The Principle of Psychiatric Confidentiality (57)
jeanc20065856 Threads 1,858 PostsYou are a psychiatrist and your patient has just confided to you that he intends to kill a woman. You're inclined to dismiss the threat as idle, but you aren't sure. Should you report the threat to the police and the woman or should you remain silent as the principle of confidentiality between psychiatrist and patient demands? Should there be a law that compels you to report such threats?
------ This thread is Archived ------
If it may save someone's life report it, even in the form of an unsigned letter.
------ This thread is Archived ------
The moral balance.....
Do what you think is right.
Do what you think is right.
------ This thread is Archived ------
I believe they are obliged to report it if they feel it is a credible threat. I'm not sure if it's a law, but I think they can lose their license if they don't. I would have some concerns about a law that required all threats to be reported regardless of their credibilty. My concern would be that so many idle threats would get reported, that legitimate threats wouldn't be given proper scrutiny.
------ This thread is Archived ------
Definately report it
------ This thread is Archived ------
I do like your challenge.
It feeds morale debate.
The pharmaceutical industry is the one of the top runners of the evil/money winning groups of our time.
I will not, subscribe to that prescription of selling temporary relief...
And to the point in hand and seriously as a parent, cannot subscribe to the moral ill doings of a perpetrator.
I do not work in the medical field, but do work in the moral standing type and can only say to turn the person in.
It feeds morale debate.
The pharmaceutical industry is the one of the top runners of the evil/money winning groups of our time.
I will not, subscribe to that prescription of selling temporary relief...
And to the point in hand and seriously as a parent, cannot subscribe to the moral ill doings of a perpetrator.
I do not work in the medical field, but do work in the moral standing type and can only say to turn the person in.
------ This thread is Archived ------
I think there is a law that compels you to report such threats, maybe one for priests too.
As far as I know, the psychiatrist will tell the patient early on that if there is a violent threat to themselves or others, they will tell.
As far as I know, the psychiatrist will tell the patient early on that if there is a violent threat to themselves or others, they will tell.
------ This thread is Archived ------
Ultimately psychiatrist/patient confidentiality doesn't even come into the picture.
If the psychiatrist believes that person is a threat to society then the psychiatrist has the right to have the patient committed to a mental institution. And therein lies your answer.
I'm not saying that it's an easy decision. I'm just saying that doctor/patient confidentiality doesn't play a role in this.
If the psychiatrist believes that person is a threat to society then the psychiatrist has the right to have the patient committed to a mental institution. And therein lies your answer.
I'm not saying that it's an easy decision. I'm just saying that doctor/patient confidentiality doesn't play a role in this.
------ This thread is Archived ------
Sure it does, as the question was posed.
A psychiatrist may not commit a person to a mental institution just because said person makes a threat. The scenario, as laid out, states that the doctor tends to dismiss the threat as idle, but isn't sure.
He may not have the legal grounds to commit the person to a psychiatric facility, but he is still contemplating that the threat might be a valid one.
In that instance, because he cannot legally commit the person (because he hasn't convinced the psychitrist that he is, indeed, a danger to himself or to society), but because he is, nonetheless, concerned, does he have a moral obligation to call the police and/or the potential victim and let them know of the threat?
The patient has the right to expect that matters discussed with his psychiatrist be kept confidential.
Society has a right to be protected from potentially dangerous people. The woman in particular has a right to be warned in advance so that she may take proper precautions.
So, should the psychiatrist break the rules of confidentiality in this case, or not?
A psychiatrist may not commit a person to a mental institution just because said person makes a threat. The scenario, as laid out, states that the doctor tends to dismiss the threat as idle, but isn't sure.
He may not have the legal grounds to commit the person to a psychiatric facility, but he is still contemplating that the threat might be a valid one.
In that instance, because he cannot legally commit the person (because he hasn't convinced the psychitrist that he is, indeed, a danger to himself or to society), but because he is, nonetheless, concerned, does he have a moral obligation to call the police and/or the potential victim and let them know of the threat?
The patient has the right to expect that matters discussed with his psychiatrist be kept confidential.
Society has a right to be protected from potentially dangerous people. The woman in particular has a right to be warned in advance so that she may take proper precautions.
So, should the psychiatrist break the rules of confidentiality in this case, or not?
------ This thread is Archived ------
"The patient has the right to expect that matters discussed with his psychiatrist be kept confidential."
within the law. by law we are bound to report, especially if they cannot for what ever reason be institutionalised... the patient is informed in writing upon intake what the restrictions are.
whether they read the fine print is another cookie!
within the law. by law we are bound to report, especially if they cannot for what ever reason be institutionalised... the patient is informed in writing upon intake what the restrictions are.
whether they read the fine print is another cookie!
------ This thread is Archived ------
Yes, that was already taken into consideration. thanks..
------ This thread is Archived ------
That answers the question right there and was what I was basically trying to say that the psychiatrist already has the right to do this so the question about breaking rules of confidentiality is moot.
However, I don't think it's ever the psychiatrist's responsibility to notify the potential victims directly. The psychiatrist's only responsibility is to notify the proper authorities (which may or may not be the police), and then it is up to those authorities to decide whether or not any potential victims need to be notified.
However, I don't think it's ever the psychiatrist's responsibility to notify the potential victims directly. The psychiatrist's only responsibility is to notify the proper authorities (which may or may not be the police), and then it is up to those authorities to decide whether or not any potential victims need to be notified.
------ This thread is Archived ------
by law if a counselor,doctor or psychiatrist knows if someone is a hurt to other's or to theirsevles.they have to hold them for treatment.if they do not voluntary go than they have to call the poliice on them.
if they do not report them,the person does what they said they was going to do.the counselor,doctor or psychiatrist can be handle responsible for their actions.which means they can lose their license,go to jail or be sued.
in most states the law for this is called the Baker act.in the case of someone getting hurt or lost of life.there is no principle of confidentiality between psychiatrist and patient demands
the Baker act frees them from that.
if they do not report them,the person does what they said they was going to do.the counselor,doctor or psychiatrist can be handle responsible for their actions.which means they can lose their license,go to jail or be sued.
in most states the law for this is called the Baker act.in the case of someone getting hurt or lost of life.there is no principle of confidentiality between psychiatrist and patient demands
the Baker act frees them from that.
------ This thread is Archived ------
It is not "moot," because he can't just go breaking the rules of confidentiality "on a whim." He has to have reasonable cause to believe that the patient is, in fact, a danger to himself and/or to others. And he (or she) does not have the legal responsibility to notify the intended victim, this is true.
But this varies from state to state. Apparently not all states have adapted this law.
For example, a precedent case to this law, Tarasoff v. Regents of the University of California, (a crime that was committed in 1969) was one in which the Surpeme Court of the State of California held that:
"When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more of various steps. Thus, it may call for him to warn the intended victim, to notify the police, or to take whatever steps are reasonably necessary under the circumstances."
The California Supreme Court found that a therapist has a duty not only to his patients, but also to persons who are specifically threatened by the patient. This decision has since been adopted by most states in the U.S. and is widely influential in jurisdictions outside the U.S. as well.
In the majority opinion, Justice Mathew O. Tobriner famously stated: "... the confidential character of patient-psychotherapist communications must yield to the extent that disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins."
Justice Clark dissented, stating in his minority opinion that "the very practice of psychiatry depends upon the reputation in the community that the psychiatrist will not tell".
It said "most" states, but not all. I'm not sure which ones don't adhere to this ruling, though.
Source: Wikepedia.
But this varies from state to state. Apparently not all states have adapted this law.
For example, a precedent case to this law, Tarasoff v. Regents of the University of California, (a crime that was committed in 1969) was one in which the Surpeme Court of the State of California held that:
"When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of this duty may require the therapist to take one or more of various steps. Thus, it may call for him to warn the intended victim, to notify the police, or to take whatever steps are reasonably necessary under the circumstances."
The California Supreme Court found that a therapist has a duty not only to his patients, but also to persons who are specifically threatened by the patient. This decision has since been adopted by most states in the U.S. and is widely influential in jurisdictions outside the U.S. as well.
In the majority opinion, Justice Mathew O. Tobriner famously stated: "... the confidential character of patient-psychotherapist communications must yield to the extent that disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins."
Justice Clark dissented, stating in his minority opinion that "the very practice of psychiatry depends upon the reputation in the community that the psychiatrist will not tell".
It said "most" states, but not all. I'm not sure which ones don't adhere to this ruling, though.
Source: Wikepedia.
------ This thread is Archived ------
every state i have been in has the law,but it is not called the same thing.trust me i know when it comes to a lost of life no matter if it is their's or someone elses there is no psychiatric confidentiality
if you don't believe me go to a doctor,counselor or psychiatrist and tell them.that you are going to kill someone or kill yourself and see what will happen to you.i take that bet anyday cause i know what will happen to you.
when it comes to psychiatry the laws are differt,if you don't believe try it and find out.
if you don't believe me go to a doctor,counselor or psychiatrist and tell them.that you are going to kill someone or kill yourself and see what will happen to you.i take that bet anyday cause i know what will happen to you.
when it comes to psychiatry the laws are differt,if you don't believe try it and find out.
------ This thread is Archived ------
what a no brainer, Jeanc.
------ This thread is Archived ------
It is not a no-brainer; you stand possibly to lose your medical license if you disclose confidential information. There is a reason why the patient/doctor privilege is in force. To report the threat may seem like a simple solution is certainly the morally correct thing to do, but there are a lot of things to take into consideration...an' stuff.
------ This thread is Archived ------
What are the criteria for involuntary psychiatric exams?
law permits a mental health professional, law enforcement officer, or judge who issues an ex parte order to initiate an involuntary examination only when a person meets the following criteria:
f there is reason to believe that he or she is mentally ill and because of his or her mental illness:
(a) 1. The person has refused voluntary examination after conscientious explanation and (a) disclosure of the purpose of the examination; or
(a) 2. The person is unable to determine for himself or herself whether the examination is (a) necessary; and
(b) 1. Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or
(a) 2. There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future
law permits a mental health professional, law enforcement officer, or judge who issues an ex parte order to initiate an involuntary examination only when a person meets the following criteria:
f there is reason to believe that he or she is mentally ill and because of his or her mental illness:
(a) 1. The person has refused voluntary examination after conscientious explanation and (a) disclosure of the purpose of the examination; or
(a) 2. The person is unable to determine for himself or herself whether the examination is (a) necessary; and
(b) 1. Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or
(a) 2. There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future
------ This thread is Archived ------
"If you don't believe me..."
Ummm....who said I believed you or didn't believe you? This isn't a discussion that's up for arguing about MY personal opinion; I'm just stating facts gleaned from a particular Supreme Court decision on the matter, and from just one website. In order to present an effective argument, it helps to quote sources, such as citing specific cases and statues relating to the situation.
Having said that, my personal opinion is that, depending on the circumstances, the psychiatrist has a moral and ethical obligation to report the threat. I do know that they don't have to take every threat they hear as being literal. That is a professional judgment call.
"The defendants contended through amici briefs, including an APA brief, that psychiatrists were unable to accurately predict violence. The Court replied that they did not require therapists to render a perfect performance, "but only to exercise that reasonable degree of skilled care ordinarily possessed by members of their profession under similar circumstances." Proof, aided by hindsight, is insufficient to establish negligence. In the Tarasoff case itself, the therapist did accurately predict Poddar's danger of violence.
The ultimate question of resolving the tension between the conflicting interests of patient and potential victim is one of social policy, not professional expertise. The risk that unnecessary warnings may be given is a reasonable price to pay for the lives of possible victims that may be saved. One of the famous alliterative quotes from this case is, "The protective privilege ends where the public peril begins."
Dissent: Concern was expressed that the majority decision may result in an increase in violence because patients might not seek treatment. There was also concern that psychiatrists may over commit patients to avoid the risk of civil liability.
Commentary: The majority of state supreme courts that have addressed the issue have concurred with the Tarasoff decision. At least 17 states have now passed Tarasoff limiting statutes, which usually require an explicit threat, and state that the therapist's Tarasoff duty will be discharged if he does one of a number of things, such as notify the intended victim, and/or law enforcement authorities.
The most common error about Tarasoff today is the misperception that it is a duty to warn rather than a duty to protect. This is due to the publicity given to the 1974 Tarasoff I case, which was superseded by Tarasoff II in 1976.
The case was settled out of court for a significant amount of money and never went to trial. Mr. Poddar served four years of a five-year prison sentence for manslaughter. His conviction was overturned due to faulty jury instructions on diminished capacity. A second trial was not held on the promise that Poddar return to India. He was last heard to be happily married in India.
Predictions that psychotherapy would be drastically altered never came to pass. Research showed that even before the Tarasoff decision, therapists were breaching confidentiality to protect intended victims."
Ummm....who said I believed you or didn't believe you? This isn't a discussion that's up for arguing about MY personal opinion; I'm just stating facts gleaned from a particular Supreme Court decision on the matter, and from just one website. In order to present an effective argument, it helps to quote sources, such as citing specific cases and statues relating to the situation.
Having said that, my personal opinion is that, depending on the circumstances, the psychiatrist has a moral and ethical obligation to report the threat. I do know that they don't have to take every threat they hear as being literal. That is a professional judgment call.
"The defendants contended through amici briefs, including an APA brief, that psychiatrists were unable to accurately predict violence. The Court replied that they did not require therapists to render a perfect performance, "but only to exercise that reasonable degree of skilled care ordinarily possessed by members of their profession under similar circumstances." Proof, aided by hindsight, is insufficient to establish negligence. In the Tarasoff case itself, the therapist did accurately predict Poddar's danger of violence.
The ultimate question of resolving the tension between the conflicting interests of patient and potential victim is one of social policy, not professional expertise. The risk that unnecessary warnings may be given is a reasonable price to pay for the lives of possible victims that may be saved. One of the famous alliterative quotes from this case is, "The protective privilege ends where the public peril begins."
Dissent: Concern was expressed that the majority decision may result in an increase in violence because patients might not seek treatment. There was also concern that psychiatrists may over commit patients to avoid the risk of civil liability.
Commentary: The majority of state supreme courts that have addressed the issue have concurred with the Tarasoff decision. At least 17 states have now passed Tarasoff limiting statutes, which usually require an explicit threat, and state that the therapist's Tarasoff duty will be discharged if he does one of a number of things, such as notify the intended victim, and/or law enforcement authorities.
The most common error about Tarasoff today is the misperception that it is a duty to warn rather than a duty to protect. This is due to the publicity given to the 1974 Tarasoff I case, which was superseded by Tarasoff II in 1976.
The case was settled out of court for a significant amount of money and never went to trial. Mr. Poddar served four years of a five-year prison sentence for manslaughter. His conviction was overturned due to faulty jury instructions on diminished capacity. A second trial was not held on the promise that Poddar return to India. He was last heard to be happily married in India.
Predictions that psychotherapy would be drastically altered never came to pass. Research showed that even before the Tarasoff decision, therapists were breaching confidentiality to protect intended victims."
------ This thread is Archived ------
This Thread is Archived
This Thread is archived, so you will no longer be able to post to it. Threads get archived automatically when they are older than 3 months.
« Go back to All Threads
« Go back to All Threads
More Threads
More Proof The GOP is a Criminal Organization
s*xual skills
Why is this shameful?
The GOP Representatives owned by Vladimir Putin
the way you look
your favorite topic?
Democrats destroyed America
I'm a 53 YEAR'S YUNG MAN that lives back in the 80s
men's perspective towards women
Gal / sdarlagg passed away on April 10, 2024
More Threads
Report threads that break rules, are offensive, or contain fighting. Staff may not be aware of the forum abuse, and cannot do anything about it unless you tell us about it. click to report forum abuse »
If one of the comments is offensive, please report the comment instead (there is a link in each comment to report it).
If one of the comments is offensive, please report the comment instead (there is a link in each comment to report it).
Stats for this Thread
2,807 Views
56 Comments
in CS Lounge
Created: Nov 2006
Last Viewed: 21 hrs ago
Last Commented: Nov 2006
0 Likes
Related Forums
- More Proof The GOP is a Criminal Organization
- s*xual skills
- Why is this shameful?
- The GOP Representatives owned by Vladimir Putin
- the way you look
- your favorite topic?
- Democrats destroyed America
- I'm a 53 YEAR'S YUNG MAN that lives back in the 80s
- men's perspective towards women
- Gal / sdarlagg passed away on April 10, 2024