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Klitzman: When Violating Patient Confidentiality is Necessary

In Psychology Today, M.S. in Bioethics director Dr. Robert Klitzman explores the ethical dilemmas regarding forgoing patient confidentiality when one’s patient appears to pose a threat to himself and others.

This line of inquiry was prompted by the recent case of a Germanwings co-pilot who suffered from mental health issues and deliberately crashed a plane, killing 150 people.

“Sometimes, physicians have to break patient confidentiality – when third parties may be endangered,” he writes. “The legal precedent for breaking patient confidentiality in this way is the so-called Tarasoff case, in which a young patient told his psychologist at the University of California at Berkeley that he wanted to kill his girlfriend, Tatiana Tarasoff. The psychologist alerted the campus police, though not the city police or Tatiana. Unfortunately, the patient then killed Tarasoff. A court found the psychologist liable.”

“These violations of patient confidentiality make us providers uncomfortable.” He looks to one of his own experiences treating a patient whose behavior posed a threat to others: “As a physician, I have had to report patients whom I even suspected might be abusing a child. I remember one patient who came to the Emergency Room for psychiatric problems mentioning that she sometimes slapped her toddler son with the end of an electrical cord, swinging it until the thick part banged him. As I asked more, she began to cry. I felt terrible for her, and was unsure how dangerous her actions were, but erred on the side of protecting the child’s safety, and contacted social services. When I told her, she nodded; then whispered thank you. She knew she needed help.”

Klitzman writes, “Still, in Germany and several states, providers do not have to break patient confidentiality, even when they think the patient may endanger others.”

Read the rest of Dr. Klitzman’s article on the ethical dilemmas faced by medical practitioners.