Suicide: Unpredictable and Unavoidable—Proposed Guidelines Provide Rational Test for Physician\u27s Liability

The physician who treats a suicidal patient faces real life-or-death decisions. The primary decision depends on his professional evaluation of the likelihood that his patient will take his own life. If the physician concludes that suicide is imminent, medical ethics and the law require he take steps to protect his patient. Failing to take appropriate protective action exposes the physician to legal liability. The physician owes a duty to his patient, but defining parameters of this duty and methods to satisfy it are not clear. Neither the legal system nor current medical knowledge or practice establishes guidelines to aid the doctor. This article briefly reviews current medical knowledge concerning suicide. It suggests that the physician must determine, aided by a proposed, defined list of risk factors, whether his patient is suicidal. If the patient is suicidal, the physician must expand his evaluation to determine if an underlying mental disease exists. If he discovers a disease, the physician must decide whether suicidal thoughts and impulses are the product of this underlying disorder. Where suicidal thoughts and impulses are the product of an underlying mental disease, the physician can—in fact, should—take reasonable steps to prevent the suicide. This article proposes a set of procedures all physicians should follow whenever suicide predictors are present and the physician decides the patient\u27s suicidal thoughts and impulses are the product of an underlying mental illness. A different analysis is suggested if the patient\u27s suicidal thoughts and impulses are a product of something other than an underlying mental disease. The article concludes that an adult whose suicidal impulses do not stem from an underlying, high-risk mental disease has a right to kill himself. So long as the physician correctly concluded these thoughts and impulses are not the result of mental disorder, explained this to the patient, thoroughly explored with him reasons for and consequences of his proposed actions, and recorded these, the physician has satisfied his legal responsibility and no basis for liability exists