title: Medico-legal notes for a new set of standards in the assessment of penal liability in psychiatry.
abstract: Negligence liability on the part of a psychiatrist belongs among high-complexity fields, for both the judge and his or her technical consultants. In most instances, there are no scientific grounds in order to ascribe with reasonable certainty liability to medical personnel and nursing staff, while often judges tend to stretch the concept of “protection” to a degree to which the psychiatrist is deemed to have a legal obligation to stave off the development of any adverse consequence which psychic distress may bring upon the patient. The case-records pertaining to suicide are symptomatic of such a tendency on the part of the Supreme Court as to convict healthcare professionals, the lack of incontrovertible evidence notwithstanding. The authors of this paper expound and elaborate on the conditions needed to ascribe liability to the psychiatrist, and the cause and effect relationship between the doctor’s professional behavior and the patient’s eventual suicide. On such basis, several sentences are perused in which the failure to institutionalize, the discharging of a patient, the granting of leaves and an obligation to supervise all come into play, highlighting how suicide is far too complex an outcome to be rationalized into the principle of causality beyond the reasonable doubt, as dictated by the criminal procedure codes, neither can it be kept from happening through the patients’ loss of personal liberty. Within such a legal framework, what becomes apparent is the inadequateness of any set of standardized rules and laws
  regulating professional liability, and its inability to properly take into account the complexities and peculiarities inherent to psychiatry. Consequently, a proper overhaul of such proceedings appears to be urgent, via a newly devised set of provisions, crafted to provide a new array of undisputable, basic behavioral standards, the breaching of which would entail the sanctioning on the part of the lawful authorities of such violations, even in absence of the suicide of a patient, or persisting the inability to demonstrate a cause-effect relationship.
authors.affiliation: Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore, "Sapienza" Università di Roma.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Montanari Vergallo
authors.affiliation: Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore, "Sapienza" Università di Roma.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rinaldi
authors.affiliation: Dipartimento di Scienze e Biotecnologie Medico-Chirurgiche, "Sapienza" Università di Roma.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bersani
authors.affiliation: Dipartimento di Scienze Anatomiche, Istologiche, Medico-Legali e dell'Apparato Locomotore, "Sapienza" Università di Roma.
authors.forename: Enrico
authors.initials: E
authors.lastname: Marinelli
mesh_terms: D003863:Depression / Q000523:psychology; D006801:Humans; D007558:Italy; D016365:Liability, Legal; D008318:Malpractice / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000523:psychology; D010817:Physician-Patient Relations; D011570:Psychiatry / Q000331:legislation & jurisprudence*; D013405:Suicide / Q000331:legislation & jurisprudence*