Case example

Dr. Ames, a psychiatrist in private practice in a medium-sized California city, is caring for Ms. Warren, a 25-year-old single woman who was diagnosed four years ago with bipolar disorder. Dr. Ames and Ms. Warren have had monthly outpatient appointments over the past six months. At her first visit, Dr. Ames prescribed one of the standard medications for this condition, and he has been monitoring his patient's progress since then. At today's visit, Ms. Warren reports that she has felt very sad for the past week and has started to think that her condition is hopeless and that her life may not be worth continuing. This is the first time that she has mentioned any thoughts of suicide in her sessions with Dr. Ames.

Dr. Ames knows that it is not unusual for a depressed patient to have suicidal thoughts and that it is very difficult to predict whether a patient who expresses such thoughts will actually commit suicide. He also knows that if Ms. Warren does commit suicide while under his care, he may be at significant risk of malpractice liability for failing to prevent her suicide. Dr. Ames could prevent her from committing suicide, at least in the short term, by involuntarily committing her to a psychiatric hospital, but commitment may not improve her longer-term prospects for survival and control of her illness. Involuntary commitment would be a major disruption of Ms. Warren's life, and she would likely view this action as a betrayal of her trust by Dr. Ames. Taking this action, therefore, would very likely undermine their therapeutic relationship. Should he nevertheless commit her, to reduce her risk of suicide and his risk of liability?

When confronted with difficult questions about what to do, health care professionals may look both to ethics and to the law for guidance. Professor Kenneth de Ville, in fact, reports that the most common and often the first question asked by physicians and medical students in ethics discussions is “What does the law say?” Clinicians may inquire about their legal responsibilities for many reasons. Like Dr. Ames in the case above, they presumably want to avoid malpractice liability, and so they may seek information about the law in order to protect themselves from an adverse judgment. They may also view the law as offering clear direction about how to resolve complex problems.