There was a case brought against an ER physician for not involuntarily admitting a man who committed suicide 18 days after an ER visit.
Patient at time of visit was passively suicidal; but nothing you’d involuntarily cert over. After patient’s wife left him; and he commit suicide; patient’s wife then sued the doctor.
So yes the statute might protect you from NOT hospitalizing someone; but you are still very very liable to being sued. With the attendant financial and emotional stress…
Right, nothing short of immunity will prevent you from being sued.
It's an occupational hazard that we have to live with, though as psychiatrists we are at far less risk of being sued than just about any other specialty.
I'm not saying that you are making this argument, but being worried about being sued is no excuse to absolve ourselves of making the most clinically appropriate decision and instead deciding to deprive someone of their civil liberties because we're anxious about legal action. We chose this job and were aware of the responsibilities and the attendant stressors (emotional and financial) that come with those responsibilities. To make the patient pay for our unwillingness to embrace them is immoral.
As a med student I don't think I'll go into psych because there's no evidence for involuntary commitment for suicidality, and I'd be expected to section people all the time... I'm huge on human rights, and need a compelling reason to take someone's freedom away from them, (like severe manic psychosis), and also am an advocate for making suicide more accessible for competent adults (I want it as an alternative to a nursing home when I get old!)... Another unpopular opinion in psych circles.
The involuntary commitment stuff for suicide stuff is a tough one because there doesn't seem to be a lot of high quality data in either direction - suicide is extremely hard to study! I absolutely trend towards your view of things, but I think it's very hard to argue that involuntary commitment for people who are acutely suicidal doesn't reduce their risk of completed suicide *while hospitalized.* There are also no RCTs on whether or not parachutes reduce the risk of mortality for people jumping out of airplanes.
Now, there is a very good question as to whether or not involuntary hospitalization does anything to change post-hospitalization risk (either in the positive or the negative direction), and I don't think we can make the assumption that it could only be positive.
I've had lots of conversations about medically assisted suicide with my colleagues in psychiatry, and I've found the views to be rather wide ranging and thoughtful, regardless of the side they take on the issue. I think psychiatry is probably one of the more intellectually flexible specialties, but of course I'm biased!
There are very few parachutes in medicine; it's patently obvious involuntary hospitalisation for suicide is not one of them! I think you need a high bar before you lock someone up who hasn't done anything wrong in substandard accommodation, and suicidal ideation doesn't cut it in my book. I wasn't impressed with my psych rotation, thoughtful psychs haven't wandered into my vicinity as preceptors, though I acknowledge they exist.
Could you share what makes you think that this is so "patently obvious"? I have not read the literature on this question in detail, would be very interested to read some compelling studies on the issue.
I'm also wondering what you have in mind when you say "suicidal ideation." That term covers a very wide range of presentations, many of which I would agree do not rise to the level of requiring involuntary hospitalization.
As an example, would you involuntarily hospitalize a patient under the following fact pattern? In a bipolar depressive episode, well established history of bipolar disorder, previously on lithium for maintenance, but stopped taking it ~1 month ago; lithium blood levels are 0. Presents via family who literally found the patient just about to start downing a bottle of extra strength acetaminophen with 3 other bottles open and at hand. All evidence/collateral shows that the patient did not intend to be discovered until after their death and it was pure luck that the family discovered them. Suicide note found on their person. Patient admits they were trying to kill themselves, wishes they succeeded, if released clearly states that they would try to kill themselves again ASAP. There are no friends or family members that would be able to surveil the patient continuously if discharged.
(Lest you think that this is a manufactured example, it is quite close to a few patients that I have seen during my training.)
I am open to considering evidence that hospitalization would not be helpful in preventing suicide for this sort of patient, but even as a psychiatrist who is pretty aggressive in coming down on the civil liberties side of things, this seems to be a very clear cut case to me.
I def. understand you guys have a lot of liability involved. I am a troubled teen industry survivor. In my case, the facility has since shut down in Utah, however the lingering trauma from the shit I saw there haunted me. Basically unwanted children foster children were dumped there and put on anti-psychotics (sometimes 3, 4, or even 5 dif. meds at a time) by NPs that may have gotten their degree from a diploma mill...
I REALLY appreciate you speaking about this, because I am stuck inbetween a hard place where I will never forgive or forget what happened in those facilities and that it took 3 deaths within a YEAR for the place to be shut down but I also acknowledge that some people truly feel helped. I don't often encounter people that had a good experience with psychiatry so it is nice to hear things directly from the Doctors who practice it.
I am still VERY weary of taking away autonomy.... and I routinely hear about abuses at facilities in the news I just wish that overall if someone HAD to be contained that it was less traumatizing than what it is.
supremely interesting
There was a case brought against an ER physician for not involuntarily admitting a man who committed suicide 18 days after an ER visit.
Patient at time of visit was passively suicidal; but nothing you’d involuntarily cert over. After patient’s wife left him; and he commit suicide; patient’s wife then sued the doctor.
So yes the statute might protect you from NOT hospitalizing someone; but you are still very very liable to being sued. With the attendant financial and emotional stress…
Right, nothing short of immunity will prevent you from being sued.
It's an occupational hazard that we have to live with, though as psychiatrists we are at far less risk of being sued than just about any other specialty.
I'm not saying that you are making this argument, but being worried about being sued is no excuse to absolve ourselves of making the most clinically appropriate decision and instead deciding to deprive someone of their civil liberties because we're anxious about legal action. We chose this job and were aware of the responsibilities and the attendant stressors (emotional and financial) that come with those responsibilities. To make the patient pay for our unwillingness to embrace them is immoral.
You're funny! I'm always looking for people to break down forensic psychiatry and riff about it. Thanks.
Glad you enjoyed!
As a med student I don't think I'll go into psych because there's no evidence for involuntary commitment for suicidality, and I'd be expected to section people all the time... I'm huge on human rights, and need a compelling reason to take someone's freedom away from them, (like severe manic psychosis), and also am an advocate for making suicide more accessible for competent adults (I want it as an alternative to a nursing home when I get old!)... Another unpopular opinion in psych circles.
The involuntary commitment stuff for suicide stuff is a tough one because there doesn't seem to be a lot of high quality data in either direction - suicide is extremely hard to study! I absolutely trend towards your view of things, but I think it's very hard to argue that involuntary commitment for people who are acutely suicidal doesn't reduce their risk of completed suicide *while hospitalized.* There are also no RCTs on whether or not parachutes reduce the risk of mortality for people jumping out of airplanes.
Now, there is a very good question as to whether or not involuntary hospitalization does anything to change post-hospitalization risk (either in the positive or the negative direction), and I don't think we can make the assumption that it could only be positive.
I've had lots of conversations about medically assisted suicide with my colleagues in psychiatry, and I've found the views to be rather wide ranging and thoughtful, regardless of the side they take on the issue. I think psychiatry is probably one of the more intellectually flexible specialties, but of course I'm biased!
There are very few parachutes in medicine; it's patently obvious involuntary hospitalisation for suicide is not one of them! I think you need a high bar before you lock someone up who hasn't done anything wrong in substandard accommodation, and suicidal ideation doesn't cut it in my book. I wasn't impressed with my psych rotation, thoughtful psychs haven't wandered into my vicinity as preceptors, though I acknowledge they exist.
Could you share what makes you think that this is so "patently obvious"? I have not read the literature on this question in detail, would be very interested to read some compelling studies on the issue.
I'm also wondering what you have in mind when you say "suicidal ideation." That term covers a very wide range of presentations, many of which I would agree do not rise to the level of requiring involuntary hospitalization.
As an example, would you involuntarily hospitalize a patient under the following fact pattern? In a bipolar depressive episode, well established history of bipolar disorder, previously on lithium for maintenance, but stopped taking it ~1 month ago; lithium blood levels are 0. Presents via family who literally found the patient just about to start downing a bottle of extra strength acetaminophen with 3 other bottles open and at hand. All evidence/collateral shows that the patient did not intend to be discovered until after their death and it was pure luck that the family discovered them. Suicide note found on their person. Patient admits they were trying to kill themselves, wishes they succeeded, if released clearly states that they would try to kill themselves again ASAP. There are no friends or family members that would be able to surveil the patient continuously if discharged.
(Lest you think that this is a manufactured example, it is quite close to a few patients that I have seen during my training.)
I am open to considering evidence that hospitalization would not be helpful in preventing suicide for this sort of patient, but even as a psychiatrist who is pretty aggressive in coming down on the civil liberties side of things, this seems to be a very clear cut case to me.
I def. understand you guys have a lot of liability involved. I am a troubled teen industry survivor. In my case, the facility has since shut down in Utah, however the lingering trauma from the shit I saw there haunted me. Basically unwanted children foster children were dumped there and put on anti-psychotics (sometimes 3, 4, or even 5 dif. meds at a time) by NPs that may have gotten their degree from a diploma mill...
I REALLY appreciate you speaking about this, because I am stuck inbetween a hard place where I will never forgive or forget what happened in those facilities and that it took 3 deaths within a YEAR for the place to be shut down but I also acknowledge that some people truly feel helped. I don't often encounter people that had a good experience with psychiatry so it is nice to hear things directly from the Doctors who practice it.
I am still VERY weary of taking away autonomy.... and I routinely hear about abuses at facilities in the news I just wish that overall if someone HAD to be contained that it was less traumatizing than what it is.
this was fascinating, thank you