Suicide Litigation: From Legal to Clinical Wisdom

Abstract

Literature on legal aspects of suicide prevention is reviewed to focus on fundamental issues of care. The legal basis of liability is discussed in the context of risk assessment and risk management of suicidal patients. The "four Ds"--duty, dereliction of duty, damages and direct causation--are illustrated. Standards are described at three levels: of the profession, the court and the individual practitioner. Risk assessment is often confused with prediction; the latter is conceptually unsound, and while the former is more sound it is disappointingly imprecise. Despite reliability problems, risk assessment and appropriate management are important, as life itself is involved. Clinicians should be aware that informed consent requires responsibility for suicide prevention to be shared with patients. Such involvement of patients in self-destructive frames of mind raises complex issues. Management issues of both inpatients and outpatients at acute or chronic risk are discussed. Potential pitfalls for clinicians are outlined. Communications with, and the supervision of, other staff must be carefully considered. Families of vulnerable persons or those following bereavement also merit consideration. Patients are entitled to treatment with dignity and liberty--the latter should not be compromised any more than is essential--even when suicide is a possibility. Balancing these difficult issues may be easier if clinicians have a clear awareness of them.

No-Suicide Contracts and No-Suicide Agreements: A Controversial Life

“…Due, in part, to the practice of supervisors requesting subordinates to secure written no-suicide contracts or documenting a patient's verbal no-suicide agreements, the terminology used 11 , 57 (i.e. contract and agreement), and the relatively infrequent nature of suicide litigation against practitioners, 58 , 59 no-suicide contracts and no-suicide agreements have established and retain a quasi-legal status for some practitioners 60 . However, as far as we can ascertain, a promise in no-suicide contracts or documented verbal no-suicide agreements has not been legally tested as offering legal protection.…”

Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment

“…Many issues are involved in the decision to hospitalize a person with suicide risk 32 . The decision should be made on clinical grounds, and with involvement of the person and their family 33 .…”

Changeability, Confidence, Common Sense and Corroboration: Comprehensive Suicide Risk Assessment

“…Indeed, hospitalization may have little predictable benefit and even increase the risk for some people. 33 The management plan is a record of interventions and contingency plans. 32 The decision should be made on clinical grounds, and with involvement of the person and their family.…”