Felthous A R
Department of Psychiatry, Southern Illinois University School of Medicine, Chester, USA.
Psychiatr Clin North Am. 1999 Mar;22(1):49-60. doi: 10.1016/s0193-953x(05)70058-7.
The jurisprudence on a clinician's duty to protect third parties is complex and continues to evolve. Clinicians should familiarize themselves with civil commitment laws, privilege and confidentiality statutes, protective disclosure statutes, reporting requirements, and the Tarasoff Principle, as they would case law in the state in which they practice. Ethical codes and ethical position statements provide useful guidance. In their practices, clinicians should endeavor to conduct careful assessments for diagnoses, the patient's current situation, and dangerousness. Traditional clinical, therapeutic, and instructional measures should always be considered first, and reasonable efforts should be made to enlist the patient's cooperation. Occasionally, however, hospitalization or protective disclosures must be made. The proposed algorithm should be of help to the clinician in making critical decisions regarding hospitalization and disclosures to protect others. In following this decision tree, four questions are of key importance: (1) Is the patient dangerous to others?; (2) Is the danger due to serious mental illness?; (3) Is the danger imminent?; and (4) Is the danger targeted at identifiable victims? This algorithm is intended to assist in the application of, and should not replace, clinical judgment.
关于临床医生保护第三方的责任的判例法很复杂,并且仍在不断发展。临床医生应熟悉民事强制住院法、特权和保密法规、保护性披露法规、报告要求以及塔拉索夫原则,就如同他们应熟悉自己执业所在州的判例法一样。道德规范和道德立场声明提供了有益的指导。在临床实践中,临床医生应努力对诊断、患者当前状况和危险性进行仔细评估。应始终首先考虑传统的临床、治疗和指导措施,并应做出合理努力争取患者的配合。然而,偶尔也必须进行住院治疗或进行保护性披露。所提出的算法应有助于临床医生在做出关于住院治疗和为保护他人而进行披露的关键决策时提供帮助。遵循此决策树时,四个问题至关重要:(1)患者是否对他人构成危险?(2)危险是否源于严重精神疾病?(3)危险是否迫在眉睫?(4)危险是否针对可识别的受害者?此算法旨在协助应用临床判断,而不应取代临床判断。