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Impacts of Tarasoff

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Running head: EXPLORING CONFIDENTIALITY 1

Impacts of Tarasoff
Jennifer Munoz
COUN 6306-28
Walden University
Impacts of Tarasoff The 1976 case Tarasoff v. The Regents of the University of California, initiated a nationwide legislature reform. The famous California Supreme Court case propelled most states to enact a form of “duty to warn” or “duty to protect” statutes (Simone & Fulero, 2005). Tarasoff has forever impacted the liability and responsibilities of medical professionals. This paper will review a Colorado state statute influenced by Tarasoff. It will further address the “duty to warn” and “duty to protect” dilemmas and the suitable ways to address them. Lastly, this paper will examine confidentiality challenges presented in Laureate Education Inc. (2012) video, Mental Health Counseling: Confidentiality.
Colorado State Law Colo. Rev. Stat. § 13-21-117 defines the responsibilities of mental health professionals. It holds mental health professionals liable for their “duty to protect” third parties in cases in which clients communicate threat or harm (Colorado Legal Resources, 2012). The statute states that a mental health professional is not liable in civil court for the failure to warn or protect a third party from a client (Colorado Legal Resources, 2012). Furthermore, it adds that the professional is not held liable to predict their client’s behavior (Colorado Legal Resources, 2012). Though, it mandates that if the client has communicated a considerable threat of forthcoming physical harm against a third party to a mental health professional, such “duty to protect” or “duty to warn” does arise (Colorado Legal Resources, 2012). In these cases, mental health professionals are compelled to make “…reasonable and timely efforts to notify any person or persons specifically threatened…” (Colorado Legal Resources, 2012). Also, the counselor has the responsibility to notify the police or take the necessary steps to hospitalize the patient (Colorado Legal Resources, 2012).
“Duty to Warn” & “Duty to Protect” Colo. Rev. Stat. § 13-21-117 and Tarasoff rulings share a foundational concept. Both share the value of safeguarding confidentiality and recognize the mental health professional’s “duty to warn” or “duty to protect”; however, they are under differing circumstances. Consistent with the Tarasoff ruling, the mental health professional has a “duty to warn” but, only when the client personally shares his cruel intentions (Colorado Legal Resources, 2012). Unlike Tarasoff, the client must communicate one’s intent to harm a specific third party. The Tarasoff ruling “duty to warn” is slightly different in that, mental health professionals must warn likely victims of clients “who represented a threat of imminent danger to them” (Simone & Fulero, 2005, p.3). Later, the California court ruled Tarasoff II, which stated that mental health professionals have a “duty to protect third parties from harmful acts perpetrated by their patients, even if the protective intervention requires a breach of the patient’s confidentiality” in response to the objections to Tarasoff I of breaking the sacredness of confidentiality in the profession (Simone & Fulero, 2005, p.3).
Ethical Dilemma A central issue among these is the extent of which threat is communicated. In Colorado, the client must directly communicate to the mental health professional about his or her intent to harm someone else. This poses several ethical dilemmas to mental health professionals practicing in Colorado. One may struggle with knowing their client has a violent tendency and is very capable of inflicting harm onto others, but is not held responsible to report such accusations. Also, Colo. Rev. Stat. § 13-21-117 conflicts with the 2005 ACA Code of Ethics Standard B.2.a. which poses that counselors must take the appropriate measures to prevent harm to an individual in potential danger (p.7). It further states that the counselor’s confidentiality condition “does not apply when disclosure is required to protect clients or identifiable others from serious and foreseeable harm” (ACA Code of Ethics, 2005, p.7). Edwards (2006) further stated that counselors must take steps to protect others even when information is communicated by someone other than the client (as cited in Remley & Herlihy, 2010). So what is a counselor in Colorado to do when a client does not communicate harmful intentions, but the counselor senses a third party is in serious danger? It is complicated because human behavior is very unpredictable and counselors can get caught in both ethical and legal dilemmas, in deciding whether to breach a client’s confidentiality in to protect others. The counselor’s duty to maintain confidentiality, but also having the ethical “duty to warn” or “duty to protect” creates confusion.
Ethical Dilemma Decision-Making Steps Gilbert (2002) stated counselors have an obligation to take necessary steps to prevent harm (as cited in Remley & Herlihy, 2010). When a Colorado mental health professional finds oneself in a situation where their client may highly inflict harm onto others, one should take the necessary steps to protect the third party. Although, Colo. Rev. Stat. § 13-21-117 fails to recognize Standard B.2.a. counselors have the ethical “duty to warn” (ACA Code of Ethics, 2005). Yes, under Colorado law a mental health professional will not be held liable if a client harms another without the counselor’s knowledge; however, counselors still need to consider their ethical duties. Certainly, the client has a right to confidentiality, but the third party also has the right to protection. Herlihy and Corey’s (2006) recommended decision-making model is good to reference: (1)identify the problem, (2) examine the relevant codes of ethics and the professional literature, (3) consider the moral principles of autonomy, nonmaleficence, beneficence, justice, and fidelity, (4) consult with colleagues, supervisors, or experts, (5) attend to your emotions, (6) involve your client in the decision-making process, (7) identify desired outcomes and generate potential courses of action, (8) consider the potential consequences of all options and determine a course of action, (9) evaluate the selected course of action, and (10) implement the course of action (pp.14-17).

A counselor may want to tread lightly pursuing step six, involving the client. In situations where the client may potentially harm another the counselor needs to be careful. One does not want to make the client feel threatened and catalyze a violent event. However, this may help the counselor find out more information. An influential step in Herlihy and Corey’s (2006) generalized decision-making model is step four, consulting with colleagues and experts. Breaching confidentiality is a major endeavor. Consultation may provide better insight on the situation and circumstances (Remley & Herlihy, 2010). Following a decision-making model helps guide a counselor in complex situations (Herlihy & Corey, 2006).
Confidentiality Challenges As Rhonda Newswald-Potter said in Laureate Education Inc. (2012) video, Mental Health Counseling: Confidentiality “confidentiality is the cornerstone, it is the foundation of our profession”. Since confidentiality is of such great importance, there are high stakes when breached. For all the more reason why informed consent is critical (Laureate Education Inc., 2012). Informed consent provides the client with pertinent information about his or her rights in seeking counseling and the rights of the counselor-, which includes the limitations of confidentiality (Remley & Herlihy, 2010). Informed consent will encourage the client-counselor relationship and protect those involved.
Conclusion
Tarasoff has influenced many state statutes with reference to “duty to protect” and “duty to warn” obligations of mental health professionals. While it has positive impact, the “duty to warn” or “duty to protect” can pose ethical dilemmas. In Colorado, when a client harms another without the counselor’s knowledge of doing so is not held liable. Although the counselor may not be held accountable for the client’s action, the counselor must still act ethically. Ethical decision-making models can aid counselors in pursuing their ethical “duty to protect”. It is highly encouraged to seek consultation when people are in danger. It is also important to emphasize informed consent at the beginning of consultation to clarify the rights of clients and the professionals. In all, confidentially plays a major role in the counseling profession and if need be it must be breached under specified circumstances for the great good. Counselors have the responsibility of being knowledgeable on the code(s) of ethics and state laws. This will help the counselor practice honestly and ethically.

References
American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper]. Retrieved from http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf- 848c-f98489937dda.
Colorado Legal Resources (2012). Colorado Revised Statutes. C.R.S. 13-21-117. Retrieved from LexisNexis Academic database http://www.lexisnexis.com/hottopics/colorado/?app=00075&view=full&interface=1&docinfo=off&searchtype=get&search=C.R.S.+13-21-117
Herlihy, B., & Corey, G. (2006). ACA ethical standards casebook (6th ed.). Alexandria, VA: American Counseling Association.
Laureate Education, Inc. (Executive Producer). (2012). Mental health counseling: Confidentiality [Video]. Baltimore, MD: Author.
Remley, T. P., Jr., & Herlihy, B. (2010). Chapter 5: Confidentiality and privileged communication. In Ethical, legal, and professional issues in counseling (3rd ed.)(pp.105- 128). Upper Saddle River, NJ: Merrill/Pearson Education.
Simone, S., & Fulero, S. M. (2005). Tarasoff and the duty to protect. Journal of Aggression, Maltreatment & Trauma, 11(1/2), 145–168. Retrieved from the Walden Library databases

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