Klinka Elisha
Fordham Law Rev. 2009 Nov;78(2):863-931.
State laws modeled on Tarasoff v. Regents of the University of California require psychotherapists to warn potential victims or law enforcement when treating dangerous patients who make serious threats of harm to another person. In practice, many psychotherapists advise their patients who make such threats about their duty under these Tarasoff-model laws. Although they are not required to make these advisories by law, psychotherapists generally assume that they also have a concomitant ethical duty to advise their patients that such threats will not be kept confidential, as their communications normally would be. This Note looks at how these advisories affect the status of privilege for subsequent threatening statements relayed to a psychotherapist. It explores the opposing views in the federal circuit courts regarding whether such an advisory precludes the existence of privilege for subsequent statements, or whether the advisory operates as a waiver to the privilege. This Note argues that threats communicated to a psychotherapist after an advisory about a psychotherapist's Tarasoff duty cannot be considered privileged if the patient intended for the threat to be passed on to a third party. Psychotherapists must now be aware of the possible legal consequences regarding the patients' diminished expectation of confidentiality and lack of privilege following such advisories. In order to act in their patients' best interest, psychotherapists should educate themselves about the scope of a Tarasoff duty in their applicable states and should consider alternative intervention techniques that could reduce dangerous patients' risk of harm. Psychotherapists should continue to follow professional ethical guidelines about advising patients of the limits of confidentiality, but implement techniques that evidence the patients' true intent about confidentiality, in order to bolster the patients' possible privilege claims later on and minimize harm to the treatment relationship.
以塔拉索夫诉加利福尼亚大学董事会案为蓝本的州法律要求心理治疗师在治疗对他人构成严重伤害威胁的危险患者时,向潜在受害者或执法部门发出警告。在实践中,许多心理治疗师会就这些以塔拉索夫案为模式的法律规定下他们的职责,向发出此类威胁的患者提供建议。尽管法律并未要求他们提供这些建议,但心理治疗师通常认为,他们也有相应的道德义务告知患者,此类威胁将不会像他们通常的交流那样被保密。本笔记探讨了这些建议如何影响后续传达给心理治疗师的威胁性陈述的保密特权地位。它探讨了联邦巡回法院中关于此类建议是否排除后续陈述的保密特权存在,或者该建议是否构成对特权的放弃的对立观点。本笔记认为,如果患者意图将威胁传达给第三方,那么在就心理治疗师的塔拉索夫职责发出建议后传达给心理治疗师的威胁不能被视为享有特权。心理治疗师现在必须意识到,此类建议之后患者对保密的期望降低以及缺乏特权可能带来的法律后果。为了维护患者的最大利益,心理治疗师应该了解其所在适用州塔拉索夫职责的范围,并应考虑可以降低危险患者伤害风险的替代干预技术。心理治疗师应继续遵循关于告知患者保密限制的专业道德准则,但实施能够证明患者对保密真实意图的技术,以便在以后加强患者可能的特权主张并尽量减少对治疗关系的损害。