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Confidentiality Versus the Duty to Protect: Foreseeable Harm in the Practice of Psychiatry

David I. Joseph, MD
JAMA. 1991;266(3):425. doi:10.1001/jama.1991.03470030127041.
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In 1974 American psychiatry was rocked by the now-famous Tarasoff decision, which held that psychotherapists had a duty to warn potential victims of violence. The immediate ramifications for maintaining the boundaries of confidentiality were many. In 1976 the case was reheard, and the new ruling emphasized the therapist's use of professional judgment and broadened the therapist's responsibility to include a duty to protect and not merely a duty to warn the victim. Since then, Tarasoff has been the basis for rulings on a therapist's duty to protect, not only in cases involving a threatened victim, but also in situations in which an individual who had never been threatened was killed and one in which a man burned a barn after threatening to do so.

The conflict between a patient's right to confidentiality and a therapist's duty to protect the community from foreseeable harm is the focus of this compact, well-edited,


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