Expert Witness Journal Issue 64 December 2025 - Flipbook - Page 11
Ethical challenges in a dual role.
Breach of Duty Analysis: A Forensic
Approach Informed by Clinical Scrutiny
Navigating ethical challenges is an integral part of
both transplant surgery and the Medical Examiner
role, and these experiences have deepened my
understanding of clinical decision-making and
professional boundaries. For example, in a recent
case I reviewed as a Medical Examiner, a patient
had died following withdrawal of life-sustaining
treatment, and organ donation was being considered.
As I was also part of the transplant team involved
in organ retrieval, I immediately recused myself
from the ME review to avoid any con昀氀ict of interest.
This decision aligned with national guidance and
preserved the integrity of both the donation process
and the scrutiny of care. The case raised important
ethical questions around timing of withdrawal,
communication with the family, and the separation
of clinical and donation-related decisions. Such
experiences reinforce the importance of impartiality,
transparency, and ethical clarity—qualities that are
essential when preparing expert witness reports.
They allow me to approach complex medico-legal
scenarios with a balanced perspective, ensuring that
my testimony is not only clinically accurate but also
ethically sound and legally defensible.
The process of identifying breach of duty in clinical
negligence cases requires a structured and impartial
assessment of whether the care provided fell below
the standard expected of a reasonably competent
practitioner. My experience as an ME has been
instrumental in re昀椀ning this analysis. Regular
scrutiny of deaths—often involving complex, multidisciplinary care—has trained me to dissect clinical
timelines, evaluate decision-making processes, and
identify missed opportunities for intervention. For
example, in reviewing cases where escalation of
care was delayed or documentation was incomplete,
I have learned to distinguish between system-level
failures and individual clinical judgments.
As a transplant surgeon, I am acutely aware of the
high-stakes nature of decision-making, particularly
in listing patients, assessing donor suitability, and
managing perioperative risks. This background
enables me to contextualise clinical actions within
the realities of surgical practice, avoiding hindsight
bias while maintaining objectivity. When preparing
expert witness reports, I apply this dual lens—clinical
and forensic—to assess whether the actions taken
were reasonable, timely, and aligned with accepted
standards. This approach ensures that my breach of
duty analysis is not only grounded in clinical reality
but also robust enough to withstand legal scrutiny.
Translating Medical Examiner
Experience into Expert Witness Practice
My role as a ME has signi昀椀cantly enhanced my
approach to expert witness work by re昀椀ning
how I analyse breach of duty, assess causation,
and structure medico-legal reports. Regular
scrutiny of deaths has trained me to identify
deviations from accepted standards of care with
precision, particularly in cases involving delayed
escalation, poor documentation, or fragmented
communication. This forensic thinking—developed
through systematic case reviews—enables me to
assess whether clinical actions were reasonable and
timely, forming the foundation of breach of duty
analysis.
Navigating Boundaries Between Clinical
and Legal Roles
Balancing the responsibilities of a clinician and
expert witness requires careful navigation of
professional boundaries. I am acutely aware of the
need to separate clinical care from legal analysis.
In my clinical role, decisions are made in real time,
often under pressure, with the primary focus on
patient outcomes. In contrast, expert witness work
demands retrospective scrutiny, impartiality, and
detachment from the emotional context of care
delivery.
In causation assessment, ME experience helps
me distinguish between contributing factors and
direct causes of harm, especially in complex, multidisciplinary cases. I apply a structured, evidencebased approach to determine whether substandard
care materially a昀昀ected the outcome.
Con昀椀dentiality is paramount in both roles. The
Medical Examiner routinely handles sensitive
information about patients and families, and
this reinforces the discipline required when
preparing medico-legal reports. Ensuring that all
documentation is anonymised, securely stored, and
shared only with appropriate legal parties is essential
to maintaining trust and professional standards.
When writing reports, I draw on the ME discipline
of clear, impartial communication. I construct
a coherent narrative, separate factual 昀椀ndings
from opinion, and ensure that my conclusions
are transparent and legally defensible. These
transferable skills—forensic thinking, impartiality,
and narrative construction—are essential to
producing expert testimony that supports fair and
informed legal decisions.
EXPERT WITNESS JOURNAL
The emotional burden of reviewing deaths—
particularly those involving missed opportunities
or preventable harm—can be signi昀椀cant. It
requires resilience and a structured approach to
avoid personal bias or emotional in昀氀uence in legal
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DECEMBER/JANUARY 2025-2026
