Margaret is 30 years old. She has been on Klonopin, an anti-anxiety medication (Micromedx 1998), for three years. One month ago, she began to have severe feelings of depression and the doctor changed her from Klonopin to Paxil, a fairly new antidepressant (Ibid.). She has continued to feel depressed; recently she gave away some of her belongings, looked happier than she had in a long time and called several family members. Her roommate, Laurie, became concerned, thinking these were pre-suicidal activities. Laurie called her boyfriend, Bill, whom concurred and the two of them alerted the psychiatrist.

Dr. Vincent has been seeing Margaret for three years. He believes Margaret is following patterns of self-destruction and needs to be admitted as an in-patient to a psychiatric hospital. He sees Margaret as a threat to herself and believes he has a duty to prevent Margaret from harming herself. His notes show that Margaret has been on one medication for three years; another medication was tried and found to be ineffective; years of therapy have proven to be of little use. Margaret's depression is not abating, instead it seems to be increasing, and she seems despondent of late. He wants to admit her today.

Laurie feels Margaret's depression might be due to the change in medication or to a recent job change. She does not want her friend to be admitted to a psychiatric center for she does not think her friend is a "nut." She thinks she can help her friend, be a support system. She asks the doctor if he could change Margaret's medication and see her on an out-patient basis.

Bill is afraid Margaret will harm or kill herself. He had a cousin who attempted suicide and thinks he sees similar patterns in Margaret. He says Margaret needs to be admitted.

Margaret admits she is confused. She sits in the doctor's office and cries. She says she knows she needs help, but does not want to be in a "mental hospital." She is afraid of the ramifications at her current job or for future employment. She says she has rights to make her own decision. She has not, she states, tried to kill herself. She says her legal rights will be violated if she is forced to be admitted. She will not sign anything now; she asks for some time to "think things over" for a few days." If you are Margaret's physician, how would you handle the rest of this conference?