Appropriate short-term risk in psychiatry and the law.
J. O. Beahrs and J. L. Rogers,
Bull. Amer. Acad. Psychiatry & the Law
21(1): 53-67, 1993.
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. [References: 64]