Substance abuse and the duty to protect.

The Tarasoff case provided some legal guidance for handling the situation where a patient threatens deliberate violence against an identifiable individual. But what about the situation where a patient's substance abuse impairs safe driving of a large commercial vehicle such as an airplane, clearly endangering a class of individuals (passengers)? Some legal restrictions on confidentiality, if followed literally, would not even permit the therapist to take preventive measures advocated by the Tarasoff court when deliberate violence is threatened, let alone more specific measures to prevent a tragic accident with loss of many lives. Review of literature on the relationship between alcohol and operator safety leads to the conclusion that therapists must have some latitude in which to exercise judgment free of professional liability. The dilemma posed by contrasting duties to maintain confidentiality and to make preventive disclosures is too rigid to govern all situations, especially a worsening risk of substance-induced accidents by drivers of public carriers.