Anybody who has been to court will be awestruck by the power of the expert witness. The medical expert's role is to inform the judge and jury on material outside their expertise in a specific area of medicine.
Last month in Britain, we learned paediatrician Prof Sir Roy Meadow was to have all cases, in which his evidence was pivotal in convicting mothers of murder, re-examined because of potential miscarriages of justice.
So powerful was this expert that in one case his testimony is said to have over-ridden that of seven other experts. The controversy began last year when two women sentenced to terms of imprisonment for murdering their children (deaths initially ascribed to cot deaths) were acquitted on appeal. Meadow gave evidence in both cases. Now some 254 manslaughter cases are to be re-examined - 54 are being fast-tracked as the mothers are still serving sentences.
What cannot really be re-examined with anything but a heart-rending outcome are cases in which babies, often newborn, were removed from parents because of evidence their mothers had a condition known as "Munchausen's by proxy". This disorder in which mothers are said to fabricate symptoms in their children to achieve attention for themselves was first described by Meadow in 1971 but evidence for its existence is in doubt as it is based on a series of single-case reports. Yet so pre-eminent was Meadow it has been elevated to the level of scientific certainty in some quarters. For many psychiatrists it is of questionable validity.
Some mothers physically abuse their children and at times murder them. Some are cruel and possibly fabricate symptoms in their children. However, it is crucial to confirm the behaviour represents a distinct clinical entity. The awesome power Meadow wielded probably emanated from his having described a hitherto unthinkable from of abuse, casting him as a pioneer in child protection. Therein lay his vulnerability with devastating consequences for possibly hundreds of parents deprived of their children and sometimes their freedom.
It is almost certain he did not act maliciously. He probably believed he acted with utmost integrity. By his absolute certainty he placed himself within an impenetrable wall, impervious to ongoing developments in his field of competence. The courtroom with its ritual and formality is a perfect setting in which to inflame desire for public respect and fan yearning for power. The medical profession has the ultimate power, that over life and death, as evidenced by the case serial killer Harold Shipman. So, medical experts have a duty above and beyond other experts to exercise restraint and even humility.
The virtue in admitting limitations and acknowledging absence of scientific information in specific instances will far outweigh the guilt after convicting an innocent party. It will be an act of munificence when compared with the tragedy of removing a child from its mother because of a false abuse conviction. Yet, the medical profession is not wholly to blame for the ethos that has lead to our elevation as experts with opinions beyond question. Doctors are highly regarded, command deep respect and are expected to speak authoritatively. Psychiatrists in this State are frequently requested by the Institutional Redress Board to quantify the proportion of damage attaching to instances of child abuse in those who were in institutions even when other traumatic events preceded or followed such abuse. Such an estimation in all but a few exceptional cases is a crude "guesstimate". We are expected to decide if a mother is a potential sufferer with Munchausen's by proxy or if a criminal will re-offend. That does not gainsay the reality that we have only limited methods for evaluating many of the areas in which we are asked to comment or prognosticate.
By all means let our courts use medical experts but let the experts accept knowledge in one decade is not writ in stone for the next and let the courts acknowledge no human being, doctor, priest, judge or teacher is the font of all wisdom. If not, then we too may have our own miscarriages of justice.