Is it acceptable for a psychiatrist to break confidentiality to prevent spousal violence?

STUDY QUESTION

When is it acceptable for a psychiatrist to break confidentiality to protect the wife of a potentially violent patient?

METHODS

153 lay persons, 13 nursing personnel, 10 physicians, and 10 psychologists in France indicated this acceptability in 48 scenarios. The scenarios were all combinations of 5 factors: gravity of threat (death or beating), certainty of mental illness (certain or not), time spent talking with patient (considerable or little), his attitude toward psychotherapy (rejection, indecision, or acceptance), and whether the physician consulted an expert.

RESULTS

Lay people favored breaking confidentiality more than did nursing personnel or psychologists. Consulting an expert had greatest impact. Lay participants were composed of groups that found breaking confidentiality "always acceptable" (22 participants), "depending on many circumstances" (106), requiring "consultation with an expert" (31), and "never acceptable" (27).

CONCLUSION

Lay people in France are influenced by situational factors when deciding if a psychiatrist should break confidentiality to protect a patient's wife.