Legal and ethical duties of the clinician treating a patient who is liable to be impulsively violent
✍ Scribed by James C. Beck
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 163 KB
- Volume
- 16
- Category
- Article
- ISSN
- 0735-3936
No coin nor oath required. For personal study only.
✦ Synopsis
This paper reviews published tort cases that arose after a patient impulsively hurt or killed someone. Plaintis alleged breach of the duty to protect (Taraso ) or negligent release from hospital. There are sixteen cases involving a variety of facts and diagnoses. As a matter of law courts typically hold that impulsive violence is not foreseeable. One jury found a defendant negligent but that verdict was ultimately overturned. Statutes on duty to protect do not imply a duty to act on the fact patterns of impulsive violence in this sample. The author concludes that the ethical duty to do careful clinical work is essentially identical to the legal duty to use due care in these cases. The law imposes no additional burden on the clinician in these cases. # 1998 John Wiley & Sons, Ltd.
This paper focuses almost entirely on legal rather than ethical duties. Clinicians always have an ethical duty to use due care in their evaluation of every patient. As will appear, the legal duty in cases of impulsive violence appears not to add anything to the ethical duty. As I read the case law, it is remarkably congruent with good clinical practice.
As with all behavior, violence is a function of the person and the environment. Some persons are more likely to be violent than others, but whether they are ``liable to'' be impulsively violent depends on the situation as well as on the person. It is essential always for the mental health professional to retain the perspective that assessment of violence, including impulsive violence, relates to a person in a situation.
Let us be clear. We are interested in assessing potential violence in order to prevent future violence if we can. There is a great deal of cant written about how psychiatrists cannot predict violence, with the implication that we should be excused from trying. True, no research has demonstrated that psychiatrists or other mental health professionals can predict violence accurately in the individual case (Monahan and Steadman, 1994). Typically, our predictions are wrong in two out of three cases. However, the practical value of psychiatric assessments of potential CCC 0735±3936/98/030375±15$17.50