To discuss the concepts of the duty to protect and the associated threat to confidentiality and their impact on practice for Canadian psychiatrists.
Method:
We review these concepts and provide a synthesis of legal cases impacting psychiatric practice.
Conclusion:
The onus is on the psychiatrist to make him or herself aware of the current state of the legal obligation with respect to duty to protect. The evolving concept of duty to protect has and will continue to have significant impact on the practice of psychiatry.
McNielDEBinderMDFultonFM. Management of threats of violence under California's Duty-to-Protect statute. Am J Psychiatry1998;155:1097–1101.
2.
FelthousAR. The clinician's duty to protect third parties. The Psychiatric Clinics of North America1999;22:49–59.
3.
KaufmanM. Post-Tarasoff legal developments and the mental health literature. Bull Menninger Clinic1991;55:308–22.
4.
DickensBM. Legal issues in medical management of violent and threatening patients. Can J Psychiatry1986;31:772–80.
5.
Tarasoff v. Regents of the University of California, 188 Cal. Rptr. 129, 529 P2d 533, 1974.
6.
Barefoot v. Estelle, 51 LW 5190, 1983.
7.
Wenden v. Trikha, Royal Alexandra Hospital and Yaltho, 14 CCLT (2d) 225 (Alta. C.A.). 1993.
8.
Smith v. Jones, 169 D.L.R. (4th) 385 (S.C.C.). 1999.
9.
BeckJC. The psychotherapist's duty to protect third parties from harm. Mental and Physical Disability Law Reporter1987;11:141–7.
10.
AppelbaumPSGutheilTG. In: Clinical Handbook of Psychiatry and the Law (2nd ed). Baltimore: Williams & Wilkins; 1991.
11.
TruscottDCrookKH. Tarasoff in the Canadian Context: Wenden and the Duty to Protect. Can J Psychiatry1993;38:84–9.
12.
American Psychiatric Association. “Principles of Medical Ethics with Annotation Especially Applicable to Psychiatry” (1993 ed), Section 4.
13.
FerrisLEBarkunHCarlisleJHoffmanBKatzCSilvermanM. Defining the physician's duty to warn: Consensus statement of Ontario's Medical Expert Panel on Duty to Inform. Can Med Assoc J1998; 158:1473–9.
14.
Tarasoff v. Regents of the University of California, 17 Cal.3d 425,551 P2d 334, 1976.
15.
RunckB. Survey Shows Therapists Misunderstand Tarasoff Rule. Hospital and Community Psychiatry May1984;35(5):429–30.
16.
BloomHBayM. A Practical Guide to Mental Health Capacity and Consent Law of Ontario. Toronto: Thomson Canada; 1996.
17.
AppelbaumPS. Tarasoff and the clinician: Problems in fulfilling the duty to protect. Am J Psychiatry1985;142:425–29.
18.
RothLHMeiselA. Dangerousness, confidentiality, and the duty to warn. Am J Psychiatry1977;134:508–11.
19.
GlancyGDRegehrCBryantAG. Confidentiality in crisis: Part I—The duty to inform. Can J Psychiatry1998;43:1001–5.
20.
HuberMGBalonRLabbateLABrandt-YoutzSHammerJHMuftiR. A survey of police officers' experience with Tarasoff warnings in two states. Psychiatr Serv2000;.51:807–9.
21.
MillsMJSullivanGEthS. Protecting third parties: A decade after Tarasoff. Am J Psychiatry1987;144:68–74.
22.
GoldmanDLJacobT. Anatomy of a second generation Tarasoff case. Can. J. Psychiatry1991;36:35–8.
23.
ZonanaH. Warning third parties at risk of AIDS: APA's policy is a reasonable approach. Hospital and Community Psychiatry February1989;40(2):162–4.
24.
PerryS. Warning third parties at risk of AIDS: APA's policy is a barrier to treatment. Hosp Community Psychiatry February1989;40(2):158–61.
25.
GlancyGDRegehrCBryantAG. Confidentiality in crisis: Part II—Confidentiality of treatment records. Can J Psychiatry1998;43:1006–11.
26.
GurevitzH. Tarasoff: Protective privilege versus public peril. Am J Psychiatry1977;134:289–92.
27.
LeongGBEthSSilvaJA. The psychotherapist as witness for the prosecution: The criminalization of Tarasoff. Am J Psychiatry1991;149:1011–5.
28.
EdelsteinLudwig. “The Hippocratic Oath: Test, translation & interpretation. Bull Hist Med (Suppl 1); Chapter 16: 402–6. Baltimore: John Hopkins Press; 1943.
29.
ShaneF. Confidentiality and dangerousness in the doctor–patient relationship: The position of the Canadian Psychiatric Association. Can J Psychiatry1988;30:293–6.
30.
MacbethJEWheelerANSitherJWOnekJN. Legal and risk management issues in the practice of psychiatry. Washington: The Psychiatric Purchasing Group Inc (PPG); 1994.
31.
MillsMJ. The so-called duty to warn: The psychotherapeutic duty to protect third parties from patients' violent acts. Behav Sci Law1984;2:237–57.
32.
SharpeG. The law and medicine in Canada. Toronto: Butterworths; 1987.
33.
McNeilDBinderR. Clinical assessment of the risk of violence among psychiatric inpatients. Am J Psychiatry1991;148:1317–21.
34.
WebsterCDouglasKEavesDHartS. The HCR-20: Assessing risk for violence, Version 2. Burnaby, BC, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University; 1997.
35.
HarrisGRiceMQuinseyV. Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument. Criminal Justice and Behavior1993;20:315–35.
36.
SteadmanJHSilverE, Monahan J, and others. A classification tree approach to the development of actuarial violence risk assessment tools. Law Hum Behav2000;24:83–100.
37.
MonahanJSteadmanHJ, Appelbaum PS, and others. Developing a clinically useful actuarial tool for assessing violence risk. Br J Psychiatry2000;176:312–9.
38.
SteadmanHJ. Dangerousness to risk assessment of community violence: Taking stock at the turn of the century. Journal of the American Academy of Psychiatry and the Law2000;28:265–71.
39.
Pittman Estate v. Bain (1994) 112 DLR (4th) 258 Ontario Central Division.
40.
O'ShaughnessyRJ. Smith v. Jones: Privileged communication versus the public interest. Canadian Psychiatric Association Bulletin1999;31:80–1.
41.
MossmanD. Commentary: Assessing the risk of violence – are “accurate” predictions useful?Journal of the American Academy of Psychiatry Law2000;28:272–81.