Fiagbe Delali, Edwin Ama Kyerewaa, Dordoye Eugene K, Dellor Dzifa, Gyamera Adwoa, Dziwornu Emmanuel
Department of Psychiatry, University of Ghana Medical School, University of Ghana, Ghana.
Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana.
Niger Med J. 2023 Jul 2;64(3):424-426. eCollection 2023 May-Jun.
This is a report of a 29-year-old female with a history of Schizophrenia and Cannabis Use Disorder who presented with auditory hallucinations that asked her to kill her immediate supervisor. She presented the ethical dilemma many healthcare providers face in balancing the principles of patient confidentiality with the duty to protect and beneficence. The clinicians breached the patient's right to confidentiality to protect her supervisor by informing the supervisor, their manager, and the police. However, they also ensured her job security, which she risked in an environment where mental illness is highly stigmatized. This case highlights the importance of considering the ethical principles of disclosing confidential information, such as the Tarasoff I and II, and beneficence (as her job was protected) in making clinical decisions. It also summarizes the legal precedents established by the Tarasoff cases and the implications for clinical practice.
这是一份关于一名29岁女性的报告，她有精神分裂症和大麻使用障碍病史，出现了幻听，幻听要求她杀死自己的直属上司。她提出了许多医疗服务提供者在平衡患者保密原则与保护及行善义务时所面临的伦理困境。临床医生为了保护她的上司，违反了患者的保密权，告知了上司、他们的经理和警方。然而，他们也确保了她的工作安全，在精神疾病受到高度污名化的环境中，她原本面临着失去工作的风险。这个案例凸显了在做出临床决策时考虑披露机密信息的伦理原则（如塔萨夫I和II）以及行善原则（因为她的工作得到了保护）的重要性。它还总结了塔萨夫案件确立的法律先例以及对临床实践的影响。
