The Public Interest Interest of Others or Patients Who Are Violent or Dangerous

Disclosure in the interests of others may be legitimate when they are at risk because a patient refuses to follow medical advice. Examples include patients who continue to drive when unfit to do so and against medical advice or who place others at risk by failing to disclose a serious communicable disease. Each case demands careful consideration, and doctors who have any doubt regarding how best to proceed should not hesitate to seek appropriate counsel.

Doctors may also be approached by the police for information to assist them in apprehending the alleged perpetrator of a serious crime. A balance must be struck between the doctor's duty to preserve the confidences of a patient and his or her duty as a citizen to assist in solving a serious crime where he or she has information that may be crucial to a police inquiry. In cases of murder, serious assaults, and rape in which the alleged assailant is still at large, the doctor may be persuaded that there is a duty to assist in the apprehension of the assailant by providing information, acquired professionally, that will be likely to assist the police in identifying and apprehending the prime suspect or suspects. However, where the accused person is already in custody, the doctor would be wise not to disclose confidential information without the agreement of the patient or legal advisers or an order from the court. Each case must be weighed on its own facts and merits, and the doctor may wish to seek advice from an appropriate source, such as a protection or defense organization. Guidance about gunshot wounds is given in Subheading 3.3.6.

A patient who is violent or dangerous poses particular dilemmas for the doctor. In the course of a consultation, a patient may tell a doctor that he or she intends to perpetrate some serious harm on another person—perhaps a close relative or friend or someone with whom there is a perceived need to "settle an old score." Each case must be carefully assessed on its own facts and merits, and careful clinical judgement exercised; however, under some circumstances, a doctor may feel obligated to override the duty of confidentiality to the individual and to disclose confidential information to the intended victim, the police, or another person in authority with the power to take appropriate action. Indeed, a failure to act in such circumstances has led to adverse judicial rulings, as in the Tarasoff (26) case in California, in which a specialist psychologist failed to give a warning to the girlfriend of a patient who was later murdered by the patient. The court decided that although no general common law duty exists to protect or warn third parties, a special relationship may impose such a duty.

In the United Kingdom, a psychiatrist was sued because he had released, without the consent of a patient who was violent, a report prepared at the request of the patient's solicitors in connection with an application for release from detention.

The psychiatrist advised against release, and the solicitors decided not to make use of the report. The psychiatrist was so concerned about his findings that he released a copy of the report to the relevant authorities and, as a consequence, the patient's application for release was refused. The patient's subsequent civil claim for compensation was rejected by the courts (27), which held that the psychiatrist was entitled, under the circumstances, to put his duty to the public above the patient's right to confidentiality.

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