Moral justification for Tarasoff-type warnings and breach of confidentiality: a clinician's perspective

After brief review of the background and context of the Tarasoff case and its impact on clinicians, the author examines the "Tarasoff warning," proposed in the 1974 Tarasoff opinion, from a moral position, with brief discussion of its clinical and risk management dimensions. Moral issues considered include confidentiality itself, agency, fiduciary duty, a shift in the victim paradigm, the emergency context, a novel risk, and a proposed approach. The dilemma presented by the original Tarasoff fact situation is re-examined. The author stresses the need for individualized responses to the risks posed by patients.