In Tarasoff-like scenarios, what are the limits of confidentiality?

• A. Breach is never permissible.
• B. If there is a credible threat to identifiable individuals, many jurisdictions permit or require breach to warn or protect.
• C. Only if patient agrees
• D. The physician must first notify the patient.

Answer: (B)

Confidentiality isn’t absolute. When there is a credible threat of serious harm to an identifiable person, clinicians have a duty to breach in order to warn or protect that person. In Tarasoff-style scenarios, the risk to a specific target allows or even requires disclosure of enough information to enable warning or protective steps, such as notifying the potential victim or law enforcement. The key is credibility and specificity: vague threats or threats to undefined people don’t justify disclosure. The breach should be narrowly tailored to what’s needed to reduce the risk, and clinicians should document their risk assessment and the rationale for disclosure. Consent from the patient isn’t required for this exception, and there isn’t a universal rule that the patient must be told first. If no credible threat or identifiable victim exists, confidentiality should be maintained.