Suicide and mental disorder: the legal perspective

To the Editor: Pridmore1 describes a case in which a man’s recent actions suggested suicidal intent. The man told police he had no ongoing suicidal plans and they took his words at face value. He subsequently killed himself. The High Court exonerated the police of any responsibility, a decision that seemed based on two premises: that suicide does not presuppose mental disorder; and that “There is no general common law duty of care to rescue a person from harm, including self-harm”.2 There is sufficient grey in both those inter-related premises to make a black-and-white judgment suspect.

I share Pridmore’s position that suicide does not always equal mental disorder, although one wonders whether situational crises in individuals with subtle vulnerabilities could be subsumed under such a label. More important is the question of individual autonomy. The reason we have no common law requiring us to “rescue” another adult is because we set such a high value on autonomy.

Although we assume a person’s competence, our curiosity about it should be aroused when people behave in unexpected ways. When the behaviour is strikingly different, and has potential for serious harm, are we not obliged to intervene or procure assessment? This is, I would have thought, a moral rather than legal or medical concern. This is what we would do for a child wandering on the road or a demented person lost at night. We might be free of legal or medical censure for ignoring them, but we would be embarrassed to publicly admit our failure to act if we might have done something useful at the time.

Making serious preparation to kill yourself is strikingly different behaviour, and should raise questions about both your competence and autonomy. Perhaps not 100% but surely more than 50% of such people have a disorder. A person preparing to suicide is “more likely than not” mentally ill, and that is how the “common person” would surely see it: “guilty”, as it were, till proven innocent. Expertise is called for to make that final determination. The police certainly do not have the expertise. Why, then, would they not seek it?

Furthermore, if the “rational, cooperative and responsible” man in this case had indicated his plans to “rationally” commit suicide to escape an intolerable predicament, it is hard to believe the police would have walked away, even though he may have been competent to make such a decision!