Bursztajn H, Gutheil T G, Brodsky A, Swagerty E L
Program in Psychiatry and the Law, Massachusetts Mental Health Center, Boston 02115.
Bull Am Acad Psychiatry Law. 1988;16(4):369-77.
Prospective clinical assessment of suicidality differs significantly from that used retrospectively in malpractice litigation. In the latter context, the judge or jury may be susceptible to hindsight reasoning and a disproportionate emphasis on the specific method of suicide, exaggerating its foreseeability and "magically" linking the means of death to the treating clinician, especially in the case of suicide by an overdose of prescribed medication. Such magical thinking, moreover, is rooted in the clinical context of suicide: The errors of reasoning observed in the courtroom exhibit striking parallels with the mind-set of the suicidal patient. An understanding of these dynamics suggests appropriate precautions for the clinician and thus contributes to the prevention both of suicide and of malpractice litigation.
对自杀倾向的前瞻性临床评估与在医疗事故诉讼中进行的回顾性评估有显著不同。在后一种情况下，法官或陪审团可能容易受到事后诸葛亮式的推理影响，并且过度强调自杀的具体方式，夸大其可预测性，并“神奇地”将死亡方式与治疗医生联系起来，尤其是在因过量服用处方药而自杀的情况下。此外，这种神奇的思维方式植根于自杀的临床背景：在法庭上观察到的推理错误与自杀患者的思维模式有着惊人的相似之处。对这些动态的理解为临床医生提供了适当的预防措施，从而有助于预防自杀和医疗事故诉讼。
