Psychiatric perspectives on civil liability for suicide.

Suicide is a complex event for which psychodynamic, social, cultural, and biochemical factors have been studied. 1-3 In spite of these multiple factors, courts are more and more willing to impose civil liability on a defendant for the suicide of another. Psychiatrists are naturally most concerned with liability for failing to prevent suicide as it arises in the context of a malpractice suit. Where the psychiatrist or psychiatric hospital is found to be negligent, liability is based on a breach of an affirmative duty of care.s However, liability not only for failing to prevent suicide, but also for causing suicide has been found recently with increasing frequency. In many instances courts have moved away from a proximate causation analysis to a simple "but for" causation test to more easily find liability for suicide. Decisions in these areas have broad-reaching consequences which need to be analyzed in light of their psychosocial implications and recent psychiatric knowledge on the causes, predictability, and prevention of suicide. In particular, this article intends to show that such broadening of liability on the basis of simple direct causation is not in line with modem psychiatric thinking, perpetuates the criminal character of suicide, and becomes a convenient method of shifting the naturally expected guilt of survivors. In addition, studies are reviewed which indicate that suicide is not predictable and, therefore, even where a proximate causation test is used the use of foreseeability does not coincide with actual facts or actual foresight. The implications of this in cases of direct causation of suicide as well as failure to prevent suicide are discussed.