Tarasoff Case Research Articles

Application of the Tarasoff ruling and its effect on the victim and the therapeutic relationship.

The Tarasoff case and subsequent court decisions and legislation in many jurisdictions established a duty to protect the intended victims of patients who pose a serious threat of violence. An approach that has been legally sanctioned is to warn the intended victim. This study examined the effects of such warnings on the warned persons and on the therapeutic relationship. All second-, third-, and fourth-year psychiatric residents (N = 46) in a university-based psychiatric residency program in San Francisco were interviewed about their experiences related to issuing Tarasoff warnings. Almost half of the residents (N = 22) reported having issued a Tarasoff warning. Most warnings were issued for patients seen in inpatient units and emergency rooms. In almost half of the cases, the resident was unable to contact the intended victim but did report the threat to a law enforcement agency. In almost three-fourths of the cases in which the intended victim was contacted, the individual already knew of the threat. The most common reaction among those warned was anxiety mixed with thankfulness; most expressed an intent to modify their behavior to increase safety. The second most common reaction was denial that the patient would ever hurt them. Clinicians reported that in most cases issuing the warning had a minimal or a positive effect on the psychotherapeutic relationship. Many of the anticipated negative effects of the Tarasoff decision have not materialized.

Client Confidentiality: Ethical Issues in Occupational Therapy

Confidentiality is a central ethical concern in occupational therapy practice and one that is emphasised in professional codes of ethics. This article examines the conceptual and moral basis of confidentiality, and relates it to the fundamental ethical principles of respect for autonomy, respect for persons and non-maleficence. The moral conflicts that may arise between the requirement of confidentiality on the one hand, and the need to safeguard the interests and welfare of others on the other hand, are explored with reference to the Tarasoff case. Both consequentialist (outcome-based) and deontological (duty-based) perspectives are examined. It is argued that confidentiality should be given a special status within the client-therapist relationship and, up to a certain critical threshold, should be protected from considerations of general welfare. It is argued that, whilst confidentiality may on occasions be breached in the interests of others, it Is rarely permissible to do so in the client's own Interest. In conclusion, occupational therapists are urged to give a high regard to confidentiality and to cultivate the virtue of discretion in their professional practice.

Clinical Crossroads: Alcoholism and HIV Infection-Reply

In Reply. —The letter by Drs Zenilman, Rompalo, and Jadack highlights several important issues that were discussed in our Clinical Crossroads article. Zenilman and colleagues raise the issue of a physician's to potential victims of future harm, a duty enshrined in the Tarasoff case. 1 The problem with respect to the patient under discussion is that to warn potential victims, the clinician must know their identities. In this case, we cannot predict who the patient's future sexual partners will be. Short of successful treatment, the clinician cannot protect or warn society at large, except by incarcerating the patient or perhaps forcing him to wear a warning label. Such measures have not been adopted by American society. Indeed, American society has, by and large, limited the paternalistic powers that physicians have. Only in limited circumstances, such as the mentally ill individual who poses an immediate risk to self or

Dangers and therapist obligations: Canadian perspective

To clarify the position Canadian therapists must adopt regarding their obligation to protect others against patients' potentially violent actions. This obligation is based on jurisprudence which has been well established in the United States since the Tarasoff case, but which does not apply in Canada. A review of jurisprudence in Canada and recent clinical recommendations. The latter are then discussed in the Canadian context and followed by a range of suggested avenues to explore. Professional standards could be established but they should be reviewed on a regular basis and allow flexibility for clinicians.

Near the Conflagration: The Wide Duty to Warn

The "duty to warn" has become fixed in US law since the 1976 case of Tarasoff v Regents of the University of California. In that case, the California Supreme Court decided that psychotherapists whose patients make a specific, serious threat of violence against a specific, clearly identifiable potential victim have a duty to warn the intended victim, directly or indirectly, of the threat. Tarasoff inspired several successful and unsuccessful lawsuits. A recent Vermont case has extended the duty to warn in that state to a threat of damage to property when persons may be physically harmed. The duty to warn is explicitly based on considerations of social utility and, as such, is attractive for courts to expand because an apparently minimal effort by therapists will often prevent substantial harm to victims. Some states have codified the duty to warn in a statute, but other states have refused to adopt the Tarasoff reasoning. In the absence of clear legal decisions to the contrary, psychotherapists may well anticipate that the duty to warn operates in their states.

Case Studies: Should Competence Be Coerced?

DL was arrested and charged with rape. He is accused of assaulting a neighborhood woman with whom he is only casually acquainted. According to police records, DL manifested psychotic symptoms--including auditory hallucinations and paranoid delusions-at the time of his arrest. He was quickly transferred to the forensic unit of the state psychiatric hospital and examined by a psychiatrist, who concluded after a thorough examination that he was not competent to stand trial. Following a brief court hearing, DL was returned to the forensic unit to receive treatment, including neuroleptic medication, designed to return him to a state of competency. Competency-which includes such factors as being able to understand the criminal charges, understand the elements of a criminal trial, and participate in one's defense-is required for a defendant to be able to stand trial. Shortly after being placed on medication, DL's psychotic symptoms remitted. According to the state-appointed forensic psychiatrist who examined him, DL is now oriented to time and place, is not hallucinating or delusional, and is able to participate in his own defense in court. The psychiatrist thus has informed DL's court-appointed attorney, the prosecutor, and the court that he is competent to stand trial. DL's attorney originally planned to enter a plea of "not guilty by reason of insanity" on his behalf. The attorney is convinced that at the time of the rape, which DL admits having committed, he was psychotic and unable to distinguish between right and wrong. However, now that DL has been medicated, is competent, and appears quite "normal," the attorney is concerned that a jury will have a difficult time believing that DL was insane at the time of the rape. On the advice of his attorney, DL refuses continued neuroleptic medication. He believes that it is in his best interests to risk the likely return of psychotic symptoms to avoid having to face a jury as a competent defendant. DL understands that this decision may mean that he will remain for years on the forensic unit of the psychiatric hospital, technically awaiting competency. The prosecutor is outraged that the defense attorney has advised his client to refuse therapeutic medication in order to avoid trial. She argues that the defense attorney is seeking to deprive his client of needed medication, contrary to his client's best interests, and also is undermining the state's legitimate interest in resolving a pending criminal matter. Does DL have the right to refuse treatment of his psychotic symptoms to avoid trial in criminal court? Is it proper for DL's attorney to advise his client to do so? By now it is well accepted that voluntary psychiatric patients have a broad-based right to refuse treatment, as long as standard informed consent procedures are followed. Paternalism has its limits. However, there is no consensus with respect to involuntary patients. Case law is evolving and there are a number of conflicting court decisions. It is not clear to what extent involuntary patients, particularly those who are hospitalized following arrest on a criminal charge, forfeit the "right to refuse" held by voluntary patients. Ordinarily, debate about the right to refuse centers on risks to the patient or to third parties who may be affected by the patient's decision to forgo treatment. In this case there is also an additional concern: whether the public's interest in resolving a pending criminal matter should take precedence over the patient's right to self-determination. Only the most orthodox libertarians would argue that a psychiatric patient has an inviolable light to determine his or her own fate. There are ample precedents where compelling public interest trumps individual rights. For instance, the well-known Tarasoff case, and others like it, demonstrates that prima facie rights ordinarily held by recipients of mental health services sometimes give way when they clash with public interest. …

Legal issues in medical management of violent and threatening patients.

The responsibility of professionals in the medical management of violent and threatening patients is discussed using the Tarasoff case (American) and the Lawson case (Canadian) as landmark cases influencing subsequent jurisprudence. It is becoming increasingly important to be aware of the court's interpretations in such areas as confidentiality, predictions regarding dangerousness, the duty to warn, and the legal duty to strangers to the therapist/patient relationship. A number of other issues relating to the risks involved in management of patients potentially dangerous as a result of the use of drugs are also discussed.

Clairvoyance vs. Common Sense: Therapist’s Duty to Warn and Protect

This article addresses the issue of a therapist's duty to warn and protect victims of domestic violence. In three different cases, California courts have found therapists liable for violent acts perpetrated by clients in their care. Based on the landmark Tarasoff case that mandated the therapist to report threats made by their clients regarding a specific victim, the courts have now extended the therapist's duty to include the reporting of those clients they assess as dangerous but who have not made specific threats, as well as the protection of unintended victims of violence, such as children. Therapists are concerned that the courts are expecting them to be clairvoyant and that psychologists may not be able to predict dangerousness. This article will discuss these concerns in light of the current state of the art regarding the prediction of dangerousness and its relationship to domestic violence. The author suggests specific clinical interventions for victims and perpetrators of domestic violence.

Judicial expansion of the Tarasoff doctrine: doctors' dilemma.

The Tarasoff case established that a psychotherapist has a legal obligation to breach a patient's confidence in certain circumstances. The subsequent judicial expansion of the original Tarasoff doctrine raises additional legal issues that confront a psychotherapist in a Tarasoff-type dilemma where the law holds the protection of third parties outweighs the patient's right to confidentiality.

Confidentiality in Medicine

Confidentiality in medicine ensures respect for the patient's privacy and improves health care by enabling the patient to trust the health professional with very personal information. Confidentiality may be breached if required in terms of the law, such as in the case of gunshot wounds, child or other abuse and communicable diseases. Other justifiable exceptions to the confidentiality rule are in an emergency situation, where the patient is incompetent or incapacitated, and in the case of psychiatrically ill patients who need to be committed to hospital. The final reason to breach confidentiality is to protect third parties, whether this is concern for the safety of a specific person or in the public interest. Two examples of the latter are the Tarasoff case and HIV / AIDS.

The Counselor's “Duty to Warn”

In the wake of the Tarasoff case in California other state courts have interpreted the legality of a helping professional's duty to warn.