Tarasoff

Dear Editor:

Regarding the article recently published in Psychiatry 2005 on Tarasoff by Richards and Richards [Psychiatry 2005 2005;2(5):40–46], the case of Tarasoff v. Regents of California set the legal precedent regarding a clinician's responsibility to breach confidentiality if he has a reasonable belief that a patient is a threat to a third party.

The case in question was heard twice by the California Supreme Court, a most unusual circumstance. The initial decision in 1974 states the clinician has a duty to use reasonable care to warn a potential victim. This finding is still cited as a duty to warn despite the fact that it was obliterated by the next decision.

The initial finding was ill received and the case was brought in front of the court and decided a second time in 1976. The second opinion called for the clinician to use reasonable care to protect the intended victim. There is no duty to warn, but a duty to protect. This duty may be exercised in a number of ways, which may include notifying the intended victim, notifying the police, or hospitalizing the patient.

The case of Tarasoff v. Regents of California was an exceptional case for a number of reasons. Doctor-patient confidentiality is a concept dating back to the Hippocratic Oath. This case imposed a duty to breach that confidentiality. The case was heard twice by the state supreme court. The case was the stepping stone for a progeny of related court decisions and statutes that vastly divide a clinician's duty from state to state. In Florida, the law is permissive. A clinician may breach confidentiality and notify a third party of a patient's communication of intent to harm under certain circumstances.¹ However, there is no duty to protect that third party. In some states a duty to protect exists. In others, the clinician is specifically prohibited from violating clinician-patient confidentiality even under circumstances involving danger to a third party.

With regards,
George M. Northrup, MD
Tampa, Florida