Friday, October 08, 2004


The Daily Standard makes some good points, lest anyone forget:

WITH THE RELEASE of the Duelfer report on Iraq's weapons programs, now is a good time to review what role the international inspections had in verifying Iraq's disarmament--a role Senator Kerry and others appear to have confusion about. The inspection regime established by the U.N. Security Council in the wake of the Gulf War was never about the number of inspections conducted or, for that matter, whether U.N. inspectors could independently determine the status of Iraq's weapons programs. It was about verifying that Saddam Hussein actively engaged in disarmament, and providing positive evidence of that disarmament to the U.N. team. Given Iraq's history of successfully hiding its illicit weapons activities in a country the size of California, there could be no certainty that Saddam Hussein had disarmed unless and until Iraq fully cooperated in documenting its disarmament.

In case anyone has forgotten, Saddam did not cooperate. Not only was he obstructing inspectors from their job, he was daily ordering fire on US jets patroling the "No-Fly" Zone, established after the Gulf War. In case anyone has forgotten, Saddam had used WMD in the past, and everyone -EVERYONE--believed he still possessed them. In case anyone has forgotten, Saddam had a history of violence against his neighbors as well as his own people.

Let me make an analogy here. As a psychiatrist, I am often called on by society's laws to make a decision if a person is "suicidal or homicidal"-- either of which indicates that hospitalization is in order. How does one make that judgement? Especially when many patients with mental illness are not particularly cooperative and deny that they have any problem to begin with. Well, it is a difficult task. While I believe that everyone is ultimately responsible for their own behavior, I am also aware that my judgement on this issue can intervene to save someone's life, so I tend to take it seriously.

Sometimes people TELL me that they are having feelings of wanting to kill themselves; and they tell me the details of how they'd go about it. Occasionally, some patients will confide in me their desire to kill a specific person. This kind of honesty and self-awareness makes my job a bit easier. But most of the time I have to act on "soft intelligence".

What do I mean by that? Well, most of the time I have to take many little things into consideration:
  • How honest do I think a person is being with me in regard to their feelings and intent?
  • How honest have they been with me and/or others in the past?
  • Do they have a history of ACTING on suicidal or homicidal feelings in the past? (one of the most significant predictors of future actions are past actions)
  • Are they trying to manipulate me (either (1) they WANT to be hospitalized and have no real intent to harm themselves or others; or( 2) they DON'T WANT to be hospitalized because they have real intent to harm themselves or others. I look especially hard at those who I think might be "shining me on"
  • Do they have the means to actually hurt themselves (e.g., if they have a plan to shoot themselves or someone else--do they actually have a gun at home? or access to a gun?
  • How seriously do their family and friends take the possibility of their suicidality or homicidality?
  • How impulsive are they now? How impulsive have they been in the past?

The above are not the only considerations that go into my assessment, but they are some of the primary ones. A particular person might not meet ALL the criteria above; and each case is different, depending on the situation. Since people's lives are at stake, I try to err on the side of caution in most cases. The potential consequences are very high, and sometimes I am a bit overwhelmed by the responsibility. I will admit that in the last 30 years, I have made mistakes. Sometimes I hospitalized someone against their will who really had no intention of hurting themselves or someone else. My judgement was incorrect about their homicidality or suicidality. The worse consequence of that was that the patient hated me and refused to see me again. OK, I can live with that.

But it has also gone the other way. I remember when I didn't hospitalize a patient of mine, because they didn't have the past history of trying to kill themselves. I was an intern at the time and somewhat inexperienced. I decided to believe the person when she said she didn't really have any "intent" to kill herself. But to my horror, that person not only killed herself the next day, but she killed her best friend --another patient of mine.

I don't know that two lives would have been saved if I had acted. I firmly believe that every person is only responsible for their own actions--not for others'. Perhaps I could have only delayed what happened if I had acted. I don't know. I will never know. But I learned this: If I have the opportunity to do something to save a life, then I must do it. I cannot know the future. I cannot know how someone will behave in the future. But I can use all available information at the time; the person's own history; and my own professional skills to the best of my ability to assess each situation. I can balance and weigh the hard and soft evidence; balance and weigh the risks and benefits; and make the best decision possible at that moment. And if I make a mistake in the future; I want it to be on the side of saving lives.

I thank God every day that George W. Bush feels the same way.

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