"Morphology is a witness which doesn't lie": Diagnosis by similarity relation and analogical inference in clinical forensic medicine

In this paper, I utilise semi-structured interviews with Forensic Medical Examiners (FMEs) in Scotland in order to investigate their diagnostic work. Drawing upon classic medical sociological work on diagnosis (for instance, the work of Paul Atkinson and Michael Bloor), my understanding of diagnosis is as a subjective, but socially-constructed activity whereby medical practitioners are taught to identify (in this case) injury types, initially by ostension, then also by examination. I then extend the analysis postulated within the classic studies by outlining a mechanistic method for the actual cognitive process of diagnosis, drawn from a sociologically informed reading of the historian of science, Thomas Kuhn. It is argued that diagnosis is achieved by similarity relation (comparing new cases to those previously observed), and analogical reasoning (drawing inferences based on the analogy with previous cases). Given that new cases subtly alter the individual FME's classificatory schema, resulting in potential differences in diagnoses, the FME community are required to conduct much reparative work in order to construct their evidence as consensual and factual, as is required by law. The paper will conclude with some brief comments on the future of forensic medical examinations, particularly concerning the fact/opinion distinction. (C) 2011 Elsevier Ltd. All rights reserved.