{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T17:01:13Z","timestamp":1784998873599,"version":"3.55.0"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Sci Law"],"abstract":"<jats:p>Deaths involving prolonged starvation and immobility are commonly interpreted through frameworks of neglect, restraint, abuse or medical failure. This paper re-examines a published forensic case involving a 47-year-old woman who died following prolonged inanition, immobility and repeated non-lethal trauma. Autopsy findings included extreme cachexia, fixed joint ankylosis, circumferential lower limb ulcers, bilateral rib fractures in different stages of healing and marked organ atrophy in the absence of disease or toxicological explanation. The reported history of recent independent ambulation and feeding was incompatible with the degree of musculoskeletal degeneration and physiological decline. The case, therefore, demonstrates the evidentiary value of physiological contradiction in reconstructing timelines of deterioration. Building on existing forensic approaches to starvation, restraint, abuse and neglect, this paper identifies a narrower classification problem: how to interpret deaths in which deterioration, dependency, survivable trauma, possible localised intervention and harm coexist within the same clinical trajectory. The analysis argues that binary distinctions between care and neglect may obscure cases where limited or selective intervention occurs alongside sustained deprivation. A trauma-informed forensic approach is proposed, not as a therapeutic framework, but as an evidence-led method for interpreting dependency, impaired resistance, delayed help-seeking, caregiver accounts and physiological contradiction without treating silence, immobility or survival as evidence of consent, passivity or adequate care.<\/jats:p>","DOI":"10.1177\/00258024261471836","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:33:13Z","timestamp":1784813593000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["When care and harm coexist: Challenges in forensic classification of prolonged fatal starvation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0807-0188","authenticated-orcid":false,"given":"Rebecca CK","family":"Ward","sequence":"first","affiliation":[{"name":"James Cook University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-38818-7"},{"key":"e_1_3_2_3_2","volume-title":"Knight\u2019s forensic pathology (4th ed.)","author":"Knight B","year":"2016","unstructured":"Knight B, Saukko P. Knight\u2019s forensic pathology (4th ed.). CRC Press, 2016."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781118570654.ch25"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2024.111941"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0379-0738(00)00401-1"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7208\/chicago\/9780226169743.001.0001"},{"key":"e_1_3_2_8_2","volume-title":"Holy feast and holy fast: The religious significance of food to medieval women","author":"Bynum CW","year":"1987","unstructured":"Bynum CW. Holy feast and holy fast: The religious significance of food to medieval women. University of California Press, 1987."},{"key":"e_1_3_2_9_2","first-page":"561","article-title":"A case of folie \u00e0 trois in a forensic setting","volume":"13","author":"Siddle R","year":"2002","unstructured":"Siddle R, Haddock G, Tarrier N, et al. A case of folie \u00e0 trois in a forensic setting. Journal of Forensic Psychiatry 2002; 13: 561\u2013566.","journal-title":"Journal of Forensic Psychiatry"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/070674379504000705"},{"key":"e_1_3_2_11_2","first-page":"80","article-title":"Shelter from the storm: Trauma-informed care in homelessness services settings","volume":"3","author":"Hopper EK","year":"2010","unstructured":"Hopper EK, Bassuk EL, Olivet J. Shelter from the storm: Trauma-informed care in homelessness services settings. Open Health Serv Policy J 2010; 3: 80\u2013100.","journal-title":"Open Health Serv Policy J"},{"key":"e_1_3_2_12_2","volume-title":"SAMHSA\u2019s concept of trauma and guidance for a trauma-informed approach","author":"Substance Abuse and Mental Health Services Administration","year":"2014","unstructured":"Substance Abuse and Mental Health Services Administration. SAMHSA\u2019s concept of trauma and guidance for a trauma-informed approach. U.S. Department of Health and Human Services, 2014."}],"container-title":["Medicine, Science and the Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258024261471836","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00258024261471836","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00258024261471836","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T16:19:36Z","timestamp":1784996376000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00258024261471836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":11,"alternative-id":["10.1177\/00258024261471836"],"URL":"https:\/\/doi.org\/10.1177\/00258024261471836","relation":{},"ISSN":["0025-8024","2042-1818"],"issn-type":[{"value":"0025-8024","type":"print"},{"value":"2042-1818","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"00258024261471836"}}