Statutory approaches to limiting psychiatrists' liability for their patients' violent acts

Article Abstract:

The impact of an opinion rendered in the 1974 case of Tarasoff v. Regents of the University of California is still being felt by mental health professionals in this country. This case represents the first judicial attempt to define the duties of mental health professionals to the public with regard to patients who are violent. Much additional state legislation was spawned in response to this case in efforts to both modify and clarify the decision. Essentially, the opinion stated that when a patient is considered a serious danger to another person, it is the therapist's duty to take necessary measures to ensure the protection of any potential victim. Much criticism has been directed towards the specific wording of this decision which, in the view of many clinicians, is vague and ambiguous. It has been argued that no precise standards currently exist that are generally accepted by the mental health community for predicting the violence of a patient. It is also unclear what steps constitute reasonable and prudent measures in protecting potential victims. In general, mental health professionals have accepted the spirit of this decision. However, as it currently stands, the opinion is subject to such broad interpretation that it places an unfair and unrealistic burden upon the clinician. It is argued that repercussions of Tarasoff v. Regents of the University of California include reluctance by patients to seek treatment and concern that confidentiality will be breached, as well as the avoidance of violent patients by some professionals out of fear of liability. The actual effectiveness of intervening in cases of potentially violent patients has also been questioned. In an effort to balance the concern for public safety with a realistic definition of professional liability, the American Psychiatric Association has created a model statute which is included as an appendix. The authors recommend this outline for use by mental health professionals as a resource document or lobbying tool in their attempts to influence legislation on the state level.

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More laws for better medicine?

Article Abstract:

The Tarasoff decision of 1974 expanded the definition of legal liability of the clinician and has become cause for justifiable concern from the mental health community. Appelbaum et al. have addressed some of these concerns, but there are still some substantial questions that remain unanswered. The article provides a good review of current state statutes and analysis of the American Psychiatric Association's suggested model document for use by mental health professionals in changing local legislation. However, much ambiguity continues to exist in some critical areas. The definition of when a professional should be prompted into action to protect the potential victim of a violent patient, which is accepted in the Appelbaum article, is not comprehensive enough. By adhering strictly to the letter of the law, too many potentially dangerous situations may be ignored. The term "sound medical ethics" has not been well defined by the court and it is argued that a correct legal definition does not exist. Although reasonable protections should be given to the clinician, it is felt that to grant automatic blanket immunity for breach of patient confidentiality is too drastic. The violation of the trust between doctor and patient should not be taken lightly and should be considered only when other approaches fail. The very act of trying to codify correct ethical behavior of mental health professionals invites additional controls and legal conditions, as well as over-regulation of an area that does not fit well into legal definitions or rigid guidelines. The danger exists of the psychiatric profession becoming a scapegoat for crime and therefore the professional should proceed cautiously when attempting to influence state legislation.

editorial

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Ethics in evolution: the incompatibility of clinical and forensic functions

Article Abstract:

Psychiatrists are faced with the conflicting ethical demands of therapeutic and forensic activities and they are obliged to make sure that ethical principles prevail regardless of a particular situation. While their clinical duties demand that they respect patients' interests, forensic activities demand that they unearth the truth in support of the judicial system. The latter function should, however, not be abused to the detriment of the patients' wellbeing.

Editorial

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