Whiting Forensic Division, Connecticut Valley Hospital, Middletown, CT, USA.
J Am Acad Psychiatry Law. 2010;38(4):474-8.
Psychiatry has been struggling for nearly 40 years to make sense of the duty to protect. The great jurisdictional disparity as to what constitutes the duty has been a significant contributing factor. The American Psychiatric Association (APA) released the Model Statute in 1987 to establish a framework to guide legislators and courts toward consensus, to some effect. In response to case law and statutory requirements in most states, psychiatric practice has incorporated the assessment of risk to third parties by patients as an essential element of psychiatric assessment and care. Although court cases shortly after the Tarasoff decision expanded the scope and breadth of the duty to protect, in recent years there appears to have been a shift toward a more narrow interpretation as to what conditions must exist to find a defendant psychiatrist guilty of failing to exercise the duty properly. The threshold for the duty to warn or protect often rests precariously beside the criteria permitting an exception to confidentiality, placing the psychiatrist in a tenuous position. If appellate verdicts continue to find for the defendant psychiatrist in cases claiming a breach of the duty to protect, it could have an impact on how psychiatrists assess and manage threats made by patients toward third parties.
精神病学近 40 年来一直在努力理解保护义务。构成保护义务的管辖权差异巨大，这是一个重要的促成因素。美国精神病学协会（APA）于 1987 年发布了示范法规，以建立一个框架，在一定程度上引导立法者和法院达成共识。为了响应大多数州的判例法和法定要求，精神病学实践已经将对患者第三方风险的评估纳入精神病学评估和护理的基本要素。尽管 Tarasoff 判决后的法院案件扩大了保护义务的范围和广度，但近年来，对于必须存在哪些条件才能认定被告精神病医生未能正确行使义务，似乎出现了一种更狭义的解释。警告或保护的义务门槛往往岌岌可危地摆在允许对保密性进行例外的标准旁边，使精神病医生处于脆弱的地位。如果上诉判决继续对声称违反保护义务的被告精神病医生作出有利于被告的裁决，这可能会对精神病医生评估和管理患者对第三方的威胁产生影响。
