Appropriate short-term risk in psychiatry and the law.
Effective treatment decisions sometimes require substantial risk of short-term harm, which can be shown after-the-fact to have been preventable, thereby carrying some liability risk. To err on the side of short-term comfort or safety, however, may greatly increase the overall and long-term risks. For instance, to intrusively restrain a borderline patient from threatened acting out, may (1) fuel a regressive cycle that heightens future risk, (2) deprive the clinician of therapeutic leverage, and/or (3) so disrupt the treatment system that other patients unnecessarily suffer. Long-term thinking is not always convincing to judge or juror, because of less direct causal connections; hence, there is pressing need to develop rational criteria for when it should hold sway. Two competing trends of legal doctrine are relevant: risk-benefit analysis (utilitarian) and absolute values (absolutist). Presumptions of appropriate short-term risk separately weigh five relevant factors, in interaction with one another: imminent safety, long-term risk, voluntariness of other agent, therapeutic boundaries, and social values. Forensic psychiatrists are advised to take a stronger stand in support of short-term risk, when needed to enhance long-term safety and optimal standards of care.
Beahrs
J O
JO
Department of Psychiatry, Oregon Health Sciences University, Portland.
Rogers
J L
JL
D003219:Confidentiality / Q000331:legislation & jurisprudence*; D017007:Duty to Warn / Q000331:legislation & jurisprudence*; D006801:Humans; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence*; D011613:Psychotherapy; D012307:Risk Factors; D013405:Suicide / Q000331:legislation & jurisprudence