Michael, age 8, developed headaches and other signs of anxiety around visits to his father, who divorced his mother several years earlier. A paradox thus arises: Good clinical treatment may require what the law generally refuses, that is, a zone of privacy.Ĭonsider the following vignette (identifying information has been changed): As a child grows into adolescence and adulthood, the surrounding zone of privacy should increase, thus making room for a more defined sense of self and a greater sense of autonomy. An important aspect of treatment is to foster an individual's autonomy, and a great pleasure of treating adolescents is to watch as they come to enjoy their growing independence. ![]() From a clinical perspective, the situation is more complex. Until that time, the law will normally give the parent access to the child's treatment.Ĭlinical practice. This state of affairs changes when the minor reaches the age of majority. The exceptions are few, however, and prove the rule that the law deems individuals under a certain age (often 18) not sufficiently mature to make treatment decisions.Ī parent who consents on the minor's behalf generally has the right to know the content of the child's treatment. Certain states allow minors whom the law deems especially mature, such as those who are married or in the armed services, to consent to treatment, and sometimes minors may consent to treatment for substance abuse or sexually transmitted diseases. Minors generally cannot consent to treatment a parent or guardian consents on the minor's behalf. The law is a blunt instrument, as the issue of minors and confidentiality well illustrates. Does the APA Ethics Code provide guidance?Ī: It is most helpful to consider this question from three perspectives: that of law, of clinical practice and of ethics. What to do when an adolescent becomes sexually active, of course, is often a difficult issue. The issue seems especially pointed when adolescents talk about activities that, while not necessarily dangerous, are illegal, such as shoplifting, the recreational use of alcohol or experimenting with drugs. With adolescents, though, I sometimes struggle with whether to share information with a parent. ![]() When treating young children, the issue rarely arises. Regents of the University of California, 551 P.Q: I work with adolescents, and am not clear about my ethical obligations concerning confidentiality. This answer card supplements the issue brief, Duty to Warn, Duty to Protect, And Duty to Control: The Exceptions to Mental Health Provider-Patient Confidentiality. Clinicians should be familiar with jurisdictional practices in their region and request consultations if they are uncertain how to proceed when potential third parties may be at risk of harm due to actions by patients. Instead, the therapist might be required “to warn the intended victim of others likely to apprise the victim of the danger, to notify the police, or to take whatever steps are reasonably necessary under the circumstances.”Īlthough this legal case applies to California only, after the ruling, other states also began to examine and codify these issues through legislation as well as other cases that shape the contours of potential responses. The California Supreme Court reheard the case and established a broader “duty to protect.” The court held, “When a therapist determines, or pursuant to the standard of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger.” The key point of the second ruling is that a therapist’s warning to a potential victim may not be sufficient to escape legal liability for harm to a third party. The American Psychiatric Association submitted a brief protesting this newly established duty. In 1974, the California Supreme Court established that a therapist had a “duty to warn” a potential victim of predictable danger. They sued the psychologist, the campus police, and the Regents of the University of California for failing to warn Tatiana. Tatiana’s parents later learned that Prosenjit had communicated this threat to his psychologist. When Tatiana returned from vacation, Prosenjit went to her home and killed her. The psychologist did not warn Tatiana or her parents of this threat as there was no duty established at this point for an outpatient psychiatry to communicate a threat of harm to a third party. The police questioned Prosenjit and after he denied wanting to harm Tatiana, they released him. In this case, Prosenjit Poddar, a student at the University of California, Berkeley, informed his outpatient treating psychologist that he had thoughts of killing fellow student Tatiana Tarasoff.
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