Discuss the ethical case

A well-known 30 year old male with "chronic depression, which seems to be getting worse". Family history of depression, brother with suicide attempt. Patient expressed "suicide ideation at the time""has even thought of a method" but never acutely. Patient states no thoughts at the time seen in the office. Patient placed on Paxil, does was increased monthly. Patient seen monthly- in follow up Paxil increased from 20.30 to 40mg. Patient does not improve, legs ache, he sees an MD for a sigmoidoscopy in between visits. PA increased Paxil to 50mg for 3 days then 60mg. Patient attempts suicide a week later.