In Reply

The critical comments by Eisenberg, Nowotny, Dietrich, and Mohnike in response to our article (1) are by no means unexpected. We are familiar with most of the arguments brought forward. Space restrictions on the actual text of the article as well as on the cited references mean that we can refer our correspondents to already published, detailed debates.

Eisenberg repeatedly expressed his view that X-ray examinations without medical indication are inadmissible. We can only point out once again that X-ray examinations without medical indication are legitimate, according to § 25 sentence 1 of the German X-Ray Ordinance, “in other cases provided or admitted by the law.” X-ray examinations are obviously associated with risks. For a serious classification of the risks of X-ray examinations used for forensic age estimation, taking into consideration the respective effective radiation doses, a comparison with natural and civilizatory radiation exposures and other everyday risks makes perfect sense and has most recently been undertaken by Meier et al. (2). It is correct that unnecessary radiation exposures should be avoided at all cost. For this reason, the Study Group on Forensic Age Diagnostics recommends CT scanning of the sternoclavicular joint only if hand ossification is completed (3). Nowotny creates the impression that only very few reference studies with small case numbers exist for the ctime course of the ossification of the medial clavicular epiphysis. An article by Schmeling et al. (4) showed that this is not the case. It is the expert’s duty to select from the multitude of existing studies those that are appropriate for the concrete individual case. The study cited by Nowotny (5) has a serious methodological flaw, since only one slice of the CT series was evaluated in each case. This study can therefore not be used for age estimation practice.

Taking a young person’s psychological maturity into account as demanded by Dietrich is justified—for example, for the purpose of assessing a possible need for youth services among persons who have completed their 18^th year of life. In all legal questions relating to the chronological age of a person with a doubtful age statement, a psychological maturity assessment is not expedient because of the lack of relevant studies that correlate indicators of psychological maturity with chronological age in a forensically useful way. Consequently, psychological and psychosocial age estimates have been rejected by numerous courts, nationally as well as internationally.

Dietrich regards the statement that in the case of X-ray examinations, “this does not necessarily require a benefit for the health of the individual, but can also be considered as the expected benefit of the relevant laws to the public,” as dangerous reasoning, which contradicts our legal system. We can follow his line of thought only if we assume an obvious lack of knowledge of the legal foundations that are valid in Germany. The quotation does not reflect our personal opinion but comes from the explanatory memorandum of the German X-Ray Ordinance (BR-Drs. 230/02).

From an expert perspective, the most recent publication on the decisions of the German Medical Assembly against forensic age diagnostics comes from Rudolf (6). He noted that the motions for the year 1995 commented, rather appropriately, that for age diagnostics in processes of aliens law on the basis of X-ray examinations, legal authorization grounds were questionable and insufficient medical scientific understanding prevailed at the time. The following decisions passed by the German Medical Assembly in 2007, 2008, 2010, and 2014, by contrast, reflected less of a professionally based position held by doctors, but, rather, the ideologically guided aims of the organizers of the initiative and their lack of understanding of what is required from expert proof. Mohnike cites several studies reporting variations in the signs of sexual maturity. We are aware of these facts. Since forensic age diagnostics—as explained in our article—is based primarily on the assessment of skeletal and dental indicators of maturity, which are far less chronologically varied, this is of no relevance to age assessment practice.

In sum, we conclude that the criticisms expressed in the readers’ letters to the editor are in our opinion not equipped to challenge the evidence based foundations of forensic age diagnostics.