Avoiding Liability Bulletin – December 2008
… Occasionally I am asked to opine on the subject of a mental health practitioner’s participation in what can be called “supportive therapy” for someone who has decided to take his or her life. The reasons for the decision to end one’s life can vary widely, but the result, at least for me, is always the same. One scenario that I have been asked about more than once involves a client suffering from an eating disorder resulting in weight loss and malnutrition to the point of dangerousness to life. Attempted suicide is a crime in many states. Aiding or abetting a patient or client to commit suicide, or simply providing supportive counseling or therapy, might likewise, depending upon the circumstances, constitute a crime.
In most states, therapists and counselors are permitted (sometimes required) to break confidentiality when the patient is a danger to self as the result of a mental or emotional condition. If the disclosure is required, the practitioner is expected to comply with the law. If the disclosure is permitted, the practitioner must make a very important judgment. In my view, that judgment should favor those disclosures calculated to prevent the threatened or imminent suicide or serious danger to self.
I would be uncomfortable taking the position (e.g., arguing in court) that since the practitioner was not mandated to warn, notify or alert anyone, he or she was therefore without blame when nothing was done to try to prevent the intended self-harm, or when supportive counseling was provided to assist the patient with his or her plans. I would much rather be defending the practitioner who made reasonable efforts to prevent the self-harm – including, if necessary, breaking the patient’s confidentiality. When states pass laws that allow people to take their own lives under specified circumstances, then mental health practitioners can perhaps more safely provide supportive counseling or therapy that is consistent with the terms and conditions of such a law. Until then, practitioners must be very cautious when confronted with this kind of a situation.