Conflict of interest between therapist-patient confidentiality and the duty to report sexual abuse of children

A misunderstanding regarding the duty to report suspected abuse

Confusion exists among professionals as to the circumstances under which a mandatory child abuse reporter must file a report. A review of the literature reveals that professionals sometimes feel obligated to make reports, even though they harbor no suspicion that abuse actually occurred. For example, some individuals believe that they must report abuse allegations made by other individuals, even if the mandatory reporter does not suspect abuse. The authors found that the mandatory reporting statutes of 49 states and the District of Columbia do not require reports unless the reporter has a suspicion of abuse. New York may be an exception. The authors conclude that mandatory reporters generally are not required to report abuse allegations if they themselves do not suspect that abuse occurred. This article encourages mandatory reporters to report abuse as required by the law, but not make unnecessary reports out of confusion or misinformation.

Clinical flexibility and confidentiality: effects of reporting laws

Legal constraints upon therapeutic flexibility, resulting in breaches of confidentiality, can promote counterproductive effects upon patients and society. Conflicts can be created for mental health professionals who sometimes must choose between maximum self-protection and doing what they believe is ethical. A survey of forensic psychiatrists indicated that most believe they face ethical problems created by some ambiguities in current reporting statutes if they are interpreted to mandate reporting and warning. Emphasis is given: (1) to the ethical choice faced by therapists as to whether rigidly to report and warn to limit liability in all Tarasoff-type situations and in some ambiguous child abuse situations, or to take an alternative action when it is clinically indicated for the benefit of a patient and/or society; (2) to the importance of understanding the distinction between potential criminal liability for failure to report under many child abuse laws, and the risk only of civil liability in Tarasoff-type cases; and (3) to appreciate the flexibility permitted by current "Tarasoff" laws. Our case histories demonstrate that mandated erosion of therapeutic confidentiality can present serious problems for patients and others. Suggestions are included for modifications in the current reporting statutes, focusing on the perspective that clinical flexibility is an essential adjunct to community protection as well as to effective therapy.

Ethical considerations of clinical use of Miranda-like warnings

Psychiatrists and other psychotherapists are not generally required to provide Miranda-like warnings to their patients. Even so, many psychotherapists issue such warnings before encountering clinical situations that frequently arise in general clinical practice and have potential involvement with the legal system. Ethical considerations of whether to utilize Miranda-like warnings in common clinical situations such as involuntary hospitalization, the duty to warn and protect, and suspected child abuse reporting, are explored.