Dr. Bernie McCabe:

With regard to the low bar, I think that was a reference to Professor Casey's submission online. This is a timing issue. The explanatory note to head 2 states that it is not necessary for the medical practitioner to be of the view that loss of life is "inevitable or immediate." It does not clarify how far into the future one should consider the risk to apply. Could it be six months, two years or ten years? That is the point that is being made. There is no bar. This can extend to anybody at any point in her life. I hope that I have answered the question.

With regard to having no way of predicting suicide, we do not predict suicide very well. I mentioned that specifically in my earlier speech. We are very good at risk assessment, though. We do a lot of risk assessment and we do it very well. We put a lot of people into the high-risk category and we monitor a lot of people as a result. However, we have no real way of knowing who is going to proceed to suicide. We just do not. We know this from various studies. We have done studies ourselves, and there have been actuarial studies that did not involve practitioners. They basically told us that we are not good at predicting who will commit suicide, so we should not try to do so; we should be over-cautious and keep monitoring the high-risk people. That is what we do. We will never be able to predict. If we could predict - and it would be very nice if we could - we would not have any suicides.

With regard to mistrust of colleagues, I am not quite sure what that is referring to. Does it refer to the letter that went to the college on Friday morning because some members did not have access to the text of the college's submission? I am not sure if that is what is being talked about. That is an area of concern to members that will play out.

There was a question about whether a determination that a patient was lacking in judgment meant that we did not believe the patient. That is not the case and never will be the case. A lack of judgment is not necessarily a lack of capacity. It ranges all the way from being upset to not being able to form thoughts properly because one is psychotic. It encompasses a wide range and does not mean the patient is not believed. It does need psychiatric interventions of all sorts, ranging from psychotherapeutic interventions to admission, if necessary, and medication, if necessary. It does not equal not being believed. We do not refuse to believe our patients. We have no choice but to believe them, and we want to believe them. That does not mean we do not assess them. We will always assess them very thoroughly, and the assessment does not take two hours for every patient.

For some, it might take two hours; for others, it might take two weeks or two months, depending on the circumstances. Who is to judge? We do not decide that until we get the patient before us. That really needs to be clarified. These matters are not written in stone. I hope that is helpful.