplotype sharing within populations was generally rare (0.8% nonunique haplotypes), significantly lower in urban (0.9%) than rural (2.1%) and highest in endogamous groups (14.3%). Analysis of molecular variance revealed 99.98% of variation within populations, 0.018% among populations within groups, and 0.002% among groups. Of the 2,372 newly and 156 previously typed male relative pairs, 29% were differentiated including 27% of the 2,378 father-son pairs. Relative to Yfiler, haplotype diversity was increased in 86% of the populations tested and overall male relative differentiation was raised by 23.5%. Our study demonstrates the value of RMY-STRs in identifying and separating unrelated and related males and provides a reference database.

Since the 1980s, cremation has become the fastest growing area of the U.S. funeral industry. At the same time, the number of litigations against funeral homes and cremation facilities has increased. Forensic anthropologists are often asked to determine whether the contents of an urn are actually cremated bone, and to address questions regarding the identity of the remains. This study uses both metric and chemical analyses for resolving a case of contested cremains. A cremains weight of 2021.8 g was predicted based on the decedent's reported stature and weight. However, the urn contents weighed 4173.5 g. The urn contents also contained material inconsistent with cremains (e.g., moist sediment, stones, ferrous metal). Analysis using XRD and SEM demonstrated that the urn contained thermally altered bone as well as inorganic material consistent with glass fiber cement. Although forensically challenging, cremains cases such as this one can be resolved using a multidisciplinary approach.

Objective: Driving under the influence of psychoactive drugs causes an increased risk for accidents. In combating this, sobriety tests at the roadside are common practice in most countries. Sampling of blood and urine for forensic investigation cannot be done at the roadside and poses practical problems associated with costs and time. An alternative specimen for roadside testing is therefore warranted and the aerosol particles in exhaled breath are one such alternative.Methods: The present study investigated how the exhaled breath sample compared with the routine legal investigations of blood and urine collected from suspects of drugged driving at 2 locations in Sweden. Exhaled breath was collected using a simple filter collection device and analyzed with state-of-the-art mass spectrometry technique.Results: The total number of cases used for this investigation was 67. In 54 of these cases (81%) the results regarding a positive or negative drug test result agreed and in 13 they disagreed. Out of these, the report from the forensic investigation of blood/urine was negative in 21 cases. In 6 of these, analytical findings were made in exhaled breath and these cases were dominated by the detection of amphetamine. In 7 cases a positive drug test from the forensic investigation was not observed in the breath sample and these cases were dominated by detection of tetrahydrocannabinol in blood. In total, 45 samples were positive with breath testing and the number of positives with established forensic methods was 46.Conclusion: The promising results from this study provide support to exhaled breath as a viable specimen for testing of drugged driving. The rapid, easy, and convenient sampling procedure offers the possibility to collect a drug test specimen at the roadside. The analytical investigation must be done in a laboratory at present because of the need for a highly sensitive instrument, which is already in use in forensic laboratories. The analytical work is not more challenging than for blood or oral fluid and should not cause an increase in cost. However, more studies need to be done before exhaled breath drug testing can be applied routinely for drugged driving investigation.

The main purpose of a medico-legal autopsy is to determine the cause and manner of death. A forensic pathologist makes assessments of this using several sources of information, one of which is the discrepancy between measured organ weight and reference values. Of particular interest is the heart weight in heart disease and the weight of the lungs in fatal intoxications. 

In this thesis, a linear model of lung weight was created, but the model could at best explain only 13% of the variation in combined lung weight (Paper I). Unsurprisingly, this meant that the model was a poor definition of “normal” lung weight and could not be used to identify intoxication cases (Paper II). A ratio of lung weight to heart weight (LWHW ratio) also failed to differentiate intoxication cases from controls. The poor performance of these methods could plausibly have been due to fatal intoxications with only some substances being associated with increased lung weight, but an analysis showed that many common intoxicants were associated with heavier lungs than hanging deaths (Paper III). 

To establish heart weight references more applicable in a medico-legal autopsy population, a model of heart weight accounting for undiagnosed cardiac hypertrophy was created (Paper IV). The model showed that for a decedent of average the evidence that a was hypertrophic reached, substantial support at around 470 g.

In conclusion, a definition of “heavy lungs” remains elusive. However, it seems to be a finding compatible with fatal intoxications with many substances and the low predictive value found may be due to study design. The heart weight model presented allows pathologists to assess the evidence of cardiac hypertrophy more easily than previously published models.

A key element for diagnosing cardiac enlargement in an autopsy setting is relevant heart weight references. However, most available references are to a large extent not representative of a medicolegal autopsy population, implying that reference weights are likely lower than those in the relevant population.To establish more applicable heart weight references in a medicolegal autopsy population, we designed a heart weight model that accounts for undiagnosed cardiac enlargement using data from 11,897 nontraumatic Swedish medicolegal autopsy cases autopsied between 2010 and 2019. The model was validated in 296 nonobese young adult suicidal hanging cases.For a decedent of average height (174 cm), the evidence that a heart weight was enlarged reached weak support at approximately 430 g, substantial support at approximately 480 g, and strong support at 520 g. The modeled prevalence of cardiac enlargement was very high among elderly and obese decedents.We believe that our model is more applicable in a medicolegal setting than those previously published. The presented quantification of the degree of uncertainty regarding diagnosis can help the pathologist in diagnosing cardiac enlargement. To facilitate the use of this model, we also made it available through a simple online tool (https://formedum.shinyapps.io/HeartWeightCalc/).

Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.

The interpretation of complex DNA profiles may differ between laboratories and reporting officers, which can lead to discrepancies in the final reports. In this study, we assessed the intra and inter laboratory variation in DNA mixture interpretation for three European ISO17025-accredited laboratories. To this aim, 26 reporting officers analyzed five sets of DNA profiles. Three main aspects were considered: 1) whether the mixed DNA profiles met the criteria for comparison to a reference profile, 2) the actual result of the comparison between references and DNA profiling data and 3) whether the weight of the DNA evidence could be assessed. Similarity in answers depended mostly on the complexity of the tasks. This study showed less variation within laboratories than between laboratories which could be the result of differences between internal laboratory guidelines and methods and tools available. Results show the profile types for which the three laboratories report differently, which informs indirectly on the complexity threshold the laboratories employ. Largest differences between laboratories were caused by the methods available to assess the weight of the DNA evidence. This exercise aids in training forensic scientists, refining laboratory guidelines and explaining differences between laboratories in court. Undertaking more collaborative exercises in future may stimulate dialog and consensus regarding interpretation. For training purposes, DNA profiles of the mixed stains and questioned references are made available.

En händelse likt Estoniakatastrofen den 28 september 1994 eller tsunamin i Sydostasien den 26 december 2004 är förödande, inte bara för inblandade och dess familj utan för hela världen. Hur kan en sådan händelse inträffa? Varför inträffade det? Hade det kunna förebyggas? Tänk om just jag hade varit med, eller känt någon som var med, hur hade jag reagerat då? Flertalet frågor bland världens befolkning uppstår. Något som kanske inte väcker särskilt mycket uppmärksamhet eller frågor är vad som händer efter att de stora tidningarna slutat skriva om katastrofen, antalet offer är fastställt och allt går tillbaka till det vanliga i övriga världen. Men sökandet, och kanske framför allt lidandet, för de inblandade och närstående har bara börjat. I de båda ovan nämnda katastroferna har många svenskar varit inblandade och i båda katastroferna slutade arbetet med att söka offer långt innan alla var hittade. Personer, som med största sannolikhet avlidit, måste alltså dödförklaras utan att deras kroppar hittats.

Den 1 april 2005 fick vi en ny lag, lag (2005:130) om dödförklaring (lagen om dödförklaring), med regler om hur och när dödförklaring ska ske. Lagen om dödförklaring ersatte kap. 25 i ärvdabalken (ÄB) som tidigare gällde. Reglerna i den nya lagen överensstämmer till viss del med den äldre regleringen men på en, för händelser likt Estoniakatastrofen och tsunamin i Sydostasien, viktig punkt skiljer de sig. Det är detta denna uppsats kommer behandla, vilken betydelse har ändringen – i teorin och i praktiken.

Den 1 juli 2010 infördes, genom SFS 2010:370, nya straffbestämmelser i brottsbalken (1962:700) (BrB). Dessa innebar en uppdelning av den grova formen av misshandel som reglerades i 3 kap. 6 § BrB, den kvalificerade formen av misshandel delades upp till grov misshandel och synnerligen grov misshandel. De grövsta brotten skulle omfattas av den strängare brottsrubriceringen som innebar en strängare straffskala på fyra till tio års fängelse, medan grov misshandel skulle ge fängelse om lägst ett år och högst sex år. Det främsta syftet med reformen var att de grövsta brotten skulle stå i proportion till brottets allvar då man tidigare gjort bedömningen att de grövsta brotten endast dömdes ut i den nedre delen av straffskalan.

Olika rekvisit tas hänsyn till när domstolarna ska bedöma en misshandel som grov eller synnerligen grov men det jag främst vill undersöka i denna promemoria är om det finns någon medicinsk gräns som man kan utläsa för att skilja på grov misshandel samt synnerligen grov misshandel. Jag kommer främst försöka finna detta genom hänvisning till de rättsintyg som eventuellt finns med i domskälen till de rättsfall jag valt att studera. Ett rättsintyg är ett dokument som har arbetats fram av en läkare innehållande bedömning och beskrivning av olika medicinska fynd. Dessa dokument ska framläggas inför domstol eller användas vid utredning av brott. Ett rättsintyg är ingen patientjournal utan har ett juridiskt ändamål. I ett rättsintyg presenteras samtliga undersökningsfynd, både förekomst och frånvaro av skador.

Between 1995 and 2004, 293 passenger car occupants died in collisions with other vehicles in northern Sweden (annual incidence: 3.3 per 100,000 inhabitants, 6.9 per 100,000 cars, or 4.8 per 109 km driven); half of these deaths involved heavy vehicles. The annual number of passenger car occupant death per 100,000 cars in var-truck/bus collisions has remained unchanged since the 1980s, , but in car-car collisions it has decreased to one third of its former level. As crash objects, trucks and buses killed five times as many car occupants per truck/bus kilometer driven as did cars.

The collisions were characterized by crashes in the oncoming vehicle´s lane, under icy, snowy, or wet conditions; crashes into heavy vehicles generally occurred in daylight, on workdays, in winter, and on 90 and 70 km/h two-lane roads. Head and chest injuries accouted for most of the fatal injuries. multiple fatal injuries and critical and deadly head injuries characterized the deaths in collisions with heavy vehicles.

An indication of suicide was present in 4% of the deaths; for thos who crashed into trucks, this percentage was doubled. Among the driver victims, 4% had blood alcohol levels above the legal limit of 0.2 g/L.

Frontal collision risks might be reduced by a mid-barrier, by building less injurious fronts on trucks and buses, by efficient skid prevention, and by use of flexible speed limits varying with road and light conditions.

Överfallsvåldtäkter är sällsynta och av naturliga skäl saknas oftast vittnen till händelsen, den huvudsakliga bevisningen består vanligtvis av målsägandens och den åtalades utsagor. I NJA 2009 s. 447 I och II menade Högsta domstolen att det inte räckte att målsägandens utsaga var mer trovärdig än den tilltalades. Det krävede dessutom att målsägandens utsaga, till den del det var möjligt, kunde kontrolleras. De två åtalade männen, som av lägre instanser dömdes för våldtäkt, friades av Högsta domstolen. Deras nekande och avsaknaden av stödbevis medförde att det inte kunde anses vara ställt utom rimligt tvivel att de gjort sig skyldiga till de påstådda brotten.

I våldtäktsmål ska alltså målsägandens utsaga kontrolleras för att kunna värderas högre än den åtalades. Det gäller, i enlighet med NJA 2009 s. 447 I och II, även om den målsägandens utsaga anses vara mer trovärdig än den åtalades. Med andra ord är det särskilt viktigt med stödbevisning, till exemple i form av rättsintyg, i våldtäksmål om en fällande dom ska kunna komma på tal. Med anledning av ovanståden finner jag det intressant att undersöka i vilken omfattning rättsintyg har åberopats och vilket bevisvärde rättsintygen tillmäts i våldtäktsmål.

Rapid DNA instruments have in recent years been developed, enabling analysis of forensic samples with a minimum of human intervention. Initially intended for fast handling of reference samples, such as samples from suspects in booking suites, attention shifted to include crime scene samples. The aim of this study was to determine whether or not the RapidHIT System (IntegenX) is fit for crime scene samples. The first runs gave very poor results, which was found to be due to an incorrect firmware setting leading to no or just minute amounts of amplicons being injected for electrophoresis. After solving this problem, 28 full runs (seven samples each) applying NGM SElect Express were performed comprising various amounts of blood on cotton swabs. Six of the runs failed completely, four due to cartridge leakage and in two runs the PCR mix was not injected. For 155 samples with 1–5ÎŒL blood (volumes for which complete DNA profiles are expected), 119 samples (77%) gave complete DNA profiles. Among the most serious failures were incorrect allele calling and leakage of DNA extract or PCR product. Other general issues were failure to export results, anode motor breakdown and broken capillary array. Due to the encountered problems with software, hardware and cartridges, together with the low success rate, it was decided not to continue towards implementation of the RapidHIT System in casework.

We describe events arising from the case of Joby Rowe, convicted of the homicide of his three month old daughter, and explore what they illustrate about systemic problems in the forensic science community in Australia. A peer reviewed journal article that scrutinized the forensic evidence presented in the Rowe case was retracted by a forensic science journal for reasons unrelated to quality or accuracy, under pressure from forensic medical experts criticized in the article. Details of the retraction obtained through freedom of information mechanisms reveal improper pressure and subversion of publishing processes in order to avoid scrutiny. The retraction was supported by the editorial board and two Australian forensic science societies, which is indicative of serious deficiencies in the leadership of forensic science in Australia. We propose paths forward including blind peer review, publication of expert reports, and a criminal cases review authority, that would help stimulate a culture that encourages scrutiny, and relies on evidence-based rather than eminence-based knowledge.

This study unveils the establishment of the United Kingdom-Netherlands Decomposition Experimental Research (UNDER) working group, marking a pioneering initiative in practical Forensic Taphonomy within the UK. Our primary objective was to craft a cohesive multidisciplinary framework, designed to ethically orchestrate, execute, and assess human decomposition. Concurrently, we aimed to amass data through human burials, fostering collaboration among diverse forensic experts across Europe. The compilation of data collected over the year, elucidates the comprehensive utilisation of cadavers through a multifaceted scientific methodology. This paper discusses the triumphs, challenges, and innovative solutions encountered during this undertaking, providing a blueprint for forthcoming European research in Forensic Taphonomy. Our efforts support the comparability of longitudinal studies and give strategies to address the challenges posed by the scarcity and diversity of human donors in forensic science. Moreover, we propose the adoption of a dynamic scientific research management framework, which includes thorough identification, measurement, analysis, and application of solutions. Emphasis is also placed on adeptly managing business processes to ensure sustained relevance in both research and other stakeholders.

This paper employs an interdisciplinary anthropological approach to a historical hydrological mass disaster to highlight the long term and ongoing significance of water based mass disasters on the surrounding community. Hydrological disasters, both natural and the result of human agency, can lead to extensive fatalities within the local population. Accurate identification of the deceased following any mass disaster event is known to be vital to fulfil the legal and humanitarian requirements of the living. The physical properties of hydrological disaster scenarios, however, can result in large numbers of long term missing bodies that do not allow for identification and the proof of death. The inability to confirm the death of a loved one and to bury a body has a significant impact on the family of the deceased and the long term treatment of the missing, or ‘virtual’ bodies, can cause moral injury and distress to surviving family members.

The Vajont disaster in northern Italy in 1963 killed almost 2,000 people when a landslide from Mont Toc collapsed into the Vajont dam triggering a 50,000,000 m3 inland tsunami. The resulting wave swept over the surrounding villages of Longarone, Erto and Casso with such destructive force that bodies were swept as far away as Venice and the remains of over 700 individuals were never located. This paper will discuss the processes used to retrieve and identify bodies after the disaster, prior to development of forensic anthropology as a discipline, and the process of the initial and secondary burials of victims, including the so called ‘virtual’ graves of the missing. The discussion highlights the need to further engage forensic anthropological theory and practice within a wider academic and humanitarian framework, engaging in interdisciplinary conversations with areas such as medical anthropology, disaster victim identification management and mortuary practices. The consideration of the long term consequences of the management of the dead and the employment of a historically deep approach to disaster victim identification will inform and develop the current practices of teaching forensic anthropology in universities and allow for a more holistic and comprehensive practice.

Contact-based evidence is likely to have limited quantities of DNA and may yield mixed profiles due to preexisting or contaminating DNA. In a recent arson investigation, a paper towel was collected and used as circumstantial evidence. The paper towel was partially burned and was likely set on fire with flammable liquid. As part of the investigation, the paper towel was treated with ninhydrin to visualize fingerprint evidence. Initial DNA analysis of two swabs was negative for short tandem repeat (STR) markers and revealed a mixture of mitochondrial DNA (mtDNA). Analysis of 13 additional cuttings yielded four more mixed profiles, but also two samples with a common single-source profile. The single-source mtDNA profile matched that of the primary suspect in the case. Thus, even if initial mtDNA analysis yields a mixed profile, a sampling strategy involving multiple locations can improve the chance of obtaining valuable single-source mtDNA profiles from compromised evidence in criminal casework.

Research on child‐related risk factors for filicide is scant. We investigated whether prior healthcare use for injury (including poisoning) influences filicide risk. Victims (0–14 years; n = 71) were identified in a national autopsy database for the years 1994–2012 and compared to matched, general population controls (n = 355). Healthcare use data were retrieved from a national patient registry. Risks were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). For females, prior inpatient care for injury conferred a statistically significant sevenfold risk (OR = 6.67 [95% CI: 1.49–29.79]), and any prior injury‐related healthcare use conferred a statistically significant fourfold risk (OR = 3.57 [95% CI: 1.13–11.25]), of filicide victimization. No statistically significant risks were found for males. Healthcare personnel should be aware that children treated for injuries, especially females, may be at an elevated risk of filicide victimization. Nevertheless, the filicide base rate remains low, and parents may be stigmatized by unfounded alerts; thus, prudent reflection should precede reports to the authorities.

Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available.

”Det bör ånyo framhållas att det inte är unikt för detta fall att sakkunniga har olika uppfattning om vilka slutsatser som kan dras av vid obduktioner och kompletterande undersökningar gjorda fynd.”[1]

Ovanstående utlåtande gav Justitiekanslern i samband med hans granskning av de rättsmedicinska undersökningarna av Osmo Vallo efter att denne avlidit i samband med ett polisingripande den 30 maj 1995. Kroppen genomgick tre oberoende rättsmedicinska undersökningar vilka resulterade i olika slutsatser. Någon dödsorsak kunde dock inte fastställas.

Till skillnad från obduktionsutlåtanden innehåller rättsintyg medicinska utlåtanden över skador på levande människor. Problemet med att fastställa orsak och verkan över skador och tillstånd är dock detsamma. Liksom i Osmo Vallos fall kan det vid utfärdande av rättsintyg vara mycket svårt att fastställa exakt hur en viss skada har uppkommit. Ett rättsintyg kan många gånger ha avgörande betydelse i brottmålsrättegång. Bland annat för att skapa en enhetlighet i verksamheten och en bättre kvalité på det rättsmedicinska arbetet i Sverige bildades 1991 Rättmedicinalverket. Detta är en statlig förvaltningsmyndighet som tillhandahåller expertis inom områdena rättspsykiatri, rättsmedicin, rättskemi och rättsgenetik. Verket är en mycket viktig del i det svenska rättssamhället genom att utfärda medicinska utlåtanden, däribland rättsintyg, till rättsväsendet. Men verket nekar idag andra parter än polis, åklagare och domstol att få rättsintyg utfärdade. Advokatsamfundet påpekade genom en skrivelse till Justitiedepartementet i september 2002 att detta inte är en acceptabel ordning och att det avsevärt kan undergräva den tilltalades möjlighet att effektivt bereda sitt försvar. [2]

[1] Justitiekanslern i JK Dnr 2684, s. 7.

[2] Advokatsamfundets skrivelse till justitiedepartementet den 16 september 2002.  (Bilaga 1).

Hösten 2010 kom ett larm från rättsmedicinska enheten i Umeå om den nya drogen krypton som vid det årsskiftet 2010/2011 tagit 9 personers liv.[1] Trots detta fanns ingen möjlighet för polisen och tullen att stoppa användandet av substansen, vilken såldes helt öppet på internet då denna inte ännu hunnit narkotikaklassas och således fortfarande var fullt laglig att såväl sälja som inneha och använda i Sverige.

I narkotikastrafflagen (1968:64) (NSL) 8 § definieras narkotika som ”läkemedel eller hälsofarliga varor med beroendeframkallande egenskaper eller euforiserande effekter”, och substanser som med lätthet kan omvandlas till sådana varor. I paragrafen stadgas även att det krävs att substansen är föremål för kontroll enligt en internationell överenskommelse som Sverige biträtt eller att substansen har förklarats vara att anse som narkotika av regeringen att för att en substans ska vara förbjuden att inneha.

Den svenska lagstiftningen medför förvisso en mycket hög grad av rättssäkerhet då man utan problem kan få fullständig klarhet i huruvida ett preparat är förbjudet eller inte. Problemet med lagstiftningen är emellertid att innan en ny substans kan narkotikaklassas måste preparatet genomgå en utredning hos Statens folkhälsoinstitut.[2] Denna tidsödande process innebär att substanser med i praktiken samma effekter som narkotikaklassade substanser kan säljas och användas fritt under långa perioder innan de kan förbjudas.

[1]  Bäckström, Jörn G, Classon, Gisela, Löwenhielm, Peter, Thelander, Gunilla. 2010. Krypton – ny, dödlig Internetdrog, Läkartidningen. Nr. 50 vol. 107: 3196-3197.

[2] 3§ 2p. Förordning (2009:267) med instruktion för Statens folkhälsoinstitut