Cantor C H, McDermott P M
Department of Psychiatry, Princess Alexandra Hospital, Wooloongabba, Queensland.
Aust N Z J Psychiatry. 1994 Sep;28(3):431-7. doi: 10.3109/00048679409075870.
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.
本文回顾了关于自杀预防法律方面的文献，重点关注护理的基本问题。在对自杀患者进行风险评估和风险管理的背景下，讨论了责任的法律依据。阐述了“四个D”——义务、失职、损害和直接因果关系。从专业层面、法院层面和个体从业者层面描述了标准。风险评估常常与预测相混淆；预测在概念上站不住脚，而风险评估虽然更合理，但却令人失望地不够精确。尽管存在可靠性问题，但由于涉及生命本身，风险评估和适当管理仍很重要。临床医生应意识到，知情同意要求与患者共同承担预防自杀的责任。让处于自我毁灭心态的患者参与进来会引发复杂的问题。讨论了急性或慢性风险的住院患者和门诊患者的管理问题。概述了临床医生可能遇到的潜在陷阱。必须仔细考虑与其他工作人员的沟通和对他们的监督。弱势群体的家属或那些经历丧亲之痛的人也值得关注。患者有权在有尊严和自由的情况下接受治疗——后者在必要时才应受到限制——即使存在自杀可能性。如果临床医生清楚地意识到这些难题，那么平衡这些难题可能会更容易。
