Moral justification for Tarasoff-type warnings and breach of confidentiality: a clinician's perspective.

After brief review of the background and context of the Tarasoff case and its impact on clinicians, the author examines the "Tarasoff warning," proposed in the 1974 Tarasoff opinion, from a moral position, with brief discussion of its clinical and risk management dimensions. Moral issues considered include confidentiality itself, agency, fiduciary duty, a shift in the victim paradigm, the emergency context, a novel risk, and a proposed approach. The dilemma presented by the original Tarasoff fact situation is re-examined. The author stresses the need for individualized responses to the risks posed by patients.