Psychological Autopsy

Forensic psychiatrist Harold Bursztajn Princeton '72, Harvard Medical School '76, acknowledges ambiguity in lawsuits

by Van Wallach
Princeton Alumni Weekly, September 8, 1999

Two malpractice suits involving informed consent show how forensic psychiatrist Harold Bursztajn, M.D. Princeton '72, Harvard Medical School '76, evaluates complex situations. In one, Meador v. Stahler and Gheridian, Bursztajn testified in favor of a woman who had a Caesarean-section procedure against her wishes, followed by serious complications. She had signed a consent form, but Bursztajn, associate clinical professor in the department of psychiatry at Harvard Medical School, argued that her doctors in fact did not get her informed consent. A jury awarded her $1.5 million. In another case, Drewry v. Harwell, he testified in favor of a doctor who performed what a patient came to consider an unwanted hysterectomy and abortion after she had given informed consent. In this episode, a 'psychological autopsy' of the decisions made by the patient and doctor convinced Bursztajn that the doctor had acted properly. A jury agreed unanimously.

Two cases, similar issues, but Bursztajn followed the facts and context in different directions. In the first case he supported a patient's right to make health-care choices, while in the second he protected a doctor's ability to make choices given a patient's consent.

"If we don't have informed consent both as a clinical practice standard and a potential defense, we don't have a respect for persons that's necessary for medical practice," he explains. Evidence, rather than ideology, guides him in these and other aspects of his work; sometimes he is retained by the plaintiff, sometimes by the defense.

Bursztajn describes his work as "not helping people win but achieving a just resolution by my ability to be both effective and ethical at the same time. My job is to go beyond the adversarial relationship and try to understand a case deeply enough so that ambiguity can be acknowledged and people can reach a settlement." A vast majority of cases on which he consults are settled before going to trial. (Bursztajn's Website,, defines a forensic psychiatrist as "a physician who integrates clinical experience, knowledge of medicine, mental health, and the neurosciences to form an independent, objective opinion.")

At a December speech at Harvard before 300 doctors, Bursztajn urged the audience to maintain "mutual respect" with patients even under trying circumstances, and guard against unconscious "abandonment" of patients by not returning their phone calls or being late for appointments, for example. Besides respect, justice is another concept that Bursztajn often mentions. He credits his "love of freedom and justice" to his parents, Polish Jews who were surviving members of the Resistance in the Lodz ghetto. Twice, he recalls, ghetto doctors saved his father's life, and their actions strongly influenced Bursztajn's career choices and perspective.

The family moved from Poland to New Jersey in 1959. At Princeton Bursztajn was a University Scholar and wrote his thesis on Wittgenstein and Husserl. He attended Harvard Medical School, and now serves as codirector of the Program in Psychiatry and the Law at the Harvard Medical School Department at the Massachusetts Mental Health Center. Bursztajn maintains a private practice in Cambridge as a psychoanalyst, psychiatrist, and primary care physician. His wife, Patricia Illingworth, J.D., is a professor of ethics at Northeastern University and they have a ten-year-old daughter, Zoe, whom he describes as "both a wonderful joy and a teacher."