Subjective data and suicide assessment in the light of recent legal developments: Part II: Clinical uses of legal standards in the interpretation of subjective data

Abstract

Suicide assessment is a problematic area for the psychiatrist, given the tension between the uncertainty inherent in subjective assessment and the risk of a fatal outcome. In addition to the dread of a tragic outcome, there is also an ever-present fear of malpractice liability, along with discomfort at the prospect of having to defend clinical judgments based on data that may not lend themselves to the usual notion of scientific objectivity. These medicolegal concerns reflect deeper intellectual misgivings about the reliability of data that are neither quantified nor based on absolutely verifiable observations. On the one hand, together with more objective data, clinicians routinely take into consideration their perceptions of patients' feelings and their own in the assessment of suicide risk. On the other, they can never be quite sure that such data meet the standards of precision set by hard science, let alone the law. In Part I of this paper we demonstrated that psychiatrists ' fears of indiscriminately rendered malpractice judgments for suicidal outcomes are largely groundless. For the careful, documented use of subjective data in arriving at a reasoned clinical assessment (particularly in the context of the attempt to obtain informed consent) satisfies all three major standards of due care typically invoked by the courts in determining negligence. Thus the clinician can follow the guidelines of clinical experience and theory without being dogged by the fantasy of judicial retribution for a lack of omniscience or omnipotence. Here we will take the argument a step further and show that the three standards of