Expert paediatric evidence in alleged infant harm: the truth, the whole truth, and nothing but the truth?
The aim of this thesis is to investigate and further understanding of the interaction between paediatricians providing expert opinion evidence in cases of alleged child abuse and the various fact-findings tribunals who require their expertise. My original contribution to this largely unexplored area of scholarship lies in the identification and analysis of potential frailties particular to the setting and process of paediatric expert assessment of cases of alleged child abuse that need to be recognised and accounted for in order to ensure that, as far as possible, expert paediatricians provide reliable opinion evidence. Specifically, informed by extensive practical experience, I deconstruct and examine the various elements that together constitute the sequential process of expert diagnostic decision-making and opinion generation. First, drawing on empirical research and theoretical constructs from a range of knowledge domains, particularly behavioural psychology and cognitive neuroscience, I consider emerging research on human factors that may influence clinical decision-making and forensic judgments, and apply this evolving understanding to the process of paediatric forensic interpretation. Here I expose a variety of potential biasing factors specific to the child protection setting that may impact on expert paediatricians’ rational judgments that an injury may abusive in origin. I then move on to provide a detailed critique of the evidence base on which such paediatric expert clinical judgments and opinions must be based. Acknowledging the absence of a gold standard test for abuse, I question some fundamental aspects of the proxy indicators of abuse currently promoted as the basis for expert opinions, before discussing the challenges for legal fact-finders tasked with interpretation of those opinions by the absence of an agreed semantic hierarchy with which the certainty of expert conclusions might be qualified. Finally, having shown that in the context of child abuse assessment there are indeed a variety of potential threats to paediatricians’ objective forensic judgments, I use alleged “shaken baby” cases as an exemplar topic to expose those frailties within such cases, and explore the challenges posed for the courts in dealing with complex and evolving paediatric expert evidence. I conclude that neither the law nor legal institutions can resolve these threats to objective expert forensic decision-making alone, and that such frailties need to be recognised and accounted for by both individual paediatric experts and the wider child protection community.