Friday, December 21, 2012

Big brother on the couch

Daniele Canarelli is a psychiatrist in Marsailles. She deals with folks who have severe mental health issues on a daily basis. Joel Galliard is a paranoid schizophrenic who needed treatment.

Mr. Galliard became Dr. Canarelli's patient. Twenty days after leaving a session, Mr. Galliard killed German Trabuc with an axe. He was judged not responsible for his actions due to his mental illness and released under medical supervision.

But you know the story didn't end there. It's such an unsatisfactory ending when the person who did the deed is found to have not been responsible for his actions. There's a dead body. Somebody must be made to account for it.

And that someone was Dr. Canarelli. She was found guilty of involuntary homicide and sentenced to one year in prison. The sentence was suspended.

It is a fact that folks with severe mental illnesses can do things that shock the conscience. They can do things that are utterly unexpected. Once that person leaves a session there is nothing that a psychiatrist can do. Sure, you can prescribe medications. You can suggest certain behaviors to combat stressful situations. You can suggest that a patient be hospitalized.

The courts in France have stepped across a very dangerous threshold. The courts are the place for the law to be dispensed by those who are trained in it. The courts are not the place to second guess a doctor's treatment plan for a patient. Dr. Canarelli dealt with Mr. Galliard. Presumably he confided in her and she maintained his confidences. She made decisions based upon her diagnosis of Mr. Galliard's condition and her training in psychiatry. Maybe her treatment plan was wrong. And maybe the treatment plan failed because Mr. Galliard decided he didn't want to follow it.
While accepting that there was no such thing as "zero risk" in such cases and that doctors could not predict the actions of their patients, the court found that Canarelli had made several mistakes in Gaillard's treatment.
But now we have a court interjecting itself into the doctor-patient relationship and assigning criminal liability on a medical professional based on the actions of her patient. We don't need courts evaluating the treatment plans of psychiatrists. We don't need courts deciding whether or not a particular treatment plan was appropriate. We don't need courts deciding whether or not a physician should have done something else.

A legal system is good (just go with the analogy for a second) at trying to determine what happened and what penalty should be levied in the event that someone acted negligently or illegally. A legal system is not able to look into the future to determine what might happen.

A psychiatrist, on the other hand, must be able to get to the bottom of what happened in the past as well as be able to predict the future to a degree.

While a court takes what has already happened and tries to piece it together into a coherent narrative to determine how and why it happened, a psychiatrist must take what happened in the past and apply it to the present in order to make an educated guess at what might happen tomorrow - or the day after.

Maybe Dr. Canarelli was negligent in her treatment of Mr. Galliard. Maybe there were other courses of treatment she could have followed. But, if that's the case, she shouldn't be placed in the dock in a criminal court - she should have been defending herself in a wrongful death suit. Any errors she may have made fall under the heading of malpractice, not criminal behavior.

And now we have the specter of the state inserting itself in determining what type of care a doctor should provide her patient. What kind of an incentive is that going to give to psychiatrists in treating their patients?

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