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In 1971 Dr Norman Guthkelch hypothesised a causal link between shaking infants, a relatively common practice in the UK at the time, and findings of retinal and subdural haemorrhage with no or minimal of trauma (see Chapter 2). The link between shaking and a ‘triad’ of retino-dural haemorrhage and encephalopathy would come to be known as shaken baby syndrome (SBS). This book has taken a broad overview and analysis of the state of SBS, addressing global medical, scientific, social, and legal aspects of the determination.
Shaken baby syndrome/abusive head trauma struggles to find a solid scientific foundation, largely because of a circularity confound, the same diagnostic features under study serve as the basis for categorising cases for research purposes. In an attempt to overcome this circularity, researchers have turned to confessions as a sorting criterion in the research, under the belief that confessions are independent of the diagnostic features and hence not subject to circularity. However, none of the research examines the nature and reliability of the confessions, or the interrogations that produce them; they simply accept the confessions as true, reliable, and independent. Research on interrogations and false confessions, however, along with extensive and wholly consistent anecdotal evidence, strongly suggest that SBS/AHT confessions are largely if not entirely produced by interrogator reliance on the diagnostic findings. That reliance undermines both the independence of the confessions, and hence their ability to break free from circularity, and the reliability of these confessions as a group. On the current state of knowledge, confessions cannot be relied upon to substitute for science to support the SBS/AHT hypothesis.
As humans, our perceptions and judgements are naturally coloured by our beliefs, experiences, and desires. Consequently, two individuals with different mindsets or working in different contexts may interpret the same information in markedly different ways (i.e., cognitive bias), especially when that information is ambiguous. In forensic and medico-legal settings, cognitive bias can influence expert decision-making in ways that produce costly miscarriages of justice. In this chapter, we first review the sources of cognitive bias, including irrelevant contextual information, base rate expectations, stress, and allegiance. Then, we review research showing that cognitive bias can affect medical diagnoses of living individuals as well as post-mortem manner-of-death judgments, and we discuss the reactions to these findings. Lastly, we describe best practices for mitigating the impact of cognitive bias and maximising the value of medico-legal judgments.
New scientific developments, addressed throughout this book, which challenge the SBS hypothesis present challenges for courts that relied upon the outdated and unchallenged hypothesis to convict caregivers of child abuse. The law is notoriously slow to respond to scientific advances, and its strong fealty to finality makes reopening old convictions, even those that are dependent on flawed science, procedurally difficult. This chapter addresses the challenges posed for courts by shifting SBS science and analyses the bases, and slowly developing movement to reopen old SBS convictions based upon outdated and flawed science.
Since the early 2000s, a growing body of scientific studies in neuropathology, neurology, neurosurgery, biomechanics, statistics, criminology and psychology has cast doubt on the forensic reliability of medical determinations of Shaken Baby Syndrome (SBS), more recently termed Abusive Head Trauma (AHT). Studies have increasingly documented that accidental short falls and a wide range of medical conditions, can cause the same symptoms and findings associated with this syndrome. Nevertheless, inaccurate diagnoses, unrealistic confidence expression, and wrongful convictions continue to this day. Bringing together contributions from a multidisciplinary expert panel of 32 professionals across 8 countries in 16 different specialties, this landmark book tackles the highly controversial topic of SBS, which lies at the intersection of medicine, science, and law. With comprehensive coverage across multiple disciplines, it explains the scientific evidence challenging SBS and advances efforts to evaluate how deaths and serious brain injuries in infants should be analysed and investigated.