Suicide of the Work-Disabled Individual Affected by Neoplasia with Unfavorable Prognosis: Evidence-Based Legal Medicine in Reconstructing the Causal Link.

چکیده اصلی

Despite the undeniable improvements made by research and therapy that have led to better prognosis and quality of life for many cancer patients, when the prognosis remains unfavorable, both in terms of survival and residual quality of life, the risk of suicide increases. If depression or another psychiatric disorder arises, the reconstruction of the causal link is more straightforward. The path appears less straightforward when this evidence is lacking, and one must question the awareness of the inevitability of the prognosis. Starting from cases of occupational neoplastic disease, in which annuity holders committed suicide, the Authors reconstruct the correct investigative methodology to follow for reconstructing the causal link, necessary to ensure Inail protection to the heirs. According to evidence-based medicine, the admissibility in the specific case of what is postulated in general must be evaluated. This requires some fundamental requirements: the diagnosis of occupational disease with unfavorable prognosis; the precise and documented knowledge of one's fate by the insured (through the development or not of a psychiatric illness already diagnosed and documented at the time of death); the absence of pre-existing (or subsequent) alternative causes independent of the occupational disease. The methodological framework adopted for neoplasias with unfavorable prognosis could also be applied to traumatic events that cause severe and drastic irreversible impairment in the subject's autonomy or to diseases that involve a progressive and worsening loss of autonomy, but in this case, the need for a well-documented psychiatric disorder, causally correlated to the consequences of the accident/disease, within which to inscribe the suicidal behavior, appears unavoidable. Some reflections from the Inail indemnity perspective must be formulated in recently observed cases of "assisted suicide," to understand how the Institute should behave if the subject's choice is related to the disability derived from a work accident or occupational disease. The Authors finally emphasize the importance of interventions useful for preventing suicidal events, measures that INAIL is beginning to implement, as demonstrated by the recent Implementation Agreement with the National Council of the Order of Psychologists.

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