Citation

Saleh FM, Malin HM. Virtual Mentor 2013; 15(10): 834-839.

Affiliation

Forensic and child and adolescent psychiatrist and assistant clinical professor of psychiatry at Harvard Medical School in Boston, and the director of the Sexual Violence Prevention and Risk Management Program at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School.

Copyright

(Copyright © 2013, American Medical Association)

DOI

10.1001/virtualmentor.2013.15.10.ecas2-1310

PMID

24152773

Abstract

Opinion 5.05 of the American Medical Association’s Code of Medical Ethics, recognizing that physicians are impeded in providing appropriate treatment if their patients do not feel safe in disclosing personal information, holds that "information disclosed to a physician by a patient should be held in confidence…subject to certain exceptions which are ethically justified because of overriding considerations". Such exceptions include threats to inflict "serious physical harm" on the self or others with a "reasonable probability that the patient may carry out the threat". In such instances, the physician should take “reasonable precautions” to protect the intended victim, including notifying law enforcement. Physicians are further admonished to “disclose the minimal information required by law, advocate for the protection of confidential information and, if appropriate, seek a change in the law” when the law is contrary to the best interests of patients.

It would be hard to overstate the importance of the Tarasoff decisions with respect to medical ethics in general and confidentiality in particular. The essence of the Tarasoff decisions is the dictum that, in conflicts between patient-therapist confidentiality and serious danger to reasonably identifiable others, protection trumps privilege. In his alliterative distillation of this dictum, California Supreme Court Justice Mathew O. Tobriner, for the majority, wrote: "The protective privilege ends where the public peril begins". It is important to note, however, that, while Tarasoff triggered a rash of "duty-to-warn" or "duty-to-protect" statutes nationwide i the USA, 16 states have adopted a discretionary approach to those duties and four states currently have no duty-to-warn or -protect statutes.

Language: en