The federal laws of the patient-psychotherapist privilege were set in place in 1996 following a U.S. These include legal proceedings where the defendant raises the issue of their mental health, involuntary hospitalizations, and where a judge orders an evaluation. There are, however, several exceptions to privilege. As a result, the clinician cannot testify in court about the communication that was made between them and the patient unless the patient waves their right to privilege. The term “privilege” is a legal term and is the right of a patient to withhold any communication with their clinician from court proceedings as long as the communication was confidential and free of presence or knowledge by third parties. It is important to note that the meaning of the term “confidentiality” is not the same as “privilege.” Confidentiality refers to an ethical concept which declares that clinicians must keep patients’ information private unless the patient (or legally appointed surrogate decision maker) provides consent for that information to be disclosed, a court order is made by a judge requesting a release of information, the (minimum necessary) information must be communicated for continued treatment of the patient such as in cases of civil commitment, and finally when mandatory reporting is required such as in suspected child abuse or the Tarasoff warning. There have been no established standard legal guidelines for assessing the risk to third parties. The provider must take reasonable precautions of protecting third parties such as notifying the identifiable victim(s), notifying the police, or hospitalizing the patient voluntarily/involuntarily. The guidelines state that a patient must express a clear threat of killing or significantly injuring a specific (or at least a reasonably identified victim), voice threats of destruction of property that may place others in danger, express intent, and also possess the ability to execute the threat. The American Psychiatric Association established guidelines for physicians on the ‘duty to protect’ in 1987. There have been other extensions to the duty to protect third parties such as in the instances where a patient should not be operating a motor vehicle as a result of certain conditions, patient notification of medication side effects as well as risks of a procedure, and when a patient may transmit an infectious disease to the public. A famous quote made by Justice Tobriner that summarized the decision stated: “The protective privilege ends where the public peril begins.” Following a rehearing of the case in 1976, Tarasoff II established not only a duty to warn potential victims by clinicians, but also to take reasonable precautions to protect these third parties of the significant danger posed by patients. Tarasoff filed a lawsuit against the University of California, resulting in the Tarasoff I decision which required mental health providers to warn potential victims. Poddar was released provided that he return to India, his home country, immediately. Authorities subsequently charged him with 2nd-degree murder however, five years following these events, Mr. Tarasoff, shot her with a pellet gun and stabbed her numerous times. from her trip in October and on October 27th of 1969, Mr. Harvey Powelson, learned of the events, he demanded the destruction of all clinical notes as well as the letter which was sent to the campus police by Dr. Poddar to a nearby hospital to initiate an involuntary examination. Moore notified the campus police and requested that they bring Mr. Lawrence Moore, that he was going to kill Ms. Poddar disclosed to his psychologist, Dr. During a counseling session in August of 1969, Mr. Poddar began struggling mentally regarding the circumstances and began seeing a counselor at Cowell Memorial Hospital at the recommendation of a friend in 1969. Tarasoff however, she did not reciprocate. In the fall of 1968, a man named Prosenjit Poddar, who was a student at the University of California at Berkeley, met a woman named Tatiana Tarasoff at a dance class. Regents of the University of California that took place in the 1970s and comprised of two rulings known as the Tarasoff I (1974) and Tarasoff II (1976). This concept of ‘duty to warn’ stems from California Supreme Court case of Tarasoff v. Confidentiality plays a critical role in patient care however, there may be special circumstances where confidentiality must be breached in order to not only ensure the safety of the patient but also to protect third parties.
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