Breaking Of Confidentiality In Order To Prevent Injury To Others

You are a psychiatrist in session with a patient who tells y u he thinks his boss at work is persecuting him. The patient has had mild schizophrenia. The patient asks you if you can keep a secret and then tells you that he is planning to kill his boss "when the time is right." You say," Of course, every thing you tell me during the session will always be confidential."

What should you do?

a. Keep the patient's session confidential but make attempts to discourage the patient from his plan.

b. Inform your medical director and let him handle it.

c. Inform law enforcement agencies of the threat to the patient's boss.

d. Inform the patient's boss that he is in danger.

e. Inform both the patient's boss as well as law enforcement of the threat.

Answer: e. Inform both the patient's boss as well as law enforcement of the threat.

Discussion: 

A patients right to confidentiality ends where another person's right to safety begins. Your duty to protect the life of person at risk is more important than keeping the patient's medical information confidential. You must see that the person at risk is warned as well as the law enforcement should be informed. 

In case only the law enforcement is informed and not the victim you may be held responsible in case of injury to the victim.