Skip to main content

Advertisement

SpringerLink
Log in

Age estimation for forensic purposes in Italy: ethical issues

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Age assessment in children and young adults is a relevant medicolegal issue due to the gradual increase of persons devoid of proper identification documents in European countries. Because of the illegal immigration and growing crime rates among children and adolescents, age estimation for forensic purposes is often required. The scientific research and the extensive experience of forensic experts in the last decades focused on the use of radiographic methods addressed to evaluate the degree of skeletal or dental development as the most accurate parameters to estimate the chronological age of children and adolescents. This paper analyzes the ethical issues related to age estimation procedures based on radiographic methods, showing how the ethical principles of beneficence, nonmalevolence, justice, and autonomy may be guaranteed during the execution of the age assessment in forensic practice. The procedure might be conducted in accordance with international guidelines and protocols, though they need a higher homogenization and standardization. A strong collaboration between various scientific societies of professionals (forensic odontologists, forensic pathologists, forensic anthropologist, radiologists, pediatricians, and psychologists), who have been involved in age estimation for years, is needed to reach this goal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ministry of Justice-Department of Juvenile Justice (2013) Office of the Chief of Department Statistics Service. http://www.giustiziaminorile.it/statistica/dati_statistici/DatiAggiornati/dati_aggiornati.pdf. Accessed 16 Jul 2013

  2. Report of the Ministry of Labour and Social Policies (2013) Directorate General for Immigration and Integration Policies-Division IV-Office for Unaccompanied Foreign Minors. http://www.lavoro.gov.it/md/AreaSociale/Immigrazione/Documents/Maggio13_ReportMSNA.pdf. Accessed 16 Jul 2013

  3. Corradi F, Pinchi V, Barsanti I, Manca R, Garatti S (2013) Optimal classification of young individuals based on dental evidence in civil and criminal proceedings. Int J Legal Med. doi:10.1007/s00414-013-0919-3

    PubMed  Google Scholar 

  4. Schmeling A, Grundmann C, Fuhrmann A, Kaatsch HJ, Knell B, Ramsthaler F, Reisinger W, Riepert T, Ritz-Timme S, Rösing FW, Rötzscher K, Geserick G (2008) Criteria for age estimation in living individuals. Int J Legal Med 122(6):457–460

    Article  CAS  PubMed  Google Scholar 

  5. Ritz-Timme S, Cattaneo C, Collins MJ, Waite ER, Schütz HW, Kaatsch HJ, Borrman HI (2000) Age estimation: the state of the art in relation to the specific demands of forensic practice. Int J Legal Med 113(3):129–136

    Article  CAS  PubMed  Google Scholar 

  6. International Organization of Forensic Odontology (IOFOS) Guidelines. http://www.iofos.eu/Quality-Ass/Age-IOFOS.htm. Accessed 16 Jul 2013

  7. Schmeling A, Olze A, Reisinger W, Geserick G (2001) Age estimation of living people undergoing criminal proceedings. The Lancet 358:89–90

    Article  CAS  Google Scholar 

  8. Black SA, Payne-James JB, Aggrawal AC (2010) Age estimation in the living. Wiley, New York

    Book  Google Scholar 

  9. Serinelli S, Panetta V, Pasqualetti P, Marchetti D (2011) Accuracy of three age determination X-ray methods on the left hand-wrist: a systematic review and meta-analysis. Leg Med (Tokyo) 13(3):120–133

    Article  CAS  Google Scholar 

  10. Morris JM, Park JH (2012) Correlation of dental maturity with skeletal maturity from radiographic assessment: a review. J Clin Pediatr Dent 36(3):309–314

    PubMed  Google Scholar 

  11. Schmidt S, Nitz I, Ribbecke S, Schulz R, Pfeiffer H, Schmeling A (2013) Skeletal age determination of the hand: a comparison of methods. Int J Legal Med 127(3):691–698. doi:10.1007/s00414-013-0845-4

    Article  CAS  PubMed  Google Scholar 

  12. Lewis JM, Senn DR (2010) Dental age estimation utilizing third molar development: a review of principles, methods, and population studies used in the United States. Forensic Sci Int 201(1–3):79–83. doi:10.1016/j.forsciint.2010.04.042

    Article  PubMed  Google Scholar 

  13. Pinchi V, Norelli GA, Pradella F, Vitale G, Rugo D, Nieri M (2012) Comparison of the applicability of four odontological methods for age estimation of the 14 years legal threshold in a sample of Italian adolescents. J Forensic Odontostomatol 30(2):17–25

    PubMed  Google Scholar 

  14. Corradi F, Pinchi V, Barsanti I, Garatti S (2013) Probabilistic classification of age by third molar development: the use of soft evidence. J Forensic Sci 58(1):51–59. doi:10.1111/j.1556-4029.2012.02216.x

    Article  PubMed  Google Scholar 

  15. Pinchi V, Parenti T, Vivoli B, Norelli GA (2003) La maturazione dell’ottavo nell’accertamento dell’età: un confronto tra metodi (The maturation of the third molar in the age estimation: a comparison of methods). Riv It Med Leg 25:365

    Google Scholar 

  16. Roberts GJ, Lucas VS (2009) Ethical dental age assessment. Br Dent J 207:251–255

    Article  PubMed  Google Scholar 

  17. Aynsley-Green A, Cole TJ, Crawley H, Lessof N, Boag LR, Wallace RM (2012) Medical, statistical, ethical and human rights considerations in the assessment of age in children and young people subject to immigration control. Br Med Bull 102:17–42

    Article  CAS  PubMed  Google Scholar 

  18. Van Ree CJ, Schulpen TW (2001) Ethical shortcomings of skeletal age determination to establish minority for single young asylum seekers. Ned Tijdschr Geneeskd 145(5):229–233

    PubMed  Google Scholar 

  19. Aynsley Green A (2009) Unethical age assessment. Br Dent J 206(7):337

    Article  CAS  PubMed  Google Scholar 

  20. Cameriere R, De Luca S, De Angelis D, Merelli V, Giuliodori A, Cingolani M, Cattaneo C, Ferrante L (2012) Reliability of Schmeling’s stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects. Int J Legal Med 126(6):923–932. doi:10.1007/s00414-012-0769-4

    Article  CAS  PubMed  Google Scholar 

  21. Smith T, Brownless L (2011) Discussion paper: age assessment practices a literature review and annotated bibliography-United Nations International Children’s Emergency Fund (UNICEF). http://www.unicef.org/protection/Age_Assessment_Practices_2010.pdf. Accessed 16 Jul 2013

  22. UNHCR (2004) Protection training manual for European border and entry officials—4. Identifying protection needs in group arrivals. Annex 13 - Separated Children in Europe Programme: Statement of Good Practice, third edition. http://www.coe.int/t/dg3/migration/archives/Source/MalagaRegConf/Statement%20of%20Good%20Practice,%20Separated%20Children%20in%20Europe%20Programme_3ed_en.pdf. Accessed 16 Jul 2013

  23. Guidelines on International Protection No. 8: Child Asylum Claims under Articles 1(A)2 and 1(F) of the 1951 Convention and/or 1967 Protocol relating to the Status of Refugees, HCR/GIP/09/08 (2009) http://www.refworld.org/docid/4b2f4f6d2.html. Accessed 16 Jul 2013

  24. Committee on Migration, Refugees and Population (2011) Doc. 12539, unaccompanied children in Europe: issues of arrival, stay and return, report. Rapporteur: Ms Mailis REPS, Estonia, Alliance of Liberals and Democrats for Europe, 21 March 2011. http://assembly.coe.int/ASP/Doc/XrefViewPDF.asp?FileID=12776&Language=en. Accessed 16 Jul 2013

  25. BMA (2004) Medical ethics today: the BMA’s handbook of ethics and law. BMJ Books, London

    Google Scholar 

  26. Pruvost MO, Boraud C, Chariot P (2010) Skeletal age determination in adolescents involved in judicial procedures: from evidence-based principles to medical practice. J Med Ethics 36(2):71–74

    Article  PubMed  Google Scholar 

  27. Hjern A, Lindqvist MB, Norredam M (2012) Age assessment of young asylum seekers. Acta Paediatr 101:4–7

    Article  PubMed  Google Scholar 

  28. Schmeling A, Geserick G, Reisinger W, Olze A (2007) Age estimation. Forensic Sci Int 17;165(2-3):178–181

    Article  Google Scholar 

  29. Separate Children in Europe Programme (2003) Report of the workshop on age assessment and identification, Bucarest, 22–23 March 2003.http://www.separated-children-europe-programme.org/publications/reports/report_workshop_age_aassessment.pdf. Accessed 17 Jul 2013

  30. European Union of Medical Specialists (UEMS) News 2005/15 en: European Definition of Medical Act, Outcomes of the UEMS Council Meeting (Munich 21–22/10/2005). http://www.uems.eu/__data/assets/pdf_file/0012/1371/649.pdf. Accessed 13 Mar 2014

  31. World Health Organization (1946) Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 Apr 1948

  32. Council of Europe, Directorate of Communications (2011) Methods for assessing the age of migrant children must be improved. https://wcd.coe.int/ViewDoc.jsp?id=1818617&Site=CommDH. Accessed 17 Jul 2013

  33. Husband J (2007) Planning better outcomes and support for unaccompanied asylum seeking children. http://www.rcr.ac.uk/docs/general/pdf/AsylumseekersRCRfinalresponse.pdf. Accessed 17 Jul 2013

  34. United Kingdom Border Agency. Entry clearance guidance Settlement 07 Children, http://www.ukba.homeoffice.gov.uk/policyandlaw/guidance/ecg/set/set7/#header4. Accessed 17 Jul 2013

  35. European Network for ombudsperson for children (2012) United Kingdom: Border Agency suspends asylum X-ray pilot. http://www.crin.org/enoc/resources/infodetail.asp?id=28295. Accessed 17 Jul 2013

  36. Senate Committees Parliament of Australia. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Completed_inquiries/2010-13/fairnessforminors/report/c02 .htm. Accessed 07 Oct 2013

  37. Decreto Legislativo 26 maggio 2000, n. 187 "Attuazione della direttiva 97/43/Euratom in materia di protezione sanitaria delle persone contro i pericoli delle radiazioni ionizzanti connesse ad esposizioni mediche" Gazzetta Ufficiale n. 157 del 7 luglio 2000 - Supplemento Ordinario n. 105. http://www.camera.it/parlam/leggi/deleghe/00187dl.htm. Accessed 13 Mar 2014

  38. De Lourdes LM, Larcher V, Kurz R (2003) Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP). Eur J Pediatr 162(9):629–633

    Article  Google Scholar 

  39. Kuther TL, Posada M (2004) Children and adolescents' capacity to provide informed consent for participation in research. Adv Psychol Res 32:163–173

    PubMed  Google Scholar 

  40. Osuna E (2010) Legal protection of informed consent of minors. Med Law 29(2):217–226

    PubMed  Google Scholar 

  41. Borry P, Stultiens L, Goffin T, Nys H, Dierickx K (2008) Minors and informed consent in carrier testing: a survey of European clinical geneticists. J Med Ethics 34(5):370–374. doi:10.1136/jme.2007.021717

    Article  CAS  PubMed  Google Scholar 

  42. Council of Europe (2011) Unaccompanied children in Europe: issues of arrival, stay and return, resolution no. 1810. Assembly debate on 15 April 2011 (18th Sitting). http://www.assembly.coe.int/Main.asp?link=/Documents/AdoptedText/ta11/ERES1810.htm. Accessed 16 Jul 2013

  43. Semelka RC, Armao DM, Elias J Jr, Picano E (2012) The information imperative: is it time for an informed consent process explaining the risks of medical radiation? Radiology 262(1):15–18

    Article  PubMed  Google Scholar 

  44. Progetto Praesidium III (2008) Accertamento dell’età di minori migranti: principi generali- CRI-OIM-UNHCR- Save the Children in Italy .http://www.unhcr.it/cms/attach/editor/PIII_AccertamentoEta.pdf Accessed 18 Jul 2013

  45. Decreto del Presidente della Repubblica Italiana (Decree of the President of the Italian Republic) n. 448/88, article n. 67. http://www.diritto.it/articoli/penale/dpr448-88.html. Accessed 13 Mar 2014

  46. Italian Criminal Procedure Code, art. n. 349 (investigations of judicial police, identification of the suspects and others). http://www.mondodiritto.it/normativa/codice-di-procedura-penale/art-349-codice-di-procedura-penale-identificazione-della-persona-nei-cui-confronti-vengono-svolte-le-indagini-e-di-altre-persone.html. Accessed 13  Mar 2014

  47. Italian Home Office (2007) Ministerial circular no. 17272/7, http://www.immigrazione.biz/upload/minori_11_lug_2007.pdf. Accessed 22 Jul 2013

  48. Italian Court of Cassation, section. IV, sentence no. 6284, 17 February. 2006. http://www.cortedicassazione.it/Notizie/GiurisprudenzaPenale/SezioniSemplici/SchedaNews.asp?ID=399. Accessed 13 Mar 2014

  49. Italian Court of Cassation sentence no. 18336, 10 March 2003. Sajfiddine rv. 225211. http://www.filodiritto.com/cassazione-esame-radiologico-disposto-coattivamente-come-modalita-di-ispezione-personale/. Accessed 13 Mar 2014

  50. Separated Children in Europe Programme (2011) Thematic group on age assessment—review of current laws, policies and practices relating to age assessment in sixteen European countries. http://www.scepnetwork.org/images/17/166.pdf. Accessed 10 Sep 2013

  51. Kleinerman RA (2006) Cancer risks following diagnostic and therapeutic radiation exposure in children. Pediatr Radiol 36:121–125

    Article  PubMed Central  PubMed  Google Scholar 

  52. Baysson H, Etard C, Brisse HJ, Bernier MO (2012) Diagnostic radiation exposure in children and cancer risk. Current knowledge and perspectives. Arch Pediatr 19:64–73

    Article  CAS  PubMed  Google Scholar 

  53. Linet M, Kim K, Rajaraman P (2009) Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric consideration. Pediatr Radiol 39:S4–S26

    Article  PubMed Central  PubMed  Google Scholar 

  54. Ludlow JB, Vies-Ludlow LE, White SC (2008) Patient risk related to common dental radiographic examinations: the impact of 2007. International Commission on Radiological Protection recommendations regarding dose calculation. J Am Dent Assoc 139:1237–1243

    Article  PubMed  Google Scholar 

  55. Linet MS, Slovis TL, Miller DL, Kleinerman R, Lee C, Rajaraman P, Berrington de Gonzalez A (2012) Cancer risks associated with external radiation from diagnostic imaging procedures. CA Cancer J Clin 62:75–100. doi:10.3322/caac.21132

    Article  Google Scholar 

  56. Grünheid T, Kolbeck Schieck J, Pliska B, Ahmad M, Larson B (2012) Dosimetry of a cone-beam computed tomography machine compared with a digital x-ray machine in orthodontic imaging. AJO-DO 141:436–443

    Google Scholar 

  57. Regulla DF, Eder H (2005) Patient exposure in medical X-ray imaging in Europe. Radiat Prot Dosimetry 114:11–25. doi:10.1093/rpd/nch538

    Article  PubMed  Google Scholar 

  58. Ramsthaler F, Proschek P, Betz W, Verhoff MA (2009) How reliable are the risk estimates for X-ray examinations in forensic age estimations? A safety update. Int J Legal Med 123(3):199–204

    Article  CAS  PubMed  Google Scholar 

  59. Abbott P (2000) Are dental radiographs safe? Aust Dent J 45:208–213

    Article  CAS  PubMed  Google Scholar 

  60. Hall EJ (1978) Radiobiology for the radiologists. Harper and Row, Hagerstown

    Google Scholar 

  61. Schmeling A, Olze A, Reisinger W, Rösing FW, Geserick G (2003) Forensic age diagnostics of living individuals in criminal proceedings. Homo 54:162–169

    Article  CAS  PubMed  Google Scholar 

  62. Marin D, Nelson RC, Rubin GD, Schindera ST (2011) Body CT: technical advances for improving safety. AJR Am J Roentgenol 197(1):33–41

    Article  PubMed  Google Scholar 

  63. Mathews JD, Forsythe AV, Brady Z, Butler MW, Goergen SK, Byrnes GB, Giles GG, Wallace AB, Anderson PR, Guiver TA, McGale P, Cain TM, Dowty JG, Bickerstaffe AC, Darby SC (2013) Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: date linkage studies of 11 million Australians'. BMJ 3:346

    Google Scholar 

  64. Hendee WR, Edwards FM (1986) ALARA and an integrated approach to radiation protection. Semin Nucl Med 16(2):142–150

    Article  CAS  PubMed  Google Scholar 

  65. Ong KK, Ahmed ML, Dunger DB (2006) Lessons from large population studies on timing and tempo of puberty (secular trends and relation to body size). The European Trend Mol Cell Endocrinol 25(254-255):8–12

    Article  Google Scholar 

  66. Karlberg J (2002) Secular trends in pubertal development. Horm Res 57(suppl 2):19–30

    Article  CAS  PubMed  Google Scholar 

  67. Rosenbloom AF, Tanner JM (1998) Misuse of tanner puberty stages to estimate chronological age. Pediatrics 102:1494

    Article  CAS  PubMed  Google Scholar 

  68. Quirmbach F, Ramsthaler F, Verhoff MA (2009) Evaluation of the ossification of the medial clavicular epiphysis with a digital ultrasonic system to determine the age threshold of 21 years. Int J Legal Med 123:241–245

    Article  PubMed  Google Scholar 

  69. Schulz R, Zwiesigk P, Schiborr M, Schmidt S, Schmeling A (2008) Ultrasound studies on the time course of clavicular ossification. Int J Legal Med 122:163–167

    Article  PubMed  Google Scholar 

  70. Hillewig E, De Tobel J, Cuche O, Vandemaele P, Piette M, Verstraete K (2011) Magnetic resonance imaging of the medial extremity of the clavicle in forensic bone age determination: a new four-minute approach. Eur Radiol 21(4):757–767

    Article  PubMed  Google Scholar 

  71. Dvorak J, George J, Junge A, Hodler J (2007) Age determination by magnetic resonance imaging of the wrist in adolescent male football players. Br J Sports Med 41(1):45–52

    PubMed Central  PubMed  Google Scholar 

  72. Cunha E, Baccino E, Martrille L, Ramsthaler F, Prieto J, Schuliar Y, Lynnerup N, Cattaneo C (2009) The problem of aging human remains and living individuals: a review. Forensic Sci Int 193(1–3):1–13

    Article  CAS  PubMed  Google Scholar 

  73. Italian Home Office (2010) Dipartimento per le Libertà Civili e l’immigrazione. Istituto Psicoanalitico.http://www.libertaciviliimmigrazione.interno.it/dipim/site/it/assets/pubblicazioni/FEI/Volume_Convegno_30.6.10.pdf. Accessed 17 Jul 2013

  74. Save the Children (2011) http://images.savethechildren.it/IT/f/img_pubblicazioni/img133_b.pdf. Accessed 17 Jul 2013

  75. Pinchi V, Norelli GA, Caputi F, Fassina G, Pradella F, Vincenti C (2012) Dental identification by comparison of antemortem and postmortem dental radiographs: influence of operator qualifications and cognitive bias. Forensic Sci Int 222:252–255

    Article  PubMed  Google Scholar 

  76. Page M, Taylor J, Blenkin M (2012) Context effects and observer bias-implications for forensic odontology. J Forensic Sci 57:108–112

    Article  PubMed  Google Scholar 

  77. De Luca F, Pinchi V, Focardi M, Norelli GA (2012) Mistakes in age identification: experience of the Legal Medicine Institute of Florence. Riv It Med Leg 2:569

    Google Scholar 

  78. Separated Children in Europe Programme (2012) Position paper on age assessment in the context of separated children in Europe http://www.refworld.org/docid/4ff535f52.html. Accessed 17 Sep 2013

  79. Thevissen PW, Kvaal SI, Dierickx K, Willems G (2012) Ethics in age estimation of unaccompanied minors. JFOS 30:85–102

    Google Scholar 

  80. Schmeling A, Reisinger W, Geserick G, Olze A (2006) Age estimation of unaccompanied minors. Part I. General considerations. Forensic Sci Int 15;159(Suppl 1):S61–S64

    Article  Google Scholar 

  81. Abbing HD (2011) Age determination of unaccompanied asylum seeking minors in the European Union: a health law perspective. Eur J Health Law 18:11–25

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy

    Martina Focardi, Vilma Pinchi, Federica De Luca & Gian-Aristide Norelli

Authors
  1. Martina Focardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vilma Pinchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Federica De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gian-Aristide Norelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martina Focardi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Focardi, M., Pinchi, V., De Luca, F. et al. Age estimation for forensic purposes in Italy: ethical issues. Int J Legal Med 128, 515–522 (2014). https://doi.org/10.1007/s00414-014-0986-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-014-0986-0

Keywords

Search

Navigation