A 28-year-old man with paranoid schizophrenia tells his psychiatrist that he intends to kill a former colleague whose address he describes in detail. The psychiatrist judges the threat to be serious and foreseeable. What is the ethically and legally appropriate course of action?

• A Maintain confidentiality completely, since disclosure violates doctor-patient privilege
• B Warn the potential victim and take reasonable steps to protect them, breaching confidentiality as justified ✓
• C Increase the antipsychotic dose and reassess after one month
• D Admit the patient involuntarily and disclose nothing to anyone outside the team

Explanation

This scenario reflects the Tarasoff principle arising from the 1976 California Supreme Court ruling: when a patient presents a serious, identifiable threat to an ascertainable victim, the clinician has a duty to protect, typically by warning the victim, notifying police, and initiating treatment or containment. Confidentiality is not absolute and is breached precisely when third-party safety is at stake. Drug adjustment alone or silent admission does not discharge the duty.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.