Legal Procedure:Procedure which is adopted by the court for the purpose of justice.

Law:“Law is a code of social and moral behavior, enacted by the parliament and codified into sections
for ease of reference.”
“Personal conduct enforced by the court is law.”
 Parliament (National Assembly + Senate+president) make the laws.
 Ignorance of law is no excuse. Knowing law is your own duty.
Types of law:
a) Common law: (old law) It is not written, based upon traditions & customs of society.
b) Statute law: It is written law. It is made by the group of people which have given the authority
to make the law as National Assembly or Senate in Pakistan.
c) Criminal law: Law related to crimes. It is made to control crimes in society, to control the law
and order situation of country. So it comes in action when society is affected.
d) Civil law: It deals with private rights of individuals or a group of individuals i.e. family laws in
which persons are affected not the society. For example, possession of children or divorce
related cases. If a person working in a factory gets injured, he will go for civil laws for
compensation.
e) Islamic law: It is made in light of Quran & Sunnah as Hudood laws, Qisas & diyat act
f) Misc. laws: family laws, labour laws.
Types of statute law:
i. Ordinance: It is temporary law, made by president of Pakistan when National Assembly is not in
session ad there is emergency to frame the law. Time limit of ordinance is 120 days. After 120
days it must be reissued or counted as null & void.
ii. Act: It is permanent law, passed by parliament. It remains effective until or unless canceled by
parliament or any amendment is made in it.
Difference between criminal law and civil law:
Criminal law Civil law
For maintaining peace & order in the society For redressing grievances between individuals
Deals with offences (state verses defendant) Deals with complaints (complainant verses
defendant)
Punishments are awarded Compensations in the form of money are
awarded
Examples: murder, rape, abortion, drinking, Examples: rents, insurance claims, recoveries
treason etc

Other Laws
CrPC: criminal procedure court
CPC: civil procedure court
Crime:
 Any harm which has been defined and made punishable under law. For example, murder.
 Capital punishment means death.
Criminal law:
 For better law & order situation
 Society is affected
 To control law and crimes in country
Civil law:
 Remedy for personal sufferings
 Private rights of individuals
Presumptions/ principles of justice:
A. Everybody is innocent until or unless proved otherwise.
B. It is the duty of the complainant to prove his case beyond doubt.
C. All the doubts should be resolved in favor of accused.
Types of courts:
1. a) Court of trail:
Where actual trail (hearing) of case is made. Magistrate court and civil courts are courts
of trail. As in case of fight between two individuals, the court of trail is court of Magistrate but in
case of murder, the court of trail is session court.
b) Court of appeal:
In court of trail, there may be two results i.e. the person is released or punishment is
awarded. So against this decision, an appeal may be lodged in the higher court. In case of
decisions made by magistrate court, appeal is lodged in session court and in case of decisions
made by session court; appeal is lodged in High court.
Session court, High court and Supreme Court are courts of appeal.
c) Mix type:
Court of trail + court of appeal; is a mix type court. Both functions are performed by a
single court as session court. Session court is court of trail for murder cases and court of appeal
against decisions of magistrate and civil court.
2. a) Criminal court:
It deals with crimes where society is affected, to control the law and order situation of
the country. Magistrate court and session court are criminal courts.
b) Civil court:
It is headed by civil judge where private rights of individuals are dealt.
3. a) Routine courts:
They are present as matter of routine. Magistrate court, civil court, session court, high
court and Supreme Court are routine courts.
b) Special courts:
For certain purposes as anti-terrorism court, labour court, family court, speedy trial
courts (for heinous crimes as rape of small children).
4. a) Higher courts:
They include High court & Supreme Court.
b) Lower courts:
They include Magistrate court, civil court & session court.
 Lowest court to award death sentence is session court but this punishment is not implemented unless
confirmed by High court. It is a law.
 If a person to whom death sentence is awarded by session court does not appeal in higher court then
government will appeal in High Court on behalf of that person.
Courts of Pakistan:
 Supreme Court
(Located in Islamabad & provincial offices in Lahore, Quetta, Karachi & Peshawar, headed
by Chief Justice. It is a court of appeal. Its duty is interpretation of law & constitution)

High court (court of 3rd instance)
(Located in every province as Lahore HC, Sindh HC)

Session court (court of 2nd instance)
(Located in every district, headed by district & session judge)

Magistrate court Civil courts

(Court of 1st instance) (Court of 1st instance)

Types of magistrate:
1. Executive magistrate: involved in management, have no judicial powers.
2. Criminal magistrate: have judicial powers.

Magistrate Imprisonment Fine

Magistrate section 30 7 years No limit
Magistrate 1st class 3 years 15000/-
nd
Magistrate 2 class 1 year 5000/-
Magistrate 3rd class 1 month 1000/-
Honorary magistrate Nil Can impose fine
Legal procedure:
Crime  police  FIR  arrest of accused  presented before Magistrate for remand (it is duty
of police to present accused before magistrate in 24 hours)  investigation of case (by police & torture
is used)  completion of chalan  case is presented before the court  trial of case 
punishment/release awarded  appeal before high court.
 Remand is awarded for 1-14 days depending upon magistrate court.

Courtroom setup
Inquest:
Legal or judicial inquiry in case of sudden and suspicious deaths. For example, a person is
healthy before death or death in mental hospitals or in police custody.
Police inquest:
 Legal inquiry in sudden or suspicious deaths. The police officer of minimum rank to conduct
inquest is ASI (assistant sub inspector).
Magistrate inquest:
Duty of inquest is given to magistrate.
Coroner’s inquest:
This system of inquest is present in England and in Mumbai city of India. Coroner is a person
appointed to hold inquiry in cases of sudden and suspicious deaths. Coroner is a first class magistrate or
a lawyer.
Powers of coroner:
a) He can order PM examination. In Pakistan, it is ASI who decides whether PME is required or not.
b) He can summon the witness.
c) He can issue warrant to arrest the accused.
d) He can order exhumation. In Pakistan, it is decide by police.
e) He can appoint deputy coroner.
Summons/subpoena:
It is a written and signed order issued by the court for appearance of a person/ witness before
the court on certain time and date.
Warrant:
It is written & signed order issued by the court for the forceful appearance of a person before
the court under penalty.
It is the next stage of summon. If a person fails to attend the court after summon being duly
served to him without a lawful excuse, and then court will issue him the warrant.
Types of warrant:
1. Bail able: Temporary release of a person by providing security for his/her later appearance
before the court. Surety is taken by another respectable person.
2. Non-bail able: Person is straight forwardly arrested by police and remain under custody of
police and then on certain date and time specified on warrant, the person is presented before
the court by the police.
Witness:He is a person who testifies the facts before court.
Types of witness:
i. Common witness: An ordinary person who testifies the facts before the court.
ii. Expert witness: An expert of some field who testifies before the court as ballistic expert (expert
of firearm), handwriting expert or a doctor. He can draw inference from the facts as he can tell
whether red spot found on victim’s shirt is blood or not.
iii. Hostile witness: Witness who makes purposefully wrong statements before the court after
taking the oath.
Perjury:
A witness who after taking oath willfully makes false statements before the court is guilty of
crime of perjury. Hostile witness is culprit of perjury.
 Ordinarily and in most of cases, a doctor is an expert witness but he can be a common witness as he is
going somewhere and an incidence occurs there. He may be a hostile witness too.
Evidence:
Acts and facts helpful in a case under discussion.
Types of evidence:
1. Oral evidence: Person describes orally in witness box the whole story that what he saw about
the incidence & what he knows about that incidence.
2. Documentary evidence: Any piece of paper containing some information is called document.
Evidence in the form of document is documentary evidence.
 3. Circumstantial evidence: Evidence from which an inference is drawn as by broken wind shield
pieces & tire marks on road it is inferred the case of accident.
4. Direct evidence: In direct evidence, the victim himself is the eye witness of incident.
5. Hear say evidence: It is also known as indirect evidence. In this, person has no direct knowledge
of incidence but has heard incidence from another person.
Ordinarily, hear say evidence is not acceptable before court, but in certain cases as a
doctor who had conducted PME, MLE or issued MLR is dead or gone abroad and it is not
possible for court to call him back, then any assistant of doctor working with him at that time
can certify the case.
Oath: section 51:
“The word ‘oath’ includes a solemn affirmation substituted by law for an oath, and any
declaration required or authorized by law to be made before a public servant or to be used for the
purpose of proof, whether in a court of Justice or not.”
Oath is not taken on any Holy book. Only the person raises his right hand above the shoulder
and says, I will speak the truth, the only truth and nothing but the truth.
Oral evidence: Stages:
a) Examination in chief: The person describes the whole story of incidence to the party who has
plot the witness for evidence. No leading questions can be asked.
b) Cross examination: This is done by opposite party.
c) Re-examination: During this, doubts which were raised during cross examination are cleared.
Documentary evidence: Types:
i. Medical certificates  Physical fitness, illness, mental health, age, death etc
ii. Medico-legal certificates  MLR, PMR, exhumation report
iii. Dying declaration/ dying deposition
Circumstantial evidence:
To establish a conclusion by inference from the facts.
Dying declaration:
“It is a statement made by an injured dying person stating the circumstances leading to his
death.”Injury may be caused by poison or weapon. In natural death like due to heart attack, there will
be no dying declaration. It is only in the case of illegal violence.
Requirements:
i. Criminal violence  person should be injured.
ii. Actually dying  doctor will certify that he is going to die
iii. Compos mentis  doctor will certify that person is mentally stable
iv. Two witnesses  may be staff nurse, dispenser or any person
Legal value:
It carries less legal value as compared to dying deposition.
Procedure:
 It is recorded in Q/ A form and it should be supposed that dying person should not lie.
 Then statement is reread over to the patient and at the end his signature or thumb impression is
taken.
 Preferably signature is taken because signature of dying person carries more value because
thumb impression may be taken after death of the person.
 Then signature of witnesses and doctor are taken
 Statement is sealed and sent to area magistrate.
Dying deposition: (section 164)
 Deposition means statement under oath before the court. So dying deposition means statement
given by injured dying person on oath before court in the presence of accused person or his lawyer.
Opportunity of cross examination is also provided to the accused person or to his lawyer.
Are magistrate is called by the doctor to the hospital to record dying deposition.
Requirements:
i. Before the court, on oath, presence of accused and his lawyer
ii. Cross examination
Difference between dying declaration & dying deposition:
Dying declaration Dying deposition
Taken by any respectable person or doctor Taken by court
Oath is not required Taken under oath
Presence of accused/ his lawyer not necessary In the presence of accused/ his lawyer
No cross examination Cross examination
 Dying declaration carries no legal value but dying deposition carries full legal value if person survives.
Medico-legal systems in world:
1. Police system: It is present in subcontinent. In India, in city of Mumbai coroner‘s system is
present while in rest of country police system is present. Here, police will decide whether PME is
required or not usually person having rank of ASI will decide. Then police will send the request
to doctor to perform PME.
2. Coroner’s system
3. Continental system: It is present in Russia and in some other countries around Russia. It is a
mixed type of system. In this, some points are taken from police system, some from coroner’s
system and some from medical examiner system.
4. Medical examiner system: This is present in America, North & South America and Canada. Here,
a medical person usually a forensic medical expert or forensic pathologist will decide whether
PME or exhumation is required or not.
It is the best medico-legal system.
Autopsy index:
Medico-legal autopsies carried out/ total death in a community.
Coroner system:
Doctor Information from police Public

Ref for
certif’n
Coroner
No autopsy
Autopsy Referred to registrar for disposal

Unnatural causes Natural causes


Inquest

Findings: homicide, accident, suicide, misadventure, industrial neglect, abortion, lack of
attention at birth.
Doctor before the court: (doctor in witness box)
i. Dress  white overall is must
ii. Temperament  don’t lose temperament, always talk to judge not to lawyer
iii. Cross examination & questions
 iv. Avoid contempt of court  6 months imprisonment in case of contempt of court
 After noting summon from the court, doctor must attend the court at given time and date. If he is in
some emergency situation, he must inform the court well in time.
Sentences authorized by law:
a) Death  In some countries it is abolished but in Pakistan it is present
b) Life imprisonment
c) Imprisonment  simple or rigorous
d) Forfeiture of property
e) Fine
f) Whipping
g) Amputation (Hudood laws)
h) Making equal injury (Qisas)
Asphyxia:
Greek word  absence of pulsation
“Any interference in process of respiration is known as asphyxia.”
Asphyxial deaths:
“Deaths resulting due to interference in process of respiration are known as asphyxial deaths.”
“Violent death initiated by interference in respiration.”
Classification of asphyxia:
1) Mechanical asphyxia: caused by any mechanical obstruction in process of respiration
2) Pathological asphyxia: due to some pathology like bronchiolitis, alveolitis
3) Toxic asphyxia: caused by poison as cyanide poison (hydrocyanic acid) present in bitter almonds
and cause cellular asphyxia.
4) Environmental asphyxia: deficiency of O2 in environment as lack of oxygen in room due to
heater or coals or in man holes.
5) Iatrogenic asphyxia: due to drugs as some drugs causes bronchoconstriction or anesthesia may
cause asphyxia.
Classification of mechanical asphyxia:
1. Hanging
2. Strangulation
3. Suffocation
4. Traumatic/ crush asphyxia & burking
5. Sexual asphyxia (auto-erotic asphyxia)
6. Drowning & immersion
Chain of events during asphyxia:
Asphyxia  capillary dilatation  stasis of blood in capillaries  decrease venous return to heart
 decrease pulmonary blood flow  deficient oxygenation  more asphyxia
Level of obstruction Types of asphyxia
Nose or mouth Suffocation (smothering & gagging)
Glottis Hanging
Larynx & upper trachea Strangulation & throttling
Trachea/ main bronchus Choking
Muscles of respiration Traumatic asphyxia
Effects of pressure on neck:
i. Carotid sinus pressure  vagus nerve stimulation leading to cardiac arrest
ii. Carotid artery blockage  unconsciousness as blood supply to brain is reduces
iii. Jugular vein blockage  congestion & hemorrhage
 iv. Airway obstruction  O2 deficiency
Post-mortem findings in asphyxia:
 General non-specific pathological changes:
Present in almost all types of asphyxia  due to increase capillary permeability and
endothelial fragility (hypoxia/anoxia).
1. Petechial hemorrhages: Pin-point hemorrhages also known as ‘Tardieu’ spots. Size of
hemorrhage is equal to size of head of common pin.
Tardieu spots are small red colored spots discovered by Tardieu, a French police
surgeon. They are present mainly above the point of constriction. They are present in all types
of asphyxia except drowning. In case of strangulation & hanging, maximum hemorrhages are
present on face, sclera, conjunctiva, thymus, brain & meninges.
They may be present in cases of scurvy, bleeding disorders, hemophilia, electric shock or
heart attack. Excessive subconjuctival hemorrhage is known as blood shot eyes.
2. Visceral congestion: Dilatation of capillaries occurs & viscera are congested.
3. Cyanosis: Minimum concentration required for cyanosis is 5mg reduced Hb/100 ml of capillary
blood. It first appears on lips.
4. Cardiac dilatation: Heart is dilated
5. Fluidity of blood increase (fibrinolysin): Blood becomes darker due to deficiency of O2 and
becomes more fluid because of release of fibrinolysin.
 Specific asphyxia changes:
Present in strangulation, hanging, throttling & suffocation  due to unique mechanism
of asphyxial death.
Biochemical changes in asphyxia:
i. Decrease level of O2 in blood
ii. Increase level of CO2 in blood
iii. Lowering of pH of blood (less than 7)
iv. Blood sugar increased
v. Exchange of Na+ & K + across cell membrane.
Hanging:
Suspension of body with ligature around the neck and weight of body acts as constricting force around
the neck.
Ligature mark is vertical and goes upwards behind the ears.
Manner of death:
i. Suicidal  common particularly among females
ii. Homicidal  very rare
iii. Accidental  very rare
 It is always considered suicidal unless proved otherwise.
Mechanism of death:
1) Upward displacement of base of tongue
2) Reflex cardiac inhibition through vagal inhibition & carotid compression
3) Fracture & dislocation of cervical vertebrae (C3-C4)
4) Compression of jugular vein & carotid arteries
Types:
a. 1) Complete: feet & lower limb does not touch the ground
2) Incomplete: feet & lower limb touch the ground
b. 1) Typical: when the knot of rope is on nap of neck (on occipital area)
2) Atypical: any other position of knot
 c. 1) Lawful: judicial hanging
2) Unlawful: suicidal, homicidal (lunching)
Specific autopsy findings:
While performing autopsy, head should be opened first because in this way blood on the
structures of neck will drain in brain and neck area becomes more prominent (visible).
I. 3.5 kg weight around neck is sufficient to cause death in ordinary course of nature if it is
maintained for sufficient time.
II. Distribution of PM lividity  tip of nose, fingers, hands, legs, feet & on genitalia.
III. Neck is stretched-elongated due to weight of body
IV. External ligature mark  mark depressed from normal level of adjacent skin.
V. Multiple bruises on neck structures & muscles.
VI. Firmly clenched hands & tongue bitten between teeth.
VII. Cervical tissue injuries (C3-C4).
VIII. No fracture of hyoid bone. Injuries to hyoid/ laryngeal cartilage.
IX. Obstruction to cerebral venous flow  congestion of face.
Additional medico-legal points:
(Suicidal (ante-mortem) vs stimulated suicidal hanging (post-mortem))
Scene of Death
Complete autupsy for any other cause of death macro/histological examination of bed of ligature
Mark in outdoor cases-rope marks on tree branches
AM hanging PM hanging
Vital reactions No vital reactions
Dribbling of saliva from mouth (surest sign) No dribbling of saliva
Place of suicide is with minimal interference Random place
Presence of table, chair Table/chair may be absent
Doors & windows bolted from inside Doors & windows open
No defense wounds Defense wounds present
Farewell note No farewell note
Previous history of suicide or psychological disorder May be no history of suicide
Judicial hanging: (death sentence awarded by court)
It is hanging till death.
Both big toes are tied together and person is made to stand on platform and on back both thumbs are
tied together. Then a black mask covering whole face and head is put on & rope is tied. Knot of rope is
usually on side of neck. Then lever is pulled and platform slips underneath the feet of person. The
person falls down almost 6-7 feet and when length of rope is over, there is a sudden jerk which causes
the fracture of 3rd & 4th cervical vertebrae.(hyoid bone- outer 1/3, inner 2/3)
Typical(knot on the back(occiput)/atypical hanging
Fatal period:5-10 mins
Lynching:It is a type of unlawful hanging in which some person empower over another person and hang
him. Usually it occurs in areas where there is lawlessness. It is very rare phenomenon.
Tension required for closing of different structure:
 Jugular vein  4.4 pounds
 Carotid artery  11 pounds
 Trachea  33 pounds
Strangulation:
Causing constriction of neck with the help of ligature around the neck.
1. Manual (throttling)  constriction of neck with help of hands. One or both hands are used.
 2. Elbow (mugging)
3. Ligature (garroting)  ligature is may be a cloth, rope or wire.
4. Bansdola  caused by single or double stick. One stick is put in front of neck and other on the
back and both sticks are squeezed and neck is constricted. May be person is pushed to the wall
and one stick in front of neck is used and squeezed.
5. Accidental  entanglement of dupatta in spokes of rear wheel of motorcycle. Use of tie in
factories may result in entanglement of tie in machinery.
Throttling:
(Manual strangulation & mugging)
Manner of death:
i. It is homicidal or accidental
ii. It is not suicidal because a person cannot press his own throat with hands sufficient enough to
cause death of himself. When a person compresses his neck to commit suicide, the blood supply
to brain is reduced and he becomes unconscious and tight grip around neck become loose.
Mechanism of death:
Pressure on neck causes:
1) Constriction of larynx
2) Pressure on carotid sinuses  reflex cardiac inhibition through vagal stimulation
3) Obstruction of carotid artery/ jugular veins  cerebral hypoxia
Autopsy findings:
I. Non-specific general pathological changes
II. Specific findings
III. External injuries  usually on neck area (mark of thumbs/ fingers)
IV. Hyoid & cervical tissue injuries
V. Cerebral congestion
VI. Other injuries  defense injuries, marks of nails
6 penny bruise:
Mark of thumb present on neck is known as 6 penny bruise.
 Tight grip for 15-20 seconds is sufficient to cause death in ordinary course of nature.
Garroting:
(Strangulation by ligature)
Manner of death:
i. Homicidal  common
ii. Suicidal  rare
iii. Accidental  to females sitting on back of motorcycles & by neck tie of person in machinery.
Mode of death
Asphyxia
Mechanism of death:
Reflex vagal stimulation
Autopsy findings:
I. External ligature mark  horizontal mark usually
II. Associated neck injuries  defense injuries
III. Hyoid injuries & laryngeal cartilage injuries
IV. Obstruction to cerebral venous flow
Additional medico-legal points:
 Strangulation by umbilical cord  very rare during the process of birth, umbilical cord wrapped
around neck of baby and causes strangulation of baby.
 Retention of ligating material in homicidal cases  may be around neck or in throat
  Mirror image phenomenon  exactly same pattern as of the ligating material is formed on neck
Common sites of injury of hyoid bone:
i. Greater cornu of hyoid bone
ii. Superior horn of thyroid cartilage
Sign of strangulation:
1) Petechial hemorrhages
2) Conjuctival hemorrhage  blood shot eyes
3) Bleeding from nose & ears
4) Nasal blood & mucus
5) Congestion & cyanosis
6) Nail scratches
7) Bruises
8) Ligature mark
9) Relative pallor below neck
Suffocation:
Obstruction in respiratory tract
i. Gassing/glue sniffing:
Gassing occurs when a shopping bag is put around the face & tied around neck. Glue
sniffing is a type of addiction of sniffing the glue. Glue is applied on inner surface of shopping
bag & is put around the face & tied around neck. In both cases, respiratory gases does not enter
into body & death occurs
ii. Smothering & over laying:
Smothering means closure of external respiratory orifices i.e. mouth & nose at same
time.
Overlaying  this occurs in small children who take mother feed. While feeding, baby is
on the side of mother, if mother goes to sleep, the breast of mother covers the mouth of child &
smothering occurs due to closure of mouth & nose of child by breast of female.
iii. Choking & gagging:
Obstruction at upper level is known as gagging while at lower level, it is known as
choking. Gagging usually occurs by putting cloth in mouth. Mostly occurs during rape, when
rapist put victim’s dupatta in her mouth to avoid shooting & biting by the victim.
Choking usually occurs when a coin is swallowed by children.
 It is level which decides whether it is gagging or choking
iv. Café coronary:
Café means to eat something, coronary means related to heart. During a long journey, a
person stops in mid way to get some refreshment. For this, he may go to some hotel & take
alcohol & food. During eating, he may fall on to table & die without a cry. In past, it is thought
that person dies of heart attack so name café coronary was given. But later on, when it was
investigated, it was found that after taking alcohol, the reflexes slow down and when he eats
food, the bolus of food is impacted in throat due to weak reflexes & cause death.
v. Impaction of foreign body
Impaction of coin in throat by children.
Traumatic/crush asphyxia & burking:
Mechanism of death:When movements of chest or respiratory vessels are blocked, it is known as
traumatic/ crush asphyxia.
Example is when a person is sleeping & other person sits on his chest, the movements of chest are
blocked & person dies. It usually occurs in stampede.
 Burking2 brothers, William Burke & William Hare take persons to their house by temptation then
Burke sits on the chest of person & close his mouth & nose simultaneously by both hands while Hare
drag the person on the floor. It causes the death of person. Then both sell the dead body to anatomy
department in medical collages. This process is called Burking.
Burking is combination of asphyxia & smothering.
Autopsy findings:
Deep cyanosis of face. Numerous petechiae. Line
of demarcation surest signarea above obstruction is (congested) hyperemic & below
obstruction it is pale. Subconjuctival
hemorrhage (blood shot eyes). Sexual asphyxia
(auto- eroticasphyxia).
It is seen when blood supply to the brain is reduced, there are pleasurable sexual hallucinations.
So to cause this condition, some person will constrict their neck to have these sexual
hallucinations. It usually practiced in West where person living alone can constrict
his neck to get sexual hallucination. A ligature is tied around neck & other end of ligature is tied
to big toe of foot, then by moving the leg, neck is constricted & blood supply to brain is reduced
& he gets sexual hallucination. But death may occur during this process.

Drowning & immersion:

When medium of submersion is water, it is known as drowning but if medium of submersion is
other than water like oil or acid, it is known as immersion. In both cases, respiratory tract fills with
medium of submersion.
Classification:
1. Typical (wet drowning): Water enters into respiratory tract then into lungs and may be into
circulation.
2. Atypical (dry drowning): Water does not enter into lungs due to laryngeal spasm. There may be
sudden vagal inhibition and cardia standstill (immersion syndrome)
Immersion syndrome:(vagal inhibition)
When person enters into cold water, there is sudden vagal inhibition and cardia standstill can
occur and water does not enter into lungs, it is known as immersion syndrome.
Fresh water drowning: (hypervolemia)
Drowning in wells, rivers & canals. In this, water enters into lungs and into circulation, resulting
in hypervolemia. It causes hemolysis which results in excess K+, hemodilution, anoxia & ventricular
fibrillation and person may die.
Fatal period is 4-5 minutes.
Salt water drowning: (increased* 3% NaCl)
Drowning into sea. In this, hypertonic water enters into lungs and squeezes back the fluid from
circulatory system into lungs resulting in edema of lungs and hypovolemia (hemoconcentration) which
results in circulatory shock and heart may standstill.
Fatal period is 8-12 minutes.
Secondary drowning syndrome:
It is also known as near drowning or post immersion drowning syndrome. In this, a living
person is removed from water and he has normal respiration and BP and is conscious but after
sometime, he may experience difficult breathing, hypotension & different types of cardiac arrhythmias,
this condition is known as secondary drowning syndrome.
Cause of death in drowning:
i. Ventricular fibrillation (fresh water) due to excessive K+ ions in blood.
ii. ASystole (sea water) cardia stands still due to hypovolemic shock.
iii. Laryngeal spasm (dry drowning)
iv. Vagal inhibition (immersion syndrome)(dry drowning)
v. Secondary drowning.
vi. Diseaseepilepsy, heart attack.
vii. Injuryperson jump from certain height & his head may struck against something & he may die.
PM appearance:
 Externally:
1. Clothes are wet.
2. Temperature of body is lower than temperature of environment because temperature of water
is lower than temperature of environment.
3. Fine froth present in mouth & nose. Whole of respiratory tract is full of fine forth. Forth is
formed by reaction of respiratory tract against pollutants present in water. If this froth is
cleaned from mouth & nose it will reappear & if you press chest of drowning person, copious
amount of froth comes out from mouth & nose. It is surest sign of ante-mortem drowning.
4. Instantaneous rigors due to great mental tension & muscular activity. Surest sign of AM
drowning. Person may contain petal, bark & sand in his hand.
5. Hypostasishead is somewhat lower than body so hypostasis is present on shoulders & face.
6. Washer man skinwrinkling of skin due to immersion of body or body parts in water for a
longer period. Mostly occurs sudden foot to hands washer man. Another name is sodden foot.
 Internal appearance:
1. Water in middle earsurest sign of ante-mortem drowning. To know the presence of water in
middle ear cavity take a syringe & needle & puncture tympanic membrane with needle & pull
out piston of syringe. Water will come out of middle ear into syringe.
2. Respiratory tract full of fine forth. During PME when sternum is removed. Lungs bulge out of the
thoracic cavity. This is called ballooning lungs.
3. GITwater may enter into GIT. In PM drowning, water does not go beyond stomach i.e. not
enter into duodenum but in AM drowning, water is present in duodenum.
4. Diatoms (unicellular algae suspended in water). Thousands types of diatoms are present in
water. Every area has different types of diatoms. They enter from respiratory tract to brain,
heart and bone marrow. Sternum is the ideal bone from where diatoms are detected. It is
surest sign of ante-mortem drowning.
Medico-legal importance:
i. Ante-mortem/post-mortem drowning
ii. Suicidal  common, particularly in females in villages where wells, canals & rivers are present
iii. Homicidal  very rare
iv. Accidental  very common particularly in warm water
Route of diatoms:
Victim falling into the water, containing diatoms

Diatoms are carried to the pulmonary parenchyma

From pulmonary parenchyma, the portable portal of entry of diatoms into blood stream
(alveolar capillaries) is through tears of alveolar walls which occur during forceful inspiratory
and expiratory efforts during process of drowning
 
Diatoms are carried to distant organs (brain, kidney, heart, bone marrow) through systemic
circulation

They are demonstrable through microscopy of bone marrow
Difference between fresh water & sea water drowning:
Features Fresh water Sea water
Absorption of water in lungs Massive None/ negligible amount
Absorption of NaCl None Massive
Plasma Hemodilution Hemoconcentration
+
RBC changes Hemolysis resulting in  K None
Blood volume Massive increase Decrease
Cause of death Ventricular fibrillation Cardia stand still
Fatal period 4-5 minutes 8-12 minutes
Difference between ante-mortem & post-mortem drowning:
Findings AM drowning PM drowning
Fine froth Present (surest sign) Absent
Cadaveric spasm Present Absent
Cyanosis Present Absent
Facial congestion Present Absent
Water in duodenum Present Absent
Water in middle ear Present (surest sign) Absent
Congestion of organs Present Absent
Diatoms Present (surest sign) Absent
Drowning & putrefaction:
As body is in the water and temperature of water is lower than the temperature of
environment. Due to low temperature of water, rate of putrefaction is slow. But when body is removed
from the water, rate of putrefaction increases greatly
Forensic psychiatry:
(Legal aspect of mental diseases)
It is the branch of medicine which focuses on interface of law & mental health.
Offence: (section 40 PPC)
An act of commission or an act of omission made punishable by the code (law).
Commission: someone has committed something that has not to be committed as commitment of
murder.
Omission: someone has not committed something that he has to commit as it is the legal duty of doctor
to take consent before any treatment. If he does not take consent, it is act of omission.
Requirements of act of commission:
i. Intention  Mens rae (bad intention)
ii. Action  Actus reus
 Mens rae + Actus reus  crime
Legal aspects of mental disease: (section 84 PPC):
Nothing is an offence, which is done by a person who at the time of doing it, by reason of
unsoundness of mind, is incapable of knowing the nature of that, or that he is doing what is either
wrong or contrary to law.
Section 84 PPC is also called NGRI (not guilty by reason of insanity)
Mental health ordinance, 2001 (Ord VIII of 2001):
 Dated 20 Feb 2001
The Lunacy Act, 1912 (IV of 1912) is hereby repealed by mental Health Act
Sec 3 – Federal Mental Health Authority
A chairperson and Members –
i. Secretary, MoH, GOP
ii. Director General, MoH, GOP
iii. Provincial Health Secretaries
iv. Advisor in psychiatry, Med Dte, GHQ
v. Seven eminent psychiatrists of at least 10 yrs good standing
Sec 4 – Provincial Boards of Visitors
A chairperson – a judge of HC and Members –
i. 2 psychiatrists – 1 with min 10 yr experience
ii. 1 prominent citizen of good standing
iii. 2 MPs of repute with min 12 yrs standing (1 nominated by PM & DC)
iv. DG Health of Province/his nominee

Chapter III – Assessment and treatment

Sec 8 – Care & treatment on an informal or voluntary basis
Sec 9 – Durations of period for detention:
a) For assessment under Sec 10 – 28 days
b) For treatment under Sec 11 – 6 months and renewable
c) For urgent admission under Sec 12 – 72 hrs
d) For emergency holding under Sec 13 – 24 hrs
Sec 19 – Mentally disordered persons found in public places:
SHO to remove such person to a place of safety (a govt hosp, psychiatric facility, suitable
relative) for 72 hrs to enable him to be examined by a psychiatrist.
Chapter IV – Leave and discharge
Sec 21 – Discharge of a patient
1) Psychiatrist in charge can discharge a patient in writing at any time during treatment
2) Psychiatrist in charge may discharge a patient upon application if he deems it fit
Sec 22 – Discharge by orders of a magistrate:
Upon application of a patient after inquiry provided the patient is not a mentally disordered prisoner
Sec 23 – Discharge of a detained person
Found not to be mentally disordered after assessment will be discharged forthwith by an
approved psychiatrist of the facility notifying the auth/relatives
Sec 24 – duty of the hospital
To inform relatives of the discharge – preferably 7 days before discharge
Sec 25 – Application to magistrate
For discharge by relatives if admitted under section 10 or 11
Chapter VII – Protection of human rights of mentally disordered persons
Sec 49 – Cases of attempted suicide
To be assessed by psychiatrist for any mental health problem
Sec 50 - Confidentiality
No disclosure to public through press/media unless permitted by the patient
Sec 51 – Informed consent
In writing to be obtained from patient/guardian on prescribed form before starting
investigation/ treatment. This consent can be withdrawn in writing by the person concerned at any time
Chapter X – Forensic psychiatric services
Sec 55 – Forensic psychiatric services
1) Special security forensic psychiatric facilities to be developed by government to house mentally
disordered prisoners/offenders as may be prescribed
2) Admission, transfer or removal of criminal patients will be under administrative control of the IG
(inspector general) prisons
3) The Board of Visitors shall have access to such persons
Chapter XI – Miscellaneous
Sec 61 – Repeal and saving
The Lunacy Act, 1912 (IV of 1912) is hereby replaced.
Lucid interval:
Time period during course of mental disease in which lunatic person becomes mentally stable person is
known as lucid interval. During this interval, he is responsible for his criminal acts.
Guilty but insane:
If an insane person commits a crime, he is not held responsible for his criminal act. He is guilty
but no punishment is awarded.
Policeman at the shoulder:
An insane person may commit a crime even a policeman is standing very near to him but a
normal person does not commit crime in presence of other person.
Unfit to plead:
It is opposite to guilty but insane. In this, person is normal when he committed the crime but
subsequently he becomes insane. In this case, he is not able to defend himself before the court. So the
court sends him to any psychiatry unit for treatment and proceedings of case remain pending till
recovery of patient.
Delusion: false believe
It is very firm belief on something which is not present. For example, a lunatic person may
consider himself as president of the country.
Illusion: false interpretation
Something is present but interpretation is false. For example, in dawn time a person may
interpret a rope as a snake.
Dangerous lunatic:
An insane person who is source of danger for another person is known as dangerous lunatic. As
a lunatic person with brick in his hand in a public place.
Criminal responsibility:
(Liability to punishment)
1) Age:
 Section 82 PPC  a child under age of 7 years will not held responsible for his crimes
 Section 83 PPC  a child between 7-12 years of age will be held responsible for his
criminal act if he got the sufficient mental maturity to know consequences of his act.
 From 12 or above years, a person is held responsible for his criminal act
2) Insanity:
Section 84 PPC  NGRI
3) Intoxication:
If a person is under the effect of alcohol in such a way that he does not know the nature
and consequence of his act, then he is not held responsible for his criminal act provided that he
has not taken the alcohol willfully.
 In cases of natural hazard, when a person is stranded somewhere and alcohol is the only
thing available there and then to save his life he takes alcohol. In this case also, he is not
responsible for his criminal act.
It does not include the willful taking of alcohol.
Diminished criminal responsibility:
Person is responsible for his crime but his punishment is lessened.
Feigned insanity:
Sometimes, a person pretends that he is suffering from some type of insanity to avoid
punishment of his crimes. This type of case is referred to psychiatrist by the court to see whether this
person is really an insane or not.
Difference between true & feigned insanity:
Features True insanity Feigned insanity
Onset Slow/ gradual Sudden
Motive No motive Definitely with motive
Facial expressions Certain expressions on face that No certain facial expressions
express mental disease
Observation No change in behavior whether he is Under observation, person behaves as
under observation or not an insane but without observation, he
becomes normal
Signs & symptoms Point our towards a certain disease Don’t point towards certain disease
Violent exertion Person is physically very powerful Feel tired after violent exertion
and by violent exertion he does not
feel tired
Habits Filthy habits. He may void urine & No filthy habits
feces on bed
Physical manifestation Certain facial expressions, dry skin, Does not occur
of insanity insomnia, anorexia, constipation
Repeated examinations Not mind repeated examinations Mind repeated examinations
McNaughten’s rule:
“To establish a defense on grounds of insanity, it must be clearly prove that at the time of
committing the offence, the party accused was laboring under such a defect of reason from disease of
mind, as not to know the nature and quality of that he was doing, or if he did know it, that he did not
know he was doing what was wrong.” Also known as NGRI (section 84 PPC).
He does not know right from wrong test. McNaughten’s rule is established in 1834 in England
where a person named McNaughten killed PA of prime minister, thinking that prime minister is
responsible for his joblessness. He was suffering from a mental disease
Durham rule:
It is formed in 1954 in USA. “An accused is not criminally responsible if his unlawful act is the
product of his mental disease.”
Civil responsibilities of insane:
1. Management of property  court appoints a manager to look after property of insane person.
2. Contracts  contracts made by insane are invalid
3. Marriage & divorce  marriage contract made by insane is null & void
4. Witness  can not appear before court as witness
5. Consent  invalid consent
6. Testamentary capacity  it is capacity to make a valid will.
Testamentary capacity:
 i. Major (mature)  18 years or above
ii. insane person does not have testamentary capacity
iii. Nature & consequence of act
iv. Detail of property  he should know details of his property
v. Undue influence  he should not under influence of other person
vi. 2 witnesses
Criminal responsibilities of insane person:
1) Use of violence
2) Sexual offences/ perversions/ deviations
Legal aspects of medical practice (LAMP)
Medical negligence:
“Lack of exercise of proper degree of skill and care in diagnostics and/or therapeutic techniques
expected of a physician of one’s own standing & repute leading to damage.’’
Damages are claimed in court for damage.
 Damage should be there for medical negligence.
“Lack of reasonable care & skill or willful negligence on the part of medical practitioner in the
treatment of a patient, where by health or life of the patient is endangered.’’
Liabilities of doctor:
i. Control of professional conduct by PM&DC.
ii. Civil law & action damages brought by police.
iii. Criminal liabilities  grievous injury or death occurs.
iv. Other aspects of professional conducts.
a) Professional confidentiality/privileged communication:
Professional confidentiality  any information which comes to know to doctor during history
taking & examination should not be communicated to any other person. It is legal duty of doctor
to keep secrets to him.
Privileged communication  in this doctor is allowed to communicate this secret information
under certain circumstances. For example, court may ask about any information of patient and
this information in handed over to court directly in sealed written form.
In communicable disease, doctor can tell DHO about the disease, to prevent the further
spread of epidemic.
b) Defamation:
Case of defamation may be put before court against doctor if he communicates any
information regarding patient.
c) Gift to doctor:
Gifts are allowed but of ordinary nature.
Res ipsa loquitur:
(Things speak for itself)
According to principles of justice,
i. Every person is innocent unless & until proved otherwise.
ii. It is duty of complainant to prove his case beyond doubt
 Burden of proof rest upon the patient, except res ispa loquitur.
For example, during operation doctor left any instrument inside the body of patient. This is case
of res ipsa loquitur. In this case, doctor has to prove that he is not medical negligent.
Professional secret/ confidentiality:
 There is no legal compulsion on a doctor to provide information concerning a criminal abortion,
venereal disease, attempted suicide or concealed birth regarding his patients to any other individual or
organization.
Issues involved in medical negligence:
1. Duty of care  whether duty of care is established or not. If a patient dies on his way to doctor,
then duty of care is not established.
2. Standard of care  according to qualification & experience of doctor
3. Duty to exercise care & skill  according to qualification & experience of doctor
4. Duty to obtain consent  legal duty of doctor to take consent before any procedure
5. Duty to keep abreast of technical knowledge  doctor should know the modern technology
6. Duty to use indicated diagnostics aids  if a person comes to a doctor with history of fall and
swelling on any joint, it is duty of doctor to prescribe X-ray.
7. Defensive medicine  when a doctor without any definite diagnosis gives multiple medicines to
a person for treatment of a disease, it is known as defensive medicine. For example, a person
comes to doctor with pain abdominal & doctor give him antibiotic, APD, spasmolytic drugs and
antacids.
8. Respondeat superior/ vicarious responsibilities  it means that the senior most person will be
held responsible for any irregularity occurring under him. As principal of college is responsible
for what is done in premises of college.
9. Res ipsa loquitur  things speak for itself
10. Abandonment & further treatment  don’t abandon your patient either treat him or discharge
him or refer him to any specialist/ consultant
Damages claimed:
i. Physical injury
ii. Pain  excessive pain due to negligence of doctor
iii. Mental sufferings
iv. Loss/ impaired earning capacity
Types of medical negligence:
1) Civil: In civil negligence, patient can claim damages against the doctor in civil court for wrong
treatment, undue prolongation of treatment, undue suffering. In this, punishment is not
awarded but compensation is awarded.
2) Criminal: Criminal negligent cases result in punishment for criminal acts e.g. grievous injury,
wrongful death, and criminal abortion.
Contributory negligence: The patient & doctor both are responsible.
Third party negligence: Negligence by relative/ nursing staff.
Proof of medical negligence:
i. Duty of care  whether duty of care is established or not. If a person dies in boundary of
hospital but he has not reached to the doctor, then duty of care is not established.
ii. Breach of duty of care  as doctor during operation leaves operation in middle and goes for
lunch or somewhere else
iii. Damages resulting due to breach of duty
iv. Breach of duty without any new intervening act (novus actus interveniens)  completely new
incident occurs during treatment. For example, there is fight between two persons and one
person gets fracture of radius. An ambulance is called, during transfer of this patient to the
hospital ambulance has an accident and patient dies. The person who has inflicted the injuries
will not be totally held responsible for his death.
v. Translation of damages in terms of compensation/ punishment  the court will decide what
compensation is awarded to complainant. In civil cases, compensation is awarded but in criminal
cases, punishment is awarded.
Examples of medical negligence:
 1) Unexplained leaving the instrument or swab in the patient’s body during operation (res ipsa
loquitur)
2) Leaving patient unattended (patient falls and sustained injuries) /during labor
3) Failure to administer anti-tetanus injection where indicated as in case of road side accident
4) Failure to diagnose fracture by not using X-ray
5) Damage to major nerves/ arteries during operation
6) Failure to remove placenta, decomposition of which may lead to death
7) Operation without consent
8) Warrantee a cure
9) Bleeding to death after an operation (criminal negligence)
10) Using non-sterile instruments
11) Neglecting patients on the plea of having more patients that could be taken care of
Criminal negligence:
i. Death of the patient due to medical negligence
ii. Operation on wrong patient
iii. Operation on wrong limb & removal of wrong organ
iv. Amputation of wrong organ e.g. finger, limb
v. Giving wrong blood transfusion
vi. Gangrene or paralysis after too tight plaster of Paris
Common surgical negligence:
1. Retained objects
2. Surgical errors as ligation of ducts
3. Paralysis from splints
4. Wrong patient
5. Wrong side
6. Tight plaster casts
7. Anesthetic mishaps
8. Transfusion mistakes
9. Removal of wrong organ
10. Wrong digit
11. Failure of X-ray to diagnose fractures
Legibility of prescription:Writing should be legible so every person can read.
Consent:To give permissions; to agree upon; voluntary agreement when two or more persons agree
upon same thing in the same sense, it is said to be consent.
Types of consent:
1. Implied (understood, indirect, unspoken):
As you are in your clinic and a person comes and sit near you & starts to explain his
problem. It is implied consent.
2. Expressed:
 Oral  admissible before court but has no proof so it is not preferred.
 Written  it is of two types:
i. Blanket consent: everything is covered. It is invalid before court
ii. Informed consent: everything is told to patient
Expressed consent:
i. Oral: both admissible before court but written is better.
ii. Written: both admissible before court but written is better.
Written consent is must in following cases:
a) Operative procedures.
 b) Examination of genitalia.
c) Medico-legal examination cases.
d) Rights of spouse(both husband/wife)
Informed consent: (rule of full disclosure)
Full information is given to the patient about:
i. The disease.
ii. Diagnostic technique/tests.
iii. Risk involvedany disability can occur.
iv. Prognosis(chances of recovery)
v. Alternative treatment methods present.
Invalid consent:
i. Age  minimum age of consent is 12 years. Consent taken under 12 years of age is invalid
ii. Insanity  consent taken by insane person is invalid.
iii. Intoxication  consent taken under effect of alcohol in such a way that he does not know the
nature and consequence of his act is invalid.
iv. Unlawful act  consent taken for unlawful act is also invalid as in cases of sodomy & criminal
abortion.
v. Impersonation  consent taken by impersonation is also invalid.
vi. Fear/fraud/force  taken by these is invalid.
vii. After the act  as after operation or examination of patient.
viii. Blanked consent  as a person says that I am ready to go under any operation under any
anesthesia by any surgeon and I will be responsible for consequences.
Section 90 PPC:
Consent known to be given under fear or misconception: A consent is not such a consent as is intended
by any section of this Code, if the consent is given by a person under fear of injury, or under a
misconception of fact, and if the person doing the act knows, or has reason to believe, that the consent
was given in consequence of such fear or misconception; or
Consent of insane person: If the consent is given by a person who, from unsoundness of mind or
intoxication is, unable to understand the nature and consequence of that to which he gives his consent;
or
Consent of child: Unless the contrary appears from the context, if the consent is given by a person who
is under twelve years of age.
Section 92: Act done in good faith for benefit of a person without consent:
Nothing is an offence by reason of any harm which it may cause to a person for whose benefit it
is done in good faith, even without that person's consent, if the circumstances are such that it is
impossible for that person to signify consent, or if that person is incapable of giving consent, and has no
guardian or other person in lawful charge of him from whom it is possible to obtain consent in time for
the thing to be done with benefit; provided:
Firstly: That this exception shall not extend to the intentional causing of death, or the attempting to
cause death;
Secondly: That this exception shall not extend to the doing of anything which the person doing it knows
to be likely to cause death, for any purpose other than the preventing the death or grievous hurt, or the
curing of any grievous disease or infirmity;
Thirdly: That this exception shall not extend to the voluntary causing of hurt, or to the attempting to
cause hurt, for any purpose other than the preventing of death or hurt;
Fourthly: That this exception shall not extend to the abetment of any offence, to the committing of
which offence it would not extend.
Compulsory medical examination:
 Consent is required before treatment but in certain cases it is not required as in cases of:
i. Prisoners in jail
ii. Orders of magistrate
iii. Notifiable diseases  corona, polio
iv. Immigrants
v. Food handlers/ dairy workers
vi. School health service
Laws of interest of medical profession:
Pakistan Penal Code (PPC) – 1860:
Chapter II – General explanation:
Sec 52 – Good faith:"Nothing is said to be done or believed in good faith which is done or believed
without due care and attention."
Example: When a person, uneducated in matters of surgery, operated on a man for internal piles by
cutting them out with an ordinary knife, and the man died from hemorrhages, it was held that he did
not act in good faith although he had performed similar operations on previous occasions.
Chapter IV – General exceptions:
Sec 80:“Nothing is an offence, which is done by accident or misfortune and without any criminal
knowledge or intention in the doing of a lawful act in a lawful manner by lawful means and with proper
care and caution”.
Sec 93 – Communication made in good faith:
“No communication made in good faith is an offence by reason of any harm to the person to whom it is
made, if it is made for the benefit of that person”.
Example: A surgeon in good faith communicates to a patient his opinion that he cannot live. The patient
dies in consequence of shock. The surgeon has committed no offence, though he knew it to be likely
that the communication might cause the patient’s death.
Chapter XI – Of false evidence and offences against public justice:
Sec 193 – Punishment for false evidence:
“Whoever intentionally gives false evidence in any stage of a judicial proceeding or fabricates
false evidence for the purpose of being used in any stage of a judicial proceeding, shall be punished with
imprisonment of either description for a term which may extend to seven years, and shall also be liable
to fine; and whoever intentionally gives or fabricates false evidence in any other case, shall be punished
with imprisonment of either description for a term which may extend to three years, and shall also be
liable to fine”.
Sec 197 – Issuing or signing false certificate
“Whoever issues or signs any certificate required by law to be given or signed, or relating to any
fact of which such certificate is by law admissible in evidence, knowing or believing that such certificate
is false in any material point, shall be punished in the same manner as if he gave false evidence
(imprisonment for 7 years & fine)”.
Chapter XIV – Offences affecting the public health, safety, convenience and morals:
Sec 270 – Malignant act likely to spread infections or disease dangerous to life:
“Whoever malignantly does any act which is, and which he knows or has reason to believe to be
likely to spread the infection or any disease dangerous to life, shall be punished with imprisonment of
either description for a term which may extend to two years, or with fine, or with both”.
Sec 274 – Adulteration of drugs:
“Whoever adulterates any drug or medical preparation in such a manner as to lessen the
efficacy or change the operation of such drug or medical preparation, or to make it noxious, intending
that it shall be sold, used for, or knowing it be likely that it will be sold or used for, any medicinal
purpose, as if it had not undergone such adulteration shall be punished with imprisonment of life with
fine which may extend to one thousand rupees, or with both”.
Chapter XVI – Offences affecting the human body, offences affecting life:
Sec 325 – Attempted suicide
Whoever attempts to commit suicide and does any act towards the commission of such offence
shall be punished with simple imprisonment for a term which may extend to one year, or with fine, or
with both.
Sec 337-J – Causing hurt by means of a poison
Whoever administers to or causes to be taken by any person, any poison or any stupefying,
intoxicating or unwholesome drug or such other thing with intent to cause hurt to such person, or with
intent to commit or to facilitate the commission of an offence, or knowing it to be likely that he will
thereby cause hurt, may, in addition to the punishment of arsh or daman provided for the kind of hurt
caused, be also punished, having regard to the nature of the hurt caused, with imprisonment of either
description for a term which may extend to ten years.
Sec 337-L – Punishment for other hurt
(1) Whoever causes hurt, not mentioned hereinbefore, which endangers life or which causes the
sufferer to remain in severe bodily pain for twenty days or more or renders him unable to follow his
ordinary pursuits for twenty days or more, shall be liable to daman and also be punished with
imprisonment of either description for a term which may extend to seven years.
(2) Whoever causes hurt not covered by sub-section (1) shall be punished with imprisonment of either
description for a term, which may extend to two years, or with Daman or with both.
Pakistan Medical & Dental Council: (Act 1975)
Reconstituted from PM & DC Ord 1962
The medical & dental council of Pakistan exists to maintain the register of medical and dental
practitioners, regulate the standards of medical practice, protect the interests of the patients, supervise
medical education and given guidelines on ethical issues.
The Pakistan Medical and Dental Council was duly constituted under the Medical & Dental
Council Ordinance No. XXXII, 1962, in June 1964 and is empowered to:
a) Look after Public interest – by maintaining proper medical /dental standards.
b) Supervise Medical/Dental Education in the country.
c) Maintain a register of qualified doctors and dentists, qualifying from duly recognized
institutions.
d) Take such disciplinary actions, which may be required for criminal convictions or serious
professional misconduct of a doctor. The Council is not an Association or a Union for protecting
professional interests.
Proficiency of medical profession:
i. Evaluation of course of studies of medical qualification.
ii. Minimum qualification for medical teachers.
iii. Inspection of medical institutions & examinations by appointing inspectors.
Sec 29 – Privileges of an RMP(registered medical practitioner)
i. Acquire a job in Govt /Army services
ii. Medical certificates signed by RMP/RDs are legally valid
iii. Can go to Court to claim medical charges for medical/dental services rendered to any person
Sec 30 – Responsibilities / obligations of RMP/RD
1) Notify any change in address/place of practice within 30 days in writing.
2) Not use any name, title, description or symbol so as to lead a person to believe that he
possesses extra qualifications which are not conferred / granted to him.
Sec 31 – Removal of name from Register
i. If convicted of any offence as implies a defect of character by the Council.
ii. If found guilty of infamous conduct in any professional respect after inquiry.
iii. If shown unfit to continue in medical practice on account of mental ill health or other grounds
The Council can also restore names to register if deemed fit.
Serious Professional Misconduct
Anything done in pursuit of profession by a medical man which will be reasonably regarded as
disgraceful or dishonorable by professional colleagues of good repute and competency.
Examples:
i. Criminal conviction involving moral turpitude
ii. Adultery with patients
iii. Criminal abortion
iv. Use of alcohol
v. Association with unqualified persons
vi. Advertising
vii. Dispensing controlled drugs
Duties of medical and dental practitioners: (International code of Medical Ethics)
Duties of physicians in general:
1. Maintenance off highest standards of professional conduct
2. Active participation in continuous medical education
3. Motives of profit
4. Provision of competent medical services in full technical and moral independence, with
compassion and respect for human dignity
5. Dealing honestly with patients and colleagues and strive to expose those physicians who are
deficient in character or competence or who engage in fraud or deception
Duties of physicians to the sick:
i. Preserving human life
ii. Complete loyalty and use the resources of science
iii. Referral of patients
iv. Professional secrecy
v. Emergency care as a humanitarian duty
Duties of physicians to each other:
1) Proper behavior
 2) Entice patients from his colleagues
3) Gratis treatment to colleagues, their spouse & children.
Euthanasia:(Mercy killing)
“A gentle and easy death.”
“The means of bringing about a gentle and easy death.”
“The action of inducing a gentle & easy death; putting painlessly to death of those suffering from
incurable & extremely painful diseases.”
Example: As a person suffering from hydrophobia or last stage cancer and is in incurable pain and doctor
knows that he will not survive then gentle and easy death in induced.
Euthanasia: “Easy death”
“Euthanasia is the deliberate killing of a person for the benefit of that person.”
“The act or practice of killing or permitting the death of hopelessly sick or injured individuals in a
relatively painless way for reasons of mercy.”
“The intentional termination of the life of one human being by another, suffering from incurable
or painful disease.”
“The practice of terminating the life of a person with an incurable disease, intolerable suffering,
or a possibly undignified death in a painless or minimally painful way, for the purpose of limiting
sufferings.”
Types of euthanasia:
1. Passive euthanasia:
Passive euthanasia is withholding common treatments (such as antibiotics, drugs or surgery)
or giving a medication such as morphine to relieve pain or removing the ventilator, knowing that it
may also result in death of patient.
2. Aggressive (active) euthanasia:
Using lethal substances or force to kill a person. For example, a heavy dose of suppressant
medicine is given.
Assisted suicide:
(Physician-assisted suicide)
“The patient self-administers the lethal dose that has been produced by a physician who knows
the patient intends to use it to end his or her life.”
It is allowed in some countries. When a person doesn’t want to live anymore, he commits
suicide by consulting a doctor and doctor advice him a lethal dose of medication.