Medicolegal Principles: What Part Does Ethics Play?

What are the principles of medicolegal ethics?

The principles of medicolegal ethics are highlighted during all our training programs for the benefit of our students: the medical expert shall base their opinion on all the evidence at the disposition, remaining within the field of their speciality.  It is very important to deliver unbiased, non-partisan opinions.  Too often, the medical experts are obeying the demands of the requesting party, giving a biased opinion, to help a lawyer winning their case.  Sometimes, the biased opinion is difficult to detect, when the reasoning seems appropriate but relies only on selected items in the medical brief of a patient.

I have seen too often medical experts lying in Court under oath, thinking that they are doing their duty, helping the lawyer that instructed them to win the case.

It is the reason why the UK Supreme Court of UK, in 2001, (Jones v Kaney) suppressed the immunity of the medical experts; since then, experts in the UK are liable for negligence if giving a biased or false opinion.

Medical experts are often biased, because if they do not give the opinion requested by the requesting party, they fear not to be paid or to lose customers.

Why is the International Court of medical ethics important?

The Canadian Society of Medical Experts and the Insurance Medicine and medicolegal expertise program at the University of Montreal decided, in 2011, to write an international code of medical ethics good for Canada and all countries who desire to promote ethical principles for medicolegal experts.  This bilingual code took over one year to be written and was adopted by both societies.   This international code of medicolegal ethics describes, step by step, what trained and unbiased medicolegal experts shall do when giving a written opinion.

Can you share when ethics can go wrong in medicolegal cases?

I spoke above about the expert lying in Court to help the lawyer’s client to win their case. I asked this expert, a professor at the university, if he would repeat to his residents what he just had told the Judge: “Of course not”, he said, “I just wanted to help this gentleman…”.

I also mentioned that some experts do conduct proper reasoning, but only on selected items of the medical brief; this untruth is more difficult to detect, as the reasoning appears correct yet the medical file has not been considered in totality.

Medical experts are often biased, because if they do not give the opinion requested by the requesting party, they fear not to be paid or to lose customers.

Lawyers should request from their medicolegal experts to provide a truly scientific opinion, and not to give a biased opinion just to win the case.

How do you advise lawyers when you are trying to assess whether medicolegal ethics have been breached? What is your process?

The first thing I can recommend to lawyers is to verify that the summary of the medical brief made by the expert is not purposely omitting some important data contained in the medical brief.  Second, I would mention to the lawyer if the reasoning has been adequate; this is important when dealing with causation: has all of the imputed criteria been dealt with?

Lawyers should request from their medicolegal experts to provide a truly scientific opinion, and not to give a biased opinion just to win the case.

Do you face any challenges with the above and how do you handle this?

In Europe, academic training is mandatory if you want to be a medicolegal expert; European countries are trying to bring more uniformity in the certification and recertification of their medical experts.

In 2015, Canada’s Royal College of Physicians refused to implement a medicolegal expertise diploma, thinking this could jeopardize the practice of medical experts… thus keeping lying experts providing opinion in Court.

It is a shame that the Canadian Royal College of Physicians, who should control and improve the standards of the medical practice in Canada, refused to create this diploma, which could have improved the quality of medical expertise across the country.

F. Sestier MD, PhD, CIME, FACC, FRCP(C), DBIM, DESS

Staff cardiologist CHUM

Clinical professor of medicine

Faculty of Medicine, University of Montreal

Member of the « Société des Experts en Évaluation Médicolégale du Québec» (SEEMLQ)

Post-graduate diploma in Medicolegal expertise, University of Montreal (DESS)

Member of the Canadian Society of Medical Experts (CSME)

Diplomat of the American Board of Insurance Medicine (DBIM)

Certified Independent Medical Examiner, USA (CIME)

Lic. : 174536

I am Dr François Sestier.  I am a cardiologist by training; I have also been a medical expert for the last 30+ years. Since 1999, I have worked at the University of Montreal and have been involved in the development of a university program for both for medical experts and for medical officers employed by insurance companies.  I headed this online bilingual program (English and French) from 1999 until April 2018. Close to 500 physicians have graduated from our programs in order to become better experts or well-trained medical officers for insurance companies; this includes 3 PhD, 7 MScs and 64 post-graduate diplomas students.