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Forensic Medicine in Estonia

Author: Marika Väli
Professor of forensic medicine of the University of Tartu
Deputy Director of the Estonian Forensic Science Institute

I Introduction
The merger of two institutions of forensic expertise in 2008 had a positive impact on the development of forensic medicine in Estonia. That brings about the usage of more versatile methods of investigation and better opportunities for the cooperation between different specialists.
The objective of Estonian forensic medical doctors is to accredit their field and to develop new scientific methods of investigation that would help to develop the legal system in Estonia. Since 2010, the newest methods of investigation in use are the computed tomography and magnetic resonance tomography examinations that are used in order to determine the cause of death and generation mechanism of injuries.

II History of forensic medicine and forensic science in Estonia
Forensic medicine has been taught in the University of Tartu since 1802, which makes it one of the oldest subjects in the re-opened University. At first, forensic science was lectured by the professors of other medical specialties, and that also meant that the Chair of Forensic Medicine was closely linked to other specialities, such as anatomy, histology, hygiene, etc.
In 1895, the Institute of Forensic Medicine was founded by Professor Afanassi Sergejevitś Ignatovski. That year is considered to be the birth of forensic medicine as an independent specialty in Estonia. Under Ignatovski's professorship, the special courses of autopsy technique were commenced. In the independent Estonia, the Chair of Forensic Medicine was lead by Siegfried Talvik and Gerhard Rooks. Under their leadership, the legislation was amended so that the right of the forensic-police doctors to perform forensic medical expert analyses was also extended to the lecturers of the Institute of Forensic Medicine at the University of Tartu. Also the Library of Forensic Medicine and the Museum of Forensic Medicine were founded. In these regions where there were no forensic-police doctors, the duties of forensic-police doctor were given to county or town doctors in 1927. During the same period the research in the field of forensic medicine greatly intensified. In 1935, the first Forensic Medicine Act was passed, as a result of which both in Tartu and in Tartu County the duties of forensic-police doctor were fulfilled by the Head of the Institute of Forensic Medicine at the University of Tartu.
The occupation of Estonia by the Soviet Union brought along the Soviet system of forensic medicine that was founded in Soviet Russia in 1919. At the end of 1944, the position of the chief expert of forensic medicine was created, and in the healthcare departments of “state-managed” cities and counties the positions of forensic experts were created. In 1950s and 60s, the conducting of forensic medical expert analysis was complicated since there were no trained forensic medical experts and autopsies were performed by the doctors of other specialities, which resulted in a number of exhumations. In the Soviet era the continuous training of Estonian forensic pathologists took place in Russia (mostly in Leningrad, the present name of which is SaintPetersburg). In 1991, after Estonia had regained its independence, we started to make contacts with the colleagues from other European countries. In 1993, the institution in charge of the forensic medical expert analyses was renamed to the Bureau of Forensic Medicine of Estonia. Furthermore, in 2002, it was removed from the jurisdiction of the Ministry of Social Affairs and it was turned into a government authority under the jurisdiction of the Ministry of Justice.

III Current structure of medical-legal (forensic) service in Estonia

In Estonia, there are two different institutions of forensic medicine which are managed by two different ministries: Estonian Forensic Science Institute is under the jurisdiction of the Ministry of Justice and Institute of Pathological Anatomy and Forensic Medicine is under the jurisdiction of the Ministry of Education and Research.

ESTONIAN FORENSIC SCIENCE INSTITUTE

The Estonian Forensic Science Institute is a state agency established on 1 January 2008 which is administered by the Ministry of Justice.
The principal objectives of the institute are the provision of forensic science expertise in criminal cases according to the competence, the development of the fields of forensic science, the forensic training of police agencies and consultation on matters related to the duties of the institute, and the administration of national databases and registers.
The institute comprises its Forensic Science Departments, the DNA Department, the Document Department, the IT-Department, the Chemistry Department, the Fingerprint Department, the Crime Scene Department, the Traffic Department, the Technical Department, the Forensic Science Division of the Security Police, the Forensic Psychiatry Division, the Economy Division, the Administration Division, the Quality Division and the Personnel Division
.
The quality system of the Estonian Forensic Science Institute is based on two internationally recognized standards: EVS-EN ISO/IEC 17025:2006 General requirements for the competence of testing and calibration laboratories (ISO/IEC 17025:2005) and EVS-EN ISO 9001:2008 Standard for Quality Management Systems (ISO 9001:2008). Estonian Forensic Institute has competence according to EN ISO/IEC 17025:2005 to conduct tests in the field of toxicology analyses of human biological materials (accredited from 14.01.2003), and DNA analyses (accredited from 27.04.2006), registration number L127.
There are four regional departments of forensic medical expertise: North Estonian department, South Estonian department, East Estonian department and West Estonian department. In all four regional departments, the forensic medical expert analyses of living persons and corpses are performed. As of 1 January 2010, there are 17 forensic pathologists (including one forensic histologist), 1 forensic toxicologist and 1 expert of forensic anthropology.
In 2007, the implementation of a system of professional qualification standards was launched. Forensic pathologist’s qualification will be reviewed once in every five years. In addition to work experience, self-education, continuous training and participation in the development of the speciality are taken into account upon determining the professional ranking.
Forensic pathologists identify physical and sexual violence. The person sent to expertise by the employee of a law enforcement authority may be a victim, an accused, or a suspect.

Expert analysis on living persons is performed to determine the existence of damage to health (injuries), how it was caused, its duration and time of generation, state of health, medical malpractice, sex offence crimes, general permanent disability, and other medicine related issues.

Forensic medical expert analysis is appointed in order to determine the state of health, when it is necessary to identify, whether the person’s physical (non-psychological) illness precludes the person from participating in procedures of the investigation, appearing in court, suffering the consequences, etc.
In Estonia, all cases of death caused by mechanical, physical, chemical, biological or other external factors (asphyxia, immersion deaths, falls, electrical fatalities, poisoning, transportation injuries, hypothermia, hyperthermia, etc) are subjects to the forensic medical autopsy. Forensic medical expert analysis of dead body is appointed when there is evidence of a crime on a body or when there is a suspicion of a crime. A forensic medical autopsy is appointed, when no crime is suspected and the death is caused by external factors, or when there is a suspicion of crime, or in case of late post-mortem alterations, or when the identity of the deceased is unknown.
Additionally, forensic anthropological expert analysis is performed in the Estonian Forensic Science Institute to determine the cause of death and the mechanism of trauma on human skeletons or on the parts of the skeleton. For that reason the trassologic, ballistic, person identification, micrologic and event reconstruction analyses are performed.
In addition, also medical toxicology expert analyses and examinations are performed, and as of 1 October 2010, there will be a possibility to perform the forensic radiology expert analyses and examinations.
The forensic medical doctors can order the examinations from different laboratories of the Institute on the basis of their referrals.
The number of forensic medical expert analyses, as well as the number of expertise reports and examinations of forensic chemistry and biology is much depending on the current law in force in the country. Until 2005, an average of 3500 forensic medical expert analyses of corpses and 2500 forensic medical expert analyses of living persons were carried out annually. But now these figures are an average of 1000 forensic medical expert analyses on corpses and 2000 forensic medical autopsies, and 1000 forensic medical expert analyses of living persons, 30 forensic anthropological expert analyses and examinations and 100 expert analyses and examinations of forensic toxicology.
During the past years, the number of forensic medical expert analyses of living persons has dropped significantly due to the amendments in law in 2003.
In 2009, the rate of forensic medical expert analyses of dead bodies per 100 000 citizens was in case of forensic medical autopsies 138.6 and in case of forensic medical expert analyses of living persons was 43.7.
All departments of the Estonian Forensic Science Institute are located in newly renovated rooms and have modern equipment.

The Institute of Pathological Anatomy and Forensic Medicine of the University of Tartu

The Chair of Forensic Medicine employs two assistants and one professor. Two PhD students have chosen forensic medicine as their research subject.
The main function of the university teaching staff is to perform the studies of the medical and dentistry students of the Faculty of Medicine and to organize the theoretical and practical studies for residents.
During past few years, one Doctoral thesis has been defended in the Chair of Forensic Medicine. The subject of the Doctoral thesis was
"Alcohol related molecular and pathomorphological damages of brain and heart and its pharmacological prevention".
In 2010, a Doctoral thesis titled
"Forensic medical differentiation of injuries caused by the pistols Tokarev, Makarov and Glock 19" will be defended.
There are two Doctoral theses in progress: "Clinical findings and significant biochemical tests of acute ethyl alcohol intoxication in different age groups of children" and “Changes in the inner organs caused by acute and chronic consumption of ethanol and its surrogates, and their correlation with various biochemical indicators on men between ages 25-45”.
The study costs of the students are covered by state; the research is financed from research project grants.

IV Teaching of forensic medicine and forensic science
Forensic medicine is taught to the sixth year medical students and the fourth year dentistry students; the extent of the subject for the medical students is 2 credit points, and for the dentistry students 1 credit point. Until 2004, the subject was included in the curriculum of law students with an extent of 1.5 credit points, but due to the reforms in the university the subject was omitted.
In the Estonian Public Service Academy, the forensic medicine is taught in the extent of 1.5 credit points.
To become a forensic pathologist, a person who has graduated from the Faculty of Medicine has to enrol into a four year pathology residency programme, which consists of one year study of pathological anatomy and three year study of forensic medicine. The academic personnel of the institute are also involved in the theoretical training of the residents.

V Key personalities in Estonia as part of forensic medicine and forensic science
One of the subjects is correlation between suicides and accidents and alcohol intoxication that was investigated by Siegfried Talvik (1878‑1929). Under his leadership a manual of autopsies was compiled and first laboratory expert analyses were performed.
Professor Gerhard Rooks (1901‑1975) published several articles on gunshot wounds, which is currently also a subject of a PhD student’s Doctoral thesis. Under Rooks’s guidance, the collection of the macropreparations for the Museum of the Chair of Forensic Medicine was commenced. We consider the collection very valuable and we are still proud of it even today.
The main research subject of Professor Alma Raatma (1901‑1967) was handwriting expert analyses, but she also studied suicides and infanticides, as well as she carried out a research on distinction between ante-mortem and post-mortem injuries. In 1940‑1941 she was also the chief expert of forensic medicine.
In 1949, the Faculty of Forensic Medicine was merged with the Faculty of Psychiatry, and as a result of this the psychiatrist Elmar Karu (1903‑1996) became the head of the Faculty. He conducted research on forensic psychiatry and also lectured several courses for the students of law. What is more, he investigated the problem of alcoholism and predicted that the fight against alcohol abuse and alcoholism will be complicated, and that it may be too late to take various necessary measures.
Assistant professor Eugen Murašev (1914‑1986) studied head traumas, including the mechanism and the determination of generation time of subarachnoidal haemorrhages.
Since 1971, the Chair of Forensic Medicine forms a combined institute with the Chair of Pathological Anatomy. Even though the Chair of Forensic Medicine has often been merged with other chairs of the university, the speciality has tried to maintain its characteristic features and tight collaboration with practical forensic medicine that has contributed to its scientific progress.
In 2004, Professor Marika Väli became the head of the institute and under her leadership the effects of alcohol to human organism have become the central subject of research in the Chair of Forensic Medicine. In 1998‑2005, Marika Väli was the chief expert of the Bureau of Forensic Medicine of Estonia, and since 2008, she is the Deputy Head of the Estonian Forensic Science Institute.

VI Major books and scientific journals in the fields of forensic medicine and forensic science in Estonian
There are 5 books on forensic medicine that have been published by the lecturers of the Chair of Forensic Medicine and the forensic pathologists of the Estonian Forensic Science Institute, and also one book that was compiled in cooperation with dentists.
In 1983, "Forensic Medicine I"
by Eugen Murašev, Julia Vapra and Ragnar Sääsk
In 1998, "Vehicle Traumas"
by Marika Väli, Ilona Drikkit, Delia Lepik and Vitali Vassiljev
In 1999, "Mechanical Injuries"
by Marika Väli, Ilona Drikkit, Delia Lepik, Vitali Vassiljev and Marika Talumäe.
In 2005, "Forensic Medical Pathologists – Experts Behind Fair Judgment"
by Ministry of Justice, Bureau of Forensic Medicine of Estonia, University of Tartu.
In 2007, "Forensic Medicine" by Marika Väli, Üllar Lanno, Hendrik kaing, Anu Adams, Hilja Pallo, Delia lepik, Ilona Drikkit, Jana Tuusov, Tanel Vaas, Aime Riikoja, Mailis Tõnisson, Vitali Vassiljev and Gunnar Tasa.
In 2010, "Forensic Dentistry" by
Kaili Mandel, Marika Väli, Delia Lepik and Vitali Vassiljev

VII Estonian scientific society in the context of forensic medicine and forensic science
The Estonian doctors, including forensic pathologists are joined in the Estonian Medical Association, which has been founded in 1918, and resumed its activities in 1988. Forensic pathologists are united in the Estonian Medico-Legal Association, which was re-established in 2000. The main tasks of the association are to discuss issues of forensic medicine, including interesting practical cases once in a quarter, and to organise continuous training.
After the Baltic States regained their independence in 1991, an organisation was founded that united forensic pathologists of the three Baltic States and Saint Petersburg: The Baltic Medico-Legal Association. In addition to exchanging experiences and arranging trainings, one of the member states organises the congress of the BMLA once in every three years. During past few years, these congresses have become an important international event for our own colleagues and also for many participants from other foreign countries.
Forensic pathologists take also active part in the work of the Association of Pathologists.

VIII Periodic national scientific meetings within the forensic medicine and forensic science
In accordance with the statutes of the institute, a research and development committee has been formed, comprising of employees and specialists, who meet four times a year, and advise management on directions the institute should be taking in terms of new methods and technology to adopt.
Once in a quarter, the association of forensic pathologists hold meetings where the practical cases are being discussed. Also the joint trainings with other associations of doctors are regularly taking place.
In Estonia, there are two journals where the articles on all fields of medicine, including forensic medicine are published. These are "Eesti Arst" (Estonian Doctor) and "Lege Artis"
.
IX Cooperation in the field of forensic medicine at national and international level
The Estonian Forensic Institute is a member of the following associations:

European Network of Forensic Science Institutes (ENFSI)
The International Association of Forensic Toxicologists (TIAFT)
European Society of Human Genetics (ESHG)
A new version of a (NBSFI) memorandum on cooperation that regulates the partnership between the Baltic States was signed in April 2008, in which the forensic agencies agreed to share information regarding their achievements, methods of investigation and new equipment and methods adopted. The directors of six forensic agencies signed the cooperation memorandum.
Professor Marika Väli, the Deputy Director of the Estonian Forensic Science Institute, is a member of ECLM’s leading committee and also the representative of Estonia at the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT).

X Addresses and contact details of medical-legal and forensic institutions in Estonia

Estonian Forensic Science Institute

Üllar Lanno
Director of the Estonian Forensic Science Institute                  
Tervise 30
Tallinn
Estonia

Telephone: + 372 663 6600
Fax: + 372 663 6605
Email: info@ekei.ee
WEB: ekei@ekei.ee

Tartu University: Institute of Pathological Anatomy and Forensic Medicine

Marika Väli
Head of the Institute of Pathological Anatomy and Forensic Medicine

Biomedicum
Ravila 19
Tartu
Telephone: + 372 737 4290
Fax:  + 372 737 4292
email: patol@ut.ee

WEB: www.biomedicum.ut.ee/arpa/

 

Eesti Kohtuarstide Selts (Association of the Estonian Forensic Medcine Doctors)

Heldi Kase

Head of the Association of the Estonian Forensic Medicine Doctors
Pärnu 80010,
Ristiku 1

XI Future prospects of forensic medicine and forensic science in Estonia, and final comment
s
The system of forensic medicine in Estonia has historically undergone different stages of evolution and the development of the speciality has been tightly connected with the reigning political order. In spite of that, the primary goal of the forensic pathologists has always been to retain impartiality and independence, and to give their contribution into a fair trial. In modern complex system of justice fair judgement is not possible if based only on the wisdom of the judge, prosecutor or attorney, or on the testimonies of eyewitnesses. The court of justice needs more and more impartial evidence and forensic pathologists are the ones to provide it.

We are certain that the modern Estonian system of forensic medicine has taken a huge leap towards Europe and more importantly, one of our goals is to develop cooperation with other members of the EU.

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