The Tarasoff Case: Implications and the Ethical Duty to Warn

QUESTION

The Tarasoff Case

On July 1, 1976, the California Supreme Court handed down a decision in the case of Tarasoff v. Regents of the University of California, one of the most important judicial cases to affect medical practice in our country’s history. The facts of the case were basically undisputed. In 1969, a student at the University of California at Berkeley, Prosenjit Poddar, confided to his psychologist, Dr. Lawrence Moore, who was on the staff at Cowell Memorial Hospital on the Berkeley campus, that he intended to kill Tatiana Tarasoff, a young woman who lived in Berkeley but was at that time on a trip to Brazil.

Dr. Moore, with the concurrence of a colleague and the assistant director of the Department of Psychiatry, reported the threat to the campus police and asked them to detain Poddar and commit him to a mental hospital for observation. The campus police questioned Poddar but satisfied that he was rational and based on his promise to stay away from Tarasoff, they released him. They reported their action to Dr. Harvey Powelson, the director of the Psychiatry Department.

Dr. Powelson requested no further action to detain Poddar or to follow up on the threats. Two months later, shortly after Tarasoff returned from her Brazil visit, Poddar went to her home and killed her. Later, when Tatiana’s parents learned that university officials had known about the threat to their daughter’s life but had failed to detain Poddar or warn them or their daughter, they brought a negligence suit against the therapists involved, the campus police, and the university, and sought additional punitive damages.

The original court hearing of the case dismissed all charges against all defendants. However, the California Supreme Court partially reversed the lower court’s judgment when a majority ruled that general damages against the therapists and the university were in order for their failure to warn the girl or her family (punitive damages were dismissed). (Due to a technical error, Poddar’s second-degree murder conviction was overturned; since more than 5 years had elapsed since the murder, he was not retried under an agreement that he would return to his native India, which he did.)

Question:

What are the implications of this ruling? Should the therapists have been morally and legally required to warn Tatiana Tarasoff? If so, what other circumstances would justify breaking confidentiality? Or should physicians maintain absolute confidentiality regarding information shared with them by all patients in all circumstances?

ANSWER

The Tarasoff Case: Implications and the Ethical Duty to Warn

Introduction

The Tarasoff v. Regents of the University of California case had significant implications for the practice of medicine, particularly regarding the duty to warn potential victims of harm. This essay examines the implications of the ruling and discusses whether therapists should have been morally and legally required to warn Tatiana Tarasoff. It also explores the circumstances that would justify breaking confidentiality and weighs the debate between maintaining absolute confidentiality and the ethical duty to protect potential victims.

Implications of the Ruling

The ruling in the Tarasoff case established that mental health professionals have a duty to protect potential victims from harm, even if it means breaching patient confidentiality. This landmark decision recognized that the welfare of potential victims should take precedence over the privacy rights of patients. By holding therapists accountable for their failure to warn, the ruling aimed to ensure that society is protected from imminent danger posed by individuals under psychiatric care.

The Duty to Warn Tatiana Tarasoff

In the Tarasoff case, the therapists treating Prosenjit Poddar were found to have a duty to warn Tatiana Tarasoff of the specific threat made against her. The court held that when a therapist knows or should have known that a patient poses a serious threat of violence to another individual, they have an obligation to take reasonable steps to protect the potential victim. In this case, the failure to warn Tatiana Tarasoff and her family was deemed a breach of the duty to protect.

Circumstances Justifying Breaking Confidentiality

While patient confidentiality is a cornerstone of medical practice, there are circumstances in which breaching confidentiality is justified to prevent harm to potential victims. These circumstances often involve a clear and imminent threat to the life or safety of an identifiable individual. Some examples include threats of violence, child abuse, elder abuse, or when a patient discloses plans for a terrorist attack. In such cases, healthcare professionals have an ethical and legal duty to breach confidentiality to ensure public safety.

The Debate on Absolute Confidentiality

The debate surrounding absolute confidentiality revolves around the tension between preserving patient trust and maintaining public safety. While absolute confidentiality may be ideal in fostering trust and encouraging patients to seek help, it can lead to adverse consequences if it prevents healthcare professionals from fulfilling their duty to protect potential victims. Striking a balance between privacy rights and the duty to warn is crucial to ensure the well-being of both patients and society.

Conclusion

The Tarasoff case set a precedent in the medical field by establishing the duty of therapists to warn potential victims of imminent harm, even if it requires breaching patient confidentiality. The ruling recognized the importance of prioritizing the safety of potential victims over maintaining absolute confidentiality. While preserving patient trust and privacy remains essential, it is crucial for healthcare professionals to carefully assess the circumstances and act in the best interest of public safety. By adhering to ethical principles and legal obligations, healthcare professionals can navigate the complex landscape of patient confidentiality and fulfill their duty to protect potential victims.