Facts
- Don Snow has a 5-year history of outpatient diagnosis treatment of paranoid schizophrenia at ABC mental hospital. This is indicated by the statement, “Don Snow, age 45has received outpatient treatment at ABC for five years…”
- Don Snow has had four inpatient admissions during the past twenty-five years due to violent attacks on family members.
- In the last eight years, Don Snow has not had any inpatient admission for violent attacks on family members.
- Don Snow has revealed intentions of harming his sister’s 8-year-old child. He even goes on to suggest to a nurse that the boy is a devil and that somebody should do something about it.
Legal issues
- ABC mental clinic owes a duty of care to Don Snow as he has a history of over 25 years with the clinic.
- Don Snow has the right of doctor–patient confidentiality.
- The nurse has a duty to report the sentiments expressed by Don Snow to the relevant therapist of Don Snow.
Elaboration of legal issues
- Duty of care: Don Snow is entitled to treatment and diagnosis from the ABC Mental clinic. This is because the clinic has a 25-year history of diagnosing Don Snow, hence the ability to identify the problem easily and the mere fact that Don Snow has been attending the same clinic for 25 years grants him the right of duty of care.
- Doctor-patient confidentiality: As a professional, the therapist is entitled to maintain the confidentiality of the patient. The patient is supposed to be comfortable while revealing his intensions/thoughts without fear of them being revealed to a third party.
- Duty of profession: The nurse, being part of the medical staff of ABC Mental clinic, is entitled to reveal any useful information to the relevant medical personnel, especially if the information will be of use in aiding the clinic’s patients. However, the information must never be divulged to third parties who do not need to have it or are unauthorized to access such information.
Rationale
Therapist/clinic action
The therapist should first handle the patient in his professional capacity as a therapist. This means that he should try to know the reasons as to why Don Snow has fantasies about harming his sister’s child, whether the intended shotgun is for the fulfillment of the fantasy, and from where he intends to purchase it. By using the available history of the patient, the therapist can know if the therapy will work in preventing the occurrence of the patient’s fantasies.
If it will not work, the therapist should inform the clinic’s management on the situation, who in turn will deliberate on whether to turn the matter to the right authorities or decide the best course of action. Before informing the relevant authorities, the clinic should explore other options like admitting the patient and working on the harmful fantasies, and gauging the response. By doing this, the clinic/therapist will be protecting the doctor–patient confidentiality rule (Showalter, 2008).
Liability to the therapist/clinic
In case Don Snow fulfills his fantasies of harming his sister’s child, the therapist/clinic might be held liable for withholding the information to the authorities before the harmful act. The question of liability may be tricky due to the patient–doctor confidentiality rule, although the therapist has the responsibility of reporting incidents that are likely to cause harm to others before they take place. Before reporting the intended harmful act to the relevant authorities, all possible channels of preventing the harm from occurring should be exhausted thus having the reporting action as the last option (Showalter, 2008). By reporting, the intended harmful act to the relevant authorities without exhausting the available channels will put the doctor–patient rule in jeopardy as patients in the future lack trust in their medical personnel.
Reference
Showalter, J. S. (2008). The Law of Healthcare Administration. Edition 5. Chicago, Health Administration Press.