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Chapter 13 - Cognitive Bias in Medico-legal Judgments

from Section 3 - Science

Published online by Cambridge University Press:  07 June 2023

By
Jeff Kukucka  and
Keith Findley
Edited by
Keith A. Findley ,
Cyrille Rossant ,
Kana Sasakura ,
Leila Schneps ,
Waney Squier  and
Knut Wester
Keith A. Findley
Affiliation:
University of Wisconsin, Madison
Cyrille Rossant
Affiliation:
University College London
Kana Sasakura
Affiliation:
Konan University, Japan
Leila Schneps
Affiliation:
Sorbonne Université, Paris
Waney Squier
Affiliation:
John Radcliffe Hospital, Oxford
Knut Wester
Affiliation:
Universitetet i Bergen, Norway
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Summary

As humans, our perceptions and judgements are naturally coloured by our beliefs, experiences, and desires. Consequently, two individuals with different mindsets or working in different contexts may interpret the same information in markedly different ways (i.e., cognitive bias), especially when that information is ambiguous. In forensic and medico-legal settings, cognitive bias can influence expert decision-making in ways that produce costly miscarriages of justice. In this chapter, we first review the sources of cognitive bias, including irrelevant contextual information, base rate expectations, stress, and allegiance. Then, we review research showing that cognitive bias can affect medical diagnoses of living individuals as well as post-mortem manner-of-death judgments, and we discuss the reactions to these findings. Lastly, we describe best practices for mitigating the impact of cognitive bias and maximising the value of medico-legal judgments.

Keywords

cognitive biasconfirmation biascontextual biaswrongful convictionstask-relevancemanner of deathforensic pathologybase rateslinear sequential unmasking
Type
Chapter
Information
Shaken Baby Syndrome
Investigating the Abusive Head Trauma Controversy
 , pp. 205 - 217
Publisher: Cambridge University Press
Print publication year: 2023

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References

Kahneman, D, Sibony, O, Sunstein, CR. Noise: A flaw in human judgment. Little Brown Spark, 2021.Google Scholar
Bressan, P, Dal Martello, MF. ‘Talis pater, talis filius’: Perceived resemblance and the belief in genetic relatedness. Psychological Science. 2002;13:213–18.CrossRefGoogle ScholarPubMed
Asch, SE. Forming impressions of personality. Journal of Abnormal and Social Psychology. 1946;41:258–90.CrossRefGoogle ScholarPubMed
Balcetis, E, Dunning, D. See what you want to see: Motivational influences on visual perception. Journal of Personality and Social Psychology. 2006;91:612–25.CrossRefGoogle ScholarPubMed
Organization of Scientific Area Committees for Forensic Science (OSAC). (2020, 1 April). OSAC preferred terms. www.nist.gov/document/osac-preferred-terms-april-2020.Google Scholar
Klayman, J, Ha, Y-W. Confirmation, disconfirmation, and information in hypothesis testing. Psychological Bulletin. 1997;94:211–28.Google Scholar
Nisbett, RE, Wilson, TD. Telling more than we can know: Verbal reports on mental processes. Psychological Review. 1977;84(3):231–59.CrossRefGoogle Scholar
Kunda, Z. The case for motivated reasoning. Psychological Bulletin. 1990;108:480–98.CrossRefGoogle ScholarPubMed
Kassin, SM, Dror, IE, Kukucka, J. The forensic confirmation bias: Problems, perspectives, and proposed solutions. Journal of Applied Research in Memory and Cognition. 2013;2:42–52.Google Scholar
Berner, ES, Graber, ML. Overconfidence as a cause of diagnostic error in medicine. American Journal of Medicine. 2008;121(5):S2–S23.CrossRefGoogle ScholarPubMed
Graber, ML, Wachter, RM, Cassel, CK. Bringing diagnosis into the quality and safety equations. JAMA. 2012;308(12):1211–12.CrossRefGoogle ScholarPubMed
Groopman, J. How doctors think. Houghton Mifflin Harcourt, 2007.Google Scholar
Kukucka, J, Dror, IE (2023). Human factors in forensic science: Psychological causes of bias and error. In The Oxford handbook of psychology and law. DeMatteo, D, Scherr, KC, eds. Oxford University Press.Google Scholar
Dror, IE, Charlton, D. Why experts make errors. Journal of Forensic Identification. 2006;56:600–16.Google Scholar
Growns, B, Kukucka, J. The prevalence effect in fingerprint identification: Match and non-match base rates impact misses and false alarms. Applied Cognitive Psychology. 2021;35:751–60.Google Scholar
Almazrouei, MA, Morgan, RM, Dror, IE. Stress and support in the workplace: The perspective of forensic examiners. Forensic Science International: Mind and Law. 2021;100059.Google Scholar
Murrie, DC, Boccaccini, MT, Guarnera, LA, Rufino, KA. Are forensic experts biased by the side that retained them? Psychological Science. 2013;24:1889–97.Google Scholar
Archer, MS, Wallman, JF. Context effects in forensic entomology and use of sequential unmasking in casework. Journal of Forensic Sciences. 2016;61:1270–7.CrossRefGoogle ScholarPubMed
Found, B, Ganas, J. The management of domain irrelevant context information in forensic handwriting examination casework. Science and Justice. 2013;53:154–8.Google Scholar
Mattijssen, EJAT, Kerkhoff, W, Berger, CEH, Dror, IE, Stoel, RD. Implementing context information management in forensic casework: Minimizing contextual bias in firearms examination. Science and Justice. 2016;56:113–22.Google Scholar
Kukucka, J, Kassin, SM, Zapf, PA, Dror, IE. Cognitive bias and blindness: A global survey of forensic science examiners. Journal of Applied Research in Memory and Cognition. 2017;6:452–9.CrossRefGoogle Scholar
Oliver, WR, Fang, X. Forensic pathologist consensus in the interpretation of photographs of patterned injuries of the skin. Journal of Forensic Sciences. 2016;61:972–8.CrossRefGoogle ScholarPubMed
Anderst, J, Nielsen-Parker, M, Moffatt, M, Frazier, T, Kennedy, C. Using simulation to identify sources of medical diagnostic error in child physical abuse. Child Abuse and Neglect. 2016;52:62–9.CrossRefGoogle ScholarPubMed
Wester, K, Stridbeck, U, Syse, A, Wikström, J. Re‐evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses. Acta Paediatrica. 2022;111(4):779–92. https://doi.org/10.1111/apa.15956.Google Scholar
Hymel, KP, Willson, DF, Boos, SC et al. Derivation of a clinical prediction rule for pediatric abusive head trauma. Pediatric Critical Care Medicine. 2013;14(2):210–20.Google Scholar
Narang, S. A Daubert analysis of abusive head trauma/shaken baby syndrome. Houston Journal of Health, Law, and Policy. 2011;11:505–633.Google Scholar
Schiff, GD. Minimizing diagnostic error: The importance of follow-up and feedback. American Journal of Medicine. 2008;121(5):S38–S42.Google Scholar
Findley, KA, Risinger, DM, Barnes, PD et al. Feigned consensus: Usurping the law in shaken baby syndrome/abusive head trauma prosecutions. Wisconsin Law Review. 2019;5:1211–68.Google Scholar
Bornstein, BH, Emler, AC. Rationality in medical decision-making: A review of the literature on doctors’ decision‐making biases. Journal of Evaluation in Clinical Practice. 2001;7(2):97–107.Google Scholar
Saposnik, G, Redelmeier, D, Ruff, CC, Tobler, PN. Cognitive biases associated with medical decisions: A systematic review. BMC Medical Informatics and Decision-Making. 2016;16(1):1–14.Google Scholar
Croskerry, P. The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine. 2016;78(8):775–80.Google Scholar
Doherty, TS, Carroll, AE. Believing in overcoming cognitive biases. American Medical Association Journal of Ethics. 2020;22(9):773–8.Google Scholar
Wolfe, JM, Brunelli, DN, Rubinstein, J, Horowitz, TS. Prevalence effects in newly trained airport checkpoint screeners: Trained observers miss rare targets, too. Journal of Vision. 2013;13:1–9.CrossRefGoogle ScholarPubMed
Papesh, MH, Goldinger, SD. Infrequent identity mismatches are frequently undetected. Attention, Perception, and Psychophysics. 2014;76:1335–49.CrossRefGoogle ScholarPubMed
Horowitz, TS. Prevalence in visual search: From the clinic to the lab and back again. Japanese Psychological Research. 2017;59(2):65–108.Google Scholar
Evans, KK, Tambouret, RH, Evered, A, Wilbur, DC, Wolfe, JM. Prevalence of abnormalities influences cytologists’ error rates in screening for cervical cancer. Archives of Pathology and Laboratory Medicine. 2011;135(12):1557–60.Google Scholar
Reed, WM, Ryan, JT, McEntee, MF, Evanoff, MG, Brennan, PC. The effect of abnormality-prevalence expectation on expert observer performance and visual search. Radiology. 2011;258(3):938–43.Google Scholar
Nakashima, R, Watanabe, C, Maeda, E et al. The effect of expert knowledge on medical search: Medical experts have specialized abilities for detecting serious lesions. Psychological Research. 2015;79(5):729–38.Google Scholar
Lazarus, RS, Deese, J, Osler, SF. The effects of psychological stress upon performance. Psychological Bulletin. 1952;49(4):293–317.Google Scholar
Motowidlo, SJ, Packard, JS, Manning, MR. Occupational stress: Its causes and consequences for job performance. Journal of Applied Psychology. 1986;71(4):618–29.Google Scholar
Dovidio, JF, Penner, LA, Albrecht, TL et al. Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Social Science and Medicine. 2008;67(3):478–86.Google Scholar
Burgess, DJ. Are providers more likely to contribute to healthcare disparities under high levels of cognitive load? How features of the healthcare setting may lead to biases in medical decision-making. Medical Decision-Making. 2010;30(2):246–57.Google Scholar
Johnson, TJ, Hickey, RW, Switzer, GE et al. The impact of cognitive stressors in the emergency department on physician implicit racial bias. Academic Emergency Medicine. 2016;23(3):297–305.Google Scholar
Gitlin, JN, Cook, LL, Linton, OW, Garrett-Mayer, E. Comparison of ‘B’ readers’ interpretations of chest radiographs for asbestos related changes. Academic Radiology. 2004;11:843–56.Google Scholar
Kempe, CH, Silverman, FN, Steele, BF, Droegemueller, W, Silver, HK. The battered-child syndrome. JAMA. 1962;181(1):17–24.Google Scholar
Leake, HC, III, Holbrook, RF. Medical testimony. In Child abuse and neglect: A medical reference. Ellerstein, NS, ed. Wiley, 1981, pp. 327–43.Google Scholar
Duhaime, AC, Christian, CW. Abusive head trauma: Evidence, obfuscation, and informed management. Journal of Neurosurgery: Pediatrics. 2019;24(5):481–8.Google Scholar
Brown, SD. Ethical challenges in child abuse: What is the harm of a misdiagnosis? Pediatric Radiology. 2021;51(6):1070–5.Google Scholar
Risinger, DM, Saks, MJ, Thompson, WC, Rosenthal, R. The Daubert/Kumho implications of observer effects in forensic science: Hidden problems of expectation and suggestion. California Law Review. 2002;90:1–56.CrossRefGoogle Scholar
Stevenage, SV, Bennett, A. A biased opinion: Demonstration of cognitive bias on a fingerprint matching task through knowledge of DNA test results. Forensic Science International. 2017;276:93–106.Google Scholar
Dror, IE, Peron, AE, Hind, S-L, Charlton, D. When emotions get the better of us: The effect of contextual top-down processing on matching fingerprints. Applied Cognitive Psychology. 2005;19:799–809.CrossRefGoogle Scholar
Kirschner, RH, Stein, RJ. The mistaken diagnosis of child abuse: A form of medical abuse? American Journal of Diseases of Children. 1985;139(9):873–5.Google Scholar
Hampton, RL, Newberger, EH. Child abuse incidence and reporting by hospitals: Significance of severity, class, and race. American Journal of Public Health. 1985;75(1):56–60.Google Scholar
Lane, WG, Rubin, DM, Monteith, R, Christian, CW. Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA. 2002;288(13):1603–9.CrossRefGoogle ScholarPubMed
Flaherty, EG, Sege, RD, Griffith, J et al. From suspicion of physical child abuse to reporting: Primary care clinician decision-making. Pediatrics. 2008;122(3):611–19.Google Scholar
Hymel, KP, Laskey, AL, Crowell, KR et al. Racial and ethnic disparities and bias in the evaluation and reporting of abusive head trauma. Journal of Pediatrics. 2018;198:137–43.Google Scholar
Jenny, C, Hymel, KP, Ritzen, A, Reinert, SE, Hay, TC. Analysis of missed cases of abusive head trauma. JAMA. 1999;281(7):621–6.Google Scholar
Laskey, AL, Stump, TE, Perkins, SM et al. Influence of race and socioeconomic status on the diagnosis of child abuse: A randomized study. Journal of Pediatrics. 2012;160(6):1003–8.Google Scholar
Loos, MLH, Allema, WM, Bakx, R et al. Paediatric femur fractures: The value of contextual information on judgement in possible child abuse cases. Are we biased? European Journal of Pediatrics. 2021;180(1):81–90.Google Scholar
Najdowski, CJ, Bernstein, KM, Wahrer, KS. Do racial stereotypes contribute to medical misdiagnosis of child abuse? Investigating tunnel vision in the emergency room. Wrongful Convictions Law Review. 2020;1(2):153–80.Google Scholar
Fawver, B, Thomas, JL, Drew, T et al. Seeing isn’t necessarily believing: Misleading contextual information influences perceptual-cognitive bias in radiologists. Journal of Experimental Psychology: Applied. 2020;26:579–92.Google Scholar
Oliver, WR. Effect of history and context on forensic pathologist interpretation of photographs of patterned injury of the skin. Journal of Forensic Sciences. 2017;62:1500–5.Google Scholar
Oliver, WR. Comment on Kukucka et al. ‘Cognitive bias and blindness: A global survey of forensic science examiners’. Journal of Applied Research in Memory and Cognition. 2018;7:161.Google Scholar
Oliver, WR. Comment on Dror et al. ‘When expert decision-making goes wrong’. Journal of Applied Research in Memory and Cognition. 2018;7:314–15.Google Scholar
Medscape. (2016, 23 January). Medscape lifestyle report 2016: Bias and burnout. www.medscape.com/slideshow/lifestyle-2016-overview-6007335.Google Scholar
Medscape. (2017, 11 January). Lifestyle report 2017: Race and ethnicity, bias and burnout. www.medscape.com/features/slideshow/lifestyle/2017/overview.Google Scholar
Dror, IE, Melinek, J, Arden, JL et al. Cognitive bias in forensic pathology decisions. Journal of Forensic Sciences. 2021;66:1751–7.Google Scholar
Duflou, J. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14836.Google Scholar
Graber, ML. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14857.CrossRefGoogle Scholar
Obenson, K. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14855.Google Scholar
Gill, JR, Pinneri, K, Denton, JS, Aiken, SS. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions.’ Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14838.Google Scholar
Speth, P, Avedschmidt, S, Baeza, JJ et al. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14835.Google Scholar
Dror, IE. The paradox of human expertise: Why experts get it wrong. In The paradoxical brain. Kapur, N., ed. Cambridge University Press, 2011, pp. 177–88.Google Scholar
Van den Eeden, CAJ, de Poot, CJ, Van Koppen, PJ. The forensic confirmation bias: A comparison between experts and novices. Journal of Forensic Sciences. 2019;64:120–6.Google Scholar
Pronin, E, Lin, DY, Ross, L. The bias blind spot: Perceptions of bias in self versus others. Personality and Social Psychology Bulletin. 2002;28:369–81.Google Scholar
Peterson, BL, Arnall, M, Avedschmidt, S et al. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14843.Google Scholar
Kukucka, J. People who live in ivory towers shouldn’t throw stones: A refutation of Curley et al. Forensic Science International: Synergy. 2020;2:110–13.Google Scholar
Oliver, WR. Commentary on Dror et al. ‘Cognitive bias in forensic pathology decisions’. Journal of Forensic Sciences. 2021. https://doi.org/10.1111/1556-4029.14841.Google Scholar
Wilson, TD, Brekke, N. Mental contamination and mental correction: Unwanted influences on judgments and evaluations. Psychological Bulletin. 1994;116:117–42.CrossRefGoogle ScholarPubMed
Sherman, M, Ricco, J, Nelson, S, Nezhad, S, Prasad, S. Implicit bias training in a residency program: Aiming for enduring effects. Family Medicine. 2019;51(8):677–81.Google Scholar
Zeidan, AJ, Khatri, UG, Aysola, J et al. Implicit bias education and emergency medicine training: Step one? Awareness. AEM Education and Training. 2019;3(1):81–5.Google Scholar
Fitzgerald, C, Martin, A, Berner, D, Hurst, S. Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: A systematic review. BMC Psychology. 2019;7(1):1–12.Google Scholar
Forscher, PS, Lai, CK, Axt, JR et al. A meta-analysis of procedures to change implicit measures. Journal of Personality and Social Psychology. 2019;117(3):522–59.Google Scholar
Simon, D. Minimizing error and bias in death investigations. Seton Hall Law Review. 2018;49:255–305.Google Scholar
McRobert, AP, Causer, J, Vassiliadis, J et al. Contextual information influences diagnosis accuracy and decision-making in simulated emergency medicine emergencies. BMJ Quality and Safety. 2013;22(6):478–84.Google Scholar
Dror, IE, Kukucka, J. Linear sequential unmasking–expanded (LSU-E): A general approach for improving decision-making as well as minimizing bias. Forensic Science International: Synergy. 2021;3:100161.Google Scholar
Quigley-McBride, A, Dror, IE, Roy, T, Garrett, BL, Kukucka, J. A practical tool for information management in forensic decisions: Using linear sequential unmasking-expanded (LSU-E) in casework. Forensic Science International: Synergy. 2022;4:100216.Google Scholar
Findley, KA, Strang, DA. Ending manner of death testimony and other opinion evidence of crime. Duquesne Law Review. 2022;60:302–39.Google Scholar

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