25 word discussion question for ethics in human services

Duty to Warn, Duty to Protect

Written by Steven Granich, LCSW, MPA, DSW   

Since the Tarasoff case in l974, duty to warn and duty to protect have become important as concepts in the field of social work and other helping disciplines. Being able to protect potential victims from harm and protecting clients from self-harm have become ethical obligations in social work practice. This area needs to be explored and understood by social work practitioners, educators, and social work students. Duty to warn and duty to protect have ethical implications for all social workers.
    Walcott, Cerundolo, and Beck (2001) describe the facts of the Tarasoff case. Prosenjit Poddar and Tatiana Tarasoff were students at UCLA. Poddar stated to the university health science psychologist that he intended to kill an unnamed woman, who was identified as Tatiana Tarasoff. Although the psychotherapist did not directly warn Tarasoff or the family, the psychologist notified the police, who interviewed Poddar for commitment. The police only warned Tarasoff to stay away. After Poddar returned for the summer from Brazil, he murdered Tatiana with a knife. Tarasoff’s family sued the campus police and the university health service for negligence. Walcott, Cerundolo, and Beck (2001) cite the second Tarasoff case, establishing a duty to protect.

When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. The discharge of the duty may require the therapist to take one or more various steps, depending on the nature of the case. Thus, it may call for him to warn the intended victim or others likely to appraise the victims of that danger, to notify the police or take whatever steps are reasonably necessary under the circumstances (p. 340).

 
    The Tarasoff case imposed a liability on all mental health professionals to protect a victim from violent acts. The first Tarasoff case imposed a duty to warn the victim, whereas the second Tarasoff case implies a duty to protect (Kopels & Kagle, 1993). There are many concerns about the implications of the Tarasoff case, especially around the confidentiality of the client-social worker relationship and violent clients avoiding treatment. 

   Since the second Tarasoff decision in 1976, there has been argument and debate as to the applicability of this judgment to the client-social worker relationship. The environment has changed for social work and confidentiality, as social workers now divulge confidential information to third-party payers. Tarasoff is an important decision with legal implications, and only 13 states in the U.S. lacked Tarasoff-like provisions at the time of Herbert’s report in 2002.
    Duty to warn means that the social worker must verbally tell the intended victim that there is a foreseeable danger of violence. Duty to protect implies a therapist determining that his or her patient presents a serious danger of violence to another and an obligation to use reasonable care to protect the intended victim against danger (Harvard Mental Health Letter, 2008, January). This may entail a warning, police notification, or other necessary steps.
    Duty to warn and duty to protect have implications for social work practitioners in the fields of mental health, HIV/AIDS, domestic violence, and medical social work. There are also serious implications for malpractice and unethical behavior. What began as a mental health issue has been expanded to other fields of social work practice.
Duty to Warn and Duty to Protect in Mental Health  
    In the field of mental health, it is difficult to actually make predictions of client violence. The Harvard Mental Health Letter (2006, January) makes recommendations for handling duty to protect with homicidal and suicidal patients.
    
The principles for managing a threat of violence are generally the same as those for dealing with a suicidal threat. Therapists should find out whether a patient has ever seriously injured or thought about seriously injuring another person. Especially with new patients or any patients whose symptoms are becoming worse, it is important to know whether they are dangerous to others and whether the danger is due to mental illness. Is the patient losing the capacity to control violent impulses? (p.4)
    Duty to protect can involve warning the potential victim, notifying the police, starting a commitment hearing, informing mental health evaluators of the threat, and utilizing professional supervision. Duty to protect involves working with homicidal and suicidal clients. The obligation of duty to protect varies from state to state (Dolgoff, Loewenberg, & Harrington, 2009).
    Failure to protect potential victims of violence can result in losing one’s job at an agency. Consider the following hypothetical example.
    
A professional social worker conducted an intake interview with a client with a history of mental health problems and violence toward his father. The client was somewhat delusional and stated that he might hurt his father that evening. The social worker made no effort to commit the patient for hospitalization. That evening, the patient became violent and broke his father’s leg. The next day, the social worker was fired for negligence.     
    Protecting the well being of homicidal and suicidal clients is the obligation of professional social workers. Social workers should frequently utilize supervision and consultation when working on this issue of duty to protect, because it has ethical and malpractice considerations.