Pain and suffering: a legal and medical lexicon for the 21st century.

Defining "suffering and pain" from both legal and medical perspectives is essential in understanding how misinterpretations, confusion and misconceptions can occur through "impressions" of events by uninvolved observers of these basic human sensations. Subjective interpretations of an individual's pain/narrative by professionals can lead to collisions in the courtroom and be a cause for clinical ambivalence in the physician's office. The phenomenon of cognitive, affective experiences with acute, chronic, and emotional pain and its association with "suffering" will be discussed. Contemporary experimental results in neuroscience and advances in clinical medical research attempting to explain how varied expressions of pain in man may have evolved, can be more carefully evaluated, and possibly visualized and measured, will be reviewed. The neurobiological impact of empathy and compassion derived from an individual's narrative and self-reporting of pain and suffering upon the psyches of physicians, juries and otherwise dispassionate observers will be discussed. The purpose of this discussion is to emphasize the importance of considering the complexities embodied in any decision-making process, legal or medical, involving the phenomenon of human perceptions and responses to pain. The data discussed are based on a comprehensive search and review of past and current pertinent literature attempting to explain and decipher man's expressions of pain and suffering in its legal, societal, clinical and scientific ramifications.

Reflections on the syndrome of the "shaken baby".

A full appreciation of the development of current concepts concerning the "shaken baby syndrome" requires a systematic review of historic and more recent interpretations of scientific data that form the bases for diagnosis in these cases. This discussion relates to the dilemma in determining the cause of shaking injuries in this age group that are not obviously accidental or inflicted. The cases in question can present with similar clinical and pathological findings and possibly result from innocent activity. Shaking of infants and children for any reason should be avoided. Debates related to the circumstances and forces required for the development of intracranial and ophthalmic pathology as a result of shaking are discussed. References to the application of "markers of abuse" and other criteria in determining guilt or innocence in these specific situations are presented and evaluated.