Introduction
Patient confidentiality is one of the ethical imperatives in counseling. However, some situations may require breaching this confidentiality to prevent harm to the patient or others (Hills, 2020). The current standards for allowed breach of confidentiality went through significant changes, sometimes through court cases.
A Comparison and Contrast of the Court Decisions
Two court cases bear particular significance to the formation of current ethical standards. In both Tarasoff v. Regents of California (1976) and Estates of Morgan v. Fairfield Family Counseling Center (1997), a breach of confidentiality by a mental health professional could have saved lives (Hills, 2020). The Supreme Courts of Ohio and California had to settle the conflicts.
Tarasoff v. Regents of California (1976)
Prosenjit Poddar, a patient of Dr. Lawrence Moore, confided his plans to murder Tatiana Tarasoff. After consulting with his colleagues, Moore elected to take no action, and soon afterward, Poddar murdered Tarasoff (Tarasoff v. Regents of California, 1976). The Supreme Court ruled that a mental health specialist’s responsibility lies not only with the patient but with others, as well. Thus, a specialist is obligated to inform or protect others in case they perceive a credible threat from his or her patient.
Estates of Morgan v. Fairfield Family Counseling Center (1997)
Matt Morgan was institutionalized and diagnosed with schizophreniform disorder but released when his mental health care provider, Dr. Ladenheim, ruled his condition could be controlled by medication (Estates of Morgan v. Fairfield Family Counseling Center, 1997). However, during follow-ups with other specialists, his medication was withdrawn, and his condition began to deteriorate, culminating in him shooting and killing or seriously injuring his family members. The court ruled that a psychiatrist can be held legally responsible for the violent acts of a voluntarily hospitalized patient after his or her release. Furthermore, he or she has a duty to act in the protection of others should a patient present a threat.
Similarities and Differences
Both cases center on the conflict of responsibility between preserving a patient’s confidentiality and protecting others from the patient’s potential violent actions. The key difference is that in Tarasoff v. Regents of California (1976), Moore perceived the threat as credible but chose not to act in response to it. In Estates of Morgan v. Fairfield Family Counseling Center (1997), malpractice was argued as Dr. Brown, Morgan’s health care provider, misdiagnosed his patient and unduly withdrawn his medication. Another key distinction is that in Tarasoff v. Regents of California (1976), Poddar made a specific threat that could be addressed directly. Morgan made no threats, but his condition made violent behavior likely. Thus, it would have been more difficult to identify a likely victim. In both cases, the practitioners’ actions were argued to be responsible for violent acts committed by patients.
Influence on Confidentiality
In the most basic sense, both cases create a precedent and impose a duty to breach confidentiality. As a mental health practitioner has an obligation to protect others from his or her patient’s potential violent acts, he or she may have to disclose information otherwise considered private (Cacialli, 2019). This is reflected in the ACA Code of ethics point B.2.a: confidentiality does not apply when disclosure is required to protect others (American Counseling Association, 2014). Consultation with colleagues, as seen in the Tarasoff case, is also recommended. School counselors are similarly required to disclose information to prevent serious and foreseeable harm in accordance with paragraphs 2e-2h of the ASCA ethics code (American School Counselor Association, 2016).
Impact on Clinical Work
The requirements imposed by these cases can be difficult to follow in practice. They necessitate a significant degree of judgment as to whether a patient’s threat is credible if he or she makes a direct threat. In a situation closer to that in Estates of Morgan v. Fairfield Family Counseling Center (1997), the counselor must estimate whether the patient’s condition can lead to violent behavior. Both situations present a balance between confidentiality and safety that needs to be considered (Cacialli, 2019). This can be challenging in cases of indirect threat or potentially dangerous conditions. Thus, the counselor has an implied responsibility to investigate and evaluate threats. This investigation goes beyond assessing the patient’s mental state and requires the identification of targets and credibility.
Conclusion
Counselors and other mental health professionals may face situations where breaching their patient’s confidentiality can prevent serious harm or death. The cases described in this paper serve as examples of such situations that have affected ethical policies in the field. For a mental health specialist, it is now critical to investigate the potential danger posed by his or her patient and decide whether there is a credible threat.
References
American Counseling Association (2014). 2014 ACA Code of Ethics. Web.
American School Counseling Association (2016). ASCA Ethical Standards for School Counselors. Web.
Cacialli, D. O. (2019). The unique role and special considerations of mental health professionals onthreat assessment teams at institutions of higher education. International Journal of Law and Psychiatry, 62, 32-44.
Estates of Morgan v. Fairfield Fam. Counseling Ctr., 77 Ohio St. 3d 284, 673 N.E.2d 1311, 1323 (1997)
Hills, B. R. (2020). The cat is already out of the bag: Resolving the circuit split over the dangerous patient exception to the psychotherapist-patient privilege. University of Baltimore Law Review, 49(2), 153-182.
Tarasoff v. Regents of University of California, 551 P.2d 334 (Cal. 1976)