Osservazioni psichiatrico-forensi in tema di imputazioni e condanne agli psichiatri per il suicidio del paziente

Objective: Purpose of the present study is to point-out ten clinical-forensic implications of the management of suicidal risk, which can be useful for assessing the professional responsibility of the psychiatrist. Method: The present study is the authors' personal contributions, based on clinical and forensic experience as experts appointed by the judge, legal advisers and experts of audits in cases in which patients committed or attempted suicide. Results: The ten clinical forensic implications highlighted by the present study are: 1) the causes of suicide are multifactorial; 2) there is a lack of reliable methodology for predicting suicide in individual cases; 3) quantity and quality of suicidal risk changes across time; 4) it is impossible to prevent suicide always; 5) there is need for clinical judgment at the moment of the facts; 6) contextualization of suicidal occurrence in the individual clinical case; 7) differential responsibility of staff; 8) apparent and real contrasts in suicidal risk evaluation; 9) the variability of the extension of the duty to care for and protect the patient; 10) the good clinical practice, seen as overcoming of the dichotomy between liability of means and liability of results. Conclusions: The ten clinical forensic implications have the immediate aim to prompt the psychiatrist to test his/her good clinical practice through the medical records. They may constitute a basis for discussion aiming to obtain consensus among psychiatrists about good clinical practice and suicide forensic implications.