When a Client Threatens Suicide

UB Law clinical professor Suzanne E. Tomkins '90 and keynote speaker Teresa Collett

"I am planning to end my life," the client says. "But I want to make sure my family is provided for. I need you to review my will, my insurance policies, all of that, so I can put this plan into motion."

If you are the lawyer, what do you do?

That was one scenario under discussion at a thought-provoking UB Law School conference, Dec. 4 and 5 at the Baldy Center for Law & Social Policy. Titled "Can Attorneys Disclose Clients' Suicidal Thoughts?," the conference brought together attorneys, judges, professors, psychiatrists and experts in suicide prevention to work through some of the ethical and legal issues that suicidal clients bring to their lawyers' office.

The conference was organized by Catherine Cerulli '92, director of research for the Law School's Women, Children and Social Justice Clinic, who is also an assistant professor as the University of Rochester School of Medicine and Dentistry. Cerulli, who has done work on methodologies to prevent suicide, opened the event with remarks that cited the importance of lawyers in identifying and helping potentially suicidal people.

Teresa Collett and Catherine Cerulli '92

"Suicide is a major public health problem," Cerulli said. "We need to take it beyond just the doctors and mental health providers and begin using a public health approach to think about lawyers being part of the solution.

"We deal with people at sometimes the most critical times for them. I had two jobs that I hated, being a waitress and being a bank teller, because I had to deal with people's food and I had to deal with their money. And as lawyers, we are dealing with their bread and better, their family, their homes, their children. We are dealing with the most important, most cherished things in their lives. In addition, we are dealing with people's liberties. The role that we play in encountering people with these stressful life events cannot be stated enough."

Part of assessing suicide risk, she said, is understanding the risk factors that can predispose individuals to self-destruction. These include a prior history of suicide attempts, a family history of suicide, exposure to suicide such as in the media, access to lethal means (especially firearms), psychiatric disorders and maladaptive personality traits. Women attempt suicide more often than men, she said, but men are overall more successful at killing themselves. Women who have been targets of domestic abuse, she said, are especially at risk, even considering suicide as an exit door from an abusive relationship.

"Suicide is about multiple risk factors," Cerulli said. "There are impulsive suicides, but many of them have risk factors. It is a chain that gets started, and suicide is often the unfortunate end of the chain."

Keynote speaker Teresa Collett, a law professor and fellow at the Holloran Center for Ethical Leadership at the University of St. Thomas School of Law, in Minneapolis, gave an overview of the legal issues involved when a lawyer's client indicates he or she plans to commit suicide.

"The answer to the question 'Can attorneys legally disclose clients' suicidal thoughts?' is clear in almost every jurisdiction," she said: Yes, they can, because professional ethical codes provide for exceptions to confidentiality rules when clients show that they have diminished capacity for decision-making. The assumption, Collett said, is that threatening suicide is prima facie evidence of an unstable mental state.

Dr. Eric Caine, Hon. Sharon S. Townsend, Hon. Patricia D. Marks, and Edward Nowak '68

The gray area, Collett said, comes "in a society that has come to see suicide as a rational choice when confronting certain circumstances. How does a lawyer respond to a rationally considered threat of suicide?"

And so, for example, comes the dilemma of the estate planning lawyer whose client asks for a review of his will and life insurance documents as part of a well-considered plan that will conclude with the client's suicide. What is the lawyer to do?

Collett cited four models of the lawyer-client relationship as ways of thinking about that question. They are:

• The lawyer as godfather, in which the lawyer's primary motive is to exercise control over the circumstances to achieve what the lawyer defines as victory for the client. "The lawyer presumes that because we have superior knowledge of the consequences of decisions, we should control the decision," Collett said. "In this model, the lawyer is justified in thwarting the client's intention."
• The lawyer as hired gun, who serves the client's interests regardless of the severity of the consequences. In this scenario, if client says he wants to kill himself, the lawyer provides no guidance beyond the legal means to achieve that objective.
• The lawyer as guru. "This model allows us to express our own values and guide the client with those values in hopes that we achieve the good of the client," Collett said. "But we really do not cooperatively determine what the good of the client is, because we already know. It is a matter of simply getting them to comply with our understanding."
• Finally, the lawyer as friend. In this model, Collett said, "there is a presumption that we both seek to do what is right, but we can only determine what is right by careful conversation and by openness about how we react to what they propose to do and trying to understanding why they propose to do it." It is this model, she said, that may be most effective to adopt when faced with a suicidal client.

Collett pointed out that, because "the vast majority of suicides are committed by individuals who are suffering from depression," lawyers who are alert to the signs of depression can intervene effectively for their clients by referring them to professional help. Depression, she said, is the most treatable psychiatric illness, and 15 point of the population will suffer from it sometime in their lifetime.

She also debunked the myth that suicide is a common response to terminal illness. Terminally ill people, she said, account for less than 4 percent of suicides; "most people who kill themselves are in good physical health." But, she said, "those of you who practice in an area where you encounter terminally ill patients, at least on occasion, will have to confront the fact that society is increasingly believing, at least in Washington and Oregon, that terminally ill patients can rationally choose to end their own lives."

Collett concluded with an eloquent plea for lawyers to advocate for hope in the lives of their clients in despair, saying that attorneys must have "the conversation about what in life they are suffering and about what can be done to change those circumstances so they can surmount them. The choice for death is not one option among many, but it is an option to end all options. We have to respond not only as legal technicians, but as human beings, to the cry of pain that our patients and our clients give us when they announce their suicide intention.

"Can we make a difference? Absolutely. But only if we enrich that relationship by friendship and by listening to their pain. That takes time and it takes openness, and it is a real challenge."

A panel that looked at case studies of client disclosures consisted of Drs. Eric Caine and Kenneth R. Conner, psychiatrists with the University of Rochester School of Medicine and Dentistry; Hon. Patricia D. Marks, a Monroe County Court judge; Hon. Sharon S. Townsend, administrative judge for the 8th Judicial District of State Supreme Court; and Edward Nowak '68, a former Monroe County public defender.