Therapists' Obligations to Report Their Patients' Criminal Acts

Paul S. Appelbaum, MD; and Alan Meisel, JD

The law govemlng the obligation of therapists to report their patients' previous criminal acts was reviewed. Most often, discussions of this subject fall under the general category of "misprision of a felony," that is, the presumed general obligation of all citizens to report felonies that come to their Ittentlon. Review of federal law revealed that the courts have consistently interpreted the federal misprision statute as requiring active concealment of a crime, not a mere failure to report, in order to convict for the offen... State law Is more diverse. Only one state has a general misprision statute labeled as such, and ..veral states have recently repealed such statutes. The strong trend In states without statutes Is to reject misprision as a common law crime, becuase of Its Incompatibility with modem notions of justice. Most states, however, have limited reporting statutes, such as for child abuse or gunshot wounds, that Impose similar obligations. Therapists' reporting of past crimes may be affected by clinical and ethical concems, as well as by obligations to protect future victims. In almost all jurisdictions, however, the fear of prosecution for failure to report a past crime should not be a factor in deciding on a course of action.

Is a psychotherapist required to report patients' past crimes-when they consti­ Crimes committed by patients that are tute felonies, and particularly when they brought to light in the course of therapy? involve threats on the President or other Are there special considerations when federal officials-may itself be criminal. the crimes involve acts of treason or Our review of the relevant law leads threats to the safety of the President of us to conclude that careful analysis does the United States? We have been asked not support this common response: This these questions dozens of times; they are conclusion must be distinguished from asked repeatedly at continuing educa­ the conclusion to the closely related, and tion sessions and raised in the psychiat­ probably more familiar, issue of whether ric literature. I Most frequently the an­ or not psychotherapists must report pa­ sWers given are that the failure to report tients' threats of committing crimes in the future, the issue thrust into the lime­ light by the Tarasoffcase a decade agO.2 llr. Appelbaum is A. F. Zeleznik Professor of Psychiatry ----and director, Law and Psychiatry Program, University While an increasing number of states : Massachusetts Medical School. Mr. Meisel is profes­ require psychotherapists to issue a warn­ Stf of law and psychiatry, University of Pittsburgh hools of Law and Medicine. ing about a patients' intended dangerous ~ddress correspondence reprint requests to Dr. Appel­ conduct (or to take other kinds of steps St urn at the University of Massachusetts Medical to prevent it from materializing),) there \V hOOI, Department of Psychiatry, 55 Lake Ave. North, OfCester, Massachusetts 01605. is no similar general requirement as to lIuli Am Acad Psychiatry Law, Vol. 14, No.3, 1986 221 Appelbaum and Meisel

completed criminal conduct, "danger­ simply invented them. Concerned about her ous" or not, of which the psychothera­ obligation to report the patient's confession, as well as about her responsibility to protect the pist becomes aware. Finally, the issue confidentiality of the therapeutic setting, she under consideration here is not whether sought advice about the appropriate nature of a therapist may disclose a patient's her response. confessions of crime, but whether there The particular criminal charges for must be such a disclosure lest the thera­ which psychotherapists are often pist also run afoul of the criminal law. thought to be at risk when they fail to However, if our conclusion that there is report their patients' confessions of no duty to report patients' confessions criminal activity belong to a class of of crimes is correct, then the issue arises offenses referred to as "inchoate" crimes of whether it is permissible to do so and include the crimes known as mis­ without incurring liability for breach of prision of a felony and accessory after confidentiality. the fact, as well as the closely related The Clinical Setting offense of obstruction of justice. These The following case example, from the inchoate offenses originated in English senior author's consultative experience, common law, were often adopted by demonstrates the situations in which the American courts and thereby incorpO­ question of reporting can arise and the rated into American common law, and complexities often associated with the have sometimes found their way into Issue. contemporary American criminal stat­ utes. Because the legal issues raised Clue Example A middle-aged, chronic schiz­ ophrenic patient with a fluid delusional system about therapists' reporting obligations and a preoccupation with publicized acts of differ under federal and state law, these violence had been in treatment with the same bodies of law will be considered sepa­ psychiatric resident for two years. During that rately. time, he had confessed to this doctor his re­ sponsibility for numerous crimes, including Therapists' Obligations under several murders, that had occurred around the country. As these confessions seemed highly Federal Law improbable and consistent with the patient's Misprision of a felony has been a stat­ grandiose delusional structure, the resident dis­ utory offense under federal law since regarded them. 4 At their most recent therapy session, the patient 1790. The current statute, which differs told his doctor about a murder he had allegedly little from the original one, defines the committed at a rooming house for transients crime in these terms: in another part of the city. He provided an unusually detailed description of the crime Whoever, having knowledge of the actual com­ scene and of the victim. The police, he claimed, mission of a felony cognizable by a court oftbe were unaware that the murder had occurred. United States, conceals and does not as SOOn Although the resident had previously shrugged as possible make known the same to some off many similar confessions, this one disturbed judge or other person in civil or military aU­ her. The patient's tone was different, the alleged thority under the United States, shall be fined site of the crime was nearby, and he seemed to not more than $500.00 or imprisoned not more know too many details of the murder to have than three years, or both.s

222 Bull Am Psychiatry Law, Vol. 14, No.3, 1986 Therapists' Obligations Concerning Patients' Criminal Acts

The statute was apparently little used disclose" is the same as in the general for 150 years after its passage. A federal misprision statuteY We have not been court concluded in the 1930s that only able to find a case in which this latter two previous cases had ever reached the statute was interpreted by a federal appellate leve1. 6 More recently there has court. been a flurry of cases decided on mispri­ Are there actions of the therapist that sion, as prosecutors have engaged in might be construed as "concealment" SOme creative uses of the statute. sufficient to bring the therapist within The rule enunciated in u.s. v. Farrar, the scope of the federal misprision stat­ however, the first case in this century to utes? First, it is important to note that address the misprision statute, has been federal criminal law, as a general matter, accepted in all subsequent cases.4 Ex­ has a very limited scope of applicability amining the language of the statute, and and is unlikely to apply to most thera­ Particularly the portion reading "con­ peutic situations. In other words, most ceals and does not as soon as possible conduct that is criminal is a violation of lllake known," the court concluded that state law, not federal law. However, it is the law "requires both concealment and conceivable that the actions of a thera­ failure to disclose. Under it some affirm­ pist could implicate federal criminal ative act toward the concealment of the statutes, such as when the patient has felony is necessary. Mere silence after committed either a crime against a fed­ knowledge of the commission of the eral official or treason. Crime is not sufficient." This rule was Assuming that there is federal jurisdic­ elaborated in Neal v. u.s. into a four­ tion, other questions remain to be an­ Part test for establishing that the crime swered. Among the actions that have of misprision had occurred: (1) the prin­ been recognized by the courts as "con­ Cipal committed and completed the cealment" are "suppression of evidence, felony alleged, (2) the defendant had full harboring of the criminal, intimidation knOWledge of that fact, (3) the defendant of witnesses, "6 aiding in the recovery of failed to notify authorities, and (4) the stolen money, 13 and holding money that defendant took an affirmative step to is being used for a bribe. 14 In general, Conceal the crime.7 It seems clear that these behaviors lie outside the scope of the therapist's mere failure to report the the therapeutic relationship. Could a Commission of a federal crime under the psychiatrist who hospitalizes a patient, Pan-ar-Neal test would not, in itself, ex­ however, knowing that the patient is ~~ the therapist to legal jeopardy.8-14 fleeing from the law after committing a I QIS would appear to be true regardless federal offense, be deemed to be "har­ of the crime involved, including threats boring" a criminal, and thus come ~o federal officials and even treason. within the ambit of the misprision stat­ Misprision of treason" is addressed by ute? Does the patient's need for hospi­ ~ separate statute, but the wording of the talization affect this determination? The ey section "conceals and . .. does not cases are silent on this question, but it

a.." Am Acad Psychiatry Law, Vol. 14, No.3, 1988 223 Appelbaum and Meisel may be that a psychiatrist who admitted or punishment."16 One federal court at­ a patient specifically to aid him or her tempted to distinguish the two crimes in escaping detection would in fact come by noting that an accessory acts with within the ambit of concealment. intent to benefit the felon, whereas one Of greater relevance to most psycho­ who commits misprision technicallY therapists is the issue of how to respond need not have that intent. 17 It is difficult to questions posed by law enforcement to imagine, however, that a person personnel. At least two federal cases would be found guilty of misprision in have held that, "Although 'mere silence' the absence of intent to aid the perpetra­ is insufficient (i.e., there is no obligation tor of the crime. However, some state to notify civil authorities) the giving of court decisions lend support to the view an untruthful statement to authorities is that both misprision and accessory lia­ a sufficient act of concealment to sustain bility require an intent to aid the perpe­ a conviction for misprision of a fel­ trator, thus making them essentially ony."IO,12 Thus, it appears that when identical crimes. 18,19 therapists respond to investigators' ques­ tions, they have an obligation to do so Therapists' Obligations under truthfully. There does not appear to be State Law an obligation, however, to say anything Our review of state statutes revealed at all, and a therapist could respond to only one state with a law specifically an investigating officer without incur­ prohibiting "misprision of a felony." ring criminal liability by stating that he South Dakota, in its misprision statute, or she is unable to provide any infor­ departs from the federal example by US­ mation because of the confidential na­ ing a disjunctive rather than a conjunc­ ture of the therapist-patient relationship. tive test. That is, misprision occurs when In the unlikely event that a therapist and a person with nonprivileged knowledge a patient had jointly participated in a of a crime "conceals the same, or does crime, the therapist would be further not immediately disclose such felony. ,,20 relieved from making any statements to Although the wording suggests that mere investigating authorities on the basis of nondisclosure is sufficient to constitute the therapist's own Fifth Amendment the crime, we could find no South Da­ privilege against self-incrimination. 9 kota cases explicating the statute. It is of interest that, as defined by the Other states have statutes that are es­ federal courts, the crime of misprision sentially misprision statutes, althougb of a felony becomes almost coterminous not denominated as such. An Ohio stat­ with the related crime of being an acces­ ute, for example, entitled "Failure to sory after the fact. This latter crime has report a crime or knowledge of a death, " traditionally been defined as the act of states simply, "no person, knowing that "one who, with knowledge of the other's a felony has been or is being committed, guilt, renders assistance to a felon in the shall knowingly fail to report such info~­ effort to hinder his detection, arrest, trial mation to law enforcement authofJ-

224 Bull Am Psychiatry Law, Vol. 14, No.3, 1986 Therapists' Obligations Concerning Patients' Criminal Acts

ties."21 The statute exempts privileged there was no obligation to report a crime relationships, including "doctor and pa­ that had occurred in another state.31 Al­ tient, licensed psychologist or licensed though under the Model Penal Code school psychologist and client," but the there is a crime known as "obstruction Ohio Attorney General has issued an ofjustice," like misprision it requires the opinion that an evaluator carrying out a performance of an affirmative act on the COurt-ordered psychiatric examination part of the therapist before liability can does not establish the requisite doctor­ be imposed.27 Patient relationship with the subject of Misprision may be an issue even in the examination and thus is obligated to states without statutes on the subject report crimes revealed.22 An Ohio case because its status as an offense derives construing this statute held that a refusal from the common law of England. All to answer police questions when the po­ states have incorporated English com­ lice were already aware of a crime having mon law into their jurisprudence at least been committed did not constitute mis­ to some extent. 32 Although the trend is Prision; dicta in the decision went so far clearly away from the imposition of lia­ as to suggest that even "unsworn oral bility on the basis of common law misstatement to the police is not punish­ crimes, states still recognizing them may able conduct. "23 Still other jurisdictions include misprision among them. The may establish what are, in effect, limited Rhode Island Supreme Court, for ex­ misprision statutes by requiring speci­ ample, has recognized misprision as an fied professionals, or in some cases the indictable offense, though it did not public, to report child abuse, crimes of reach the issue of how the crime should Violence, or treason, under threat of pen­ be defined, i.e., whether an act of con­ alty for failure to comply.24-26 cealment is required.33 Delaware and It should be noted that the popularity Vermont courts accepted the common of misprision statutes appears to be de­ law crime of misprision earlier in this creasing. The Model Penal Code, for century, but the current status of those example, deletes misprision from its holdings is unclear. 34, 35 The Vermont classificatory scheme.27 Maine repealed case limited the scope of the offense by its misprision statute in 1975,28 as did nothing that, "The motive prompting New Jersey in 1978. 29 Interestingly, be­ the neglect of a misprision must be in fore the Maine statute was repealed, the the some form evil as respects the ad­ state's supreme court construed its lan­ ministration of justice"35-thus possibly gUage covering persons who conceal or excluding cases in which failure to report rail to disclose information of a felony is motivated by fear or indifference. to require that they conceal and fail to Whether a therapist could claim that disclose. 30 State statutes have generally failure to report was motivated by a been construed narrowly. A Louisiana desire to keep a patient in treatment, COUrt, for instance, interpreting that and thus not "evil," is an interesting but state's now repealed statute, ruled that unexplored possibility. The Massachu-

!SuI! Am Acad Psychiatry Law, Vol. 14, No.3, 1986 225 Appelbaum and Meisel setts Supreme Court later followed Ver­ confused, delusional ramblings present mont in declaring that if misprision were certain enough evidence of a crime to to be accepted as a common law offense require reporting. There appears, in ad­ in that state, the crime would require an dition, to be no common law limitation evil intent. 36 regarding reporting of crimes that oc­ Most of the more recent decisions on curred many years ago. Summing up, the status of the common law crime, the Pope court concluded, "We believe however, have rejected misprision as an that the common law offense is not ac­ offense. As early as 1940, ,the Supreme ceptable by today's standards." Court of Michigan determined that, Courts in Nevada and Florida have "The old-time common law offense of also rejected a common law basis for misprision of felony, short of an acces­ misprision in the recent past. 19. 38 In the sory after the fact, ... is not a substantive words of the Florida court, "While it offense and not adopted by the consti­ may be desirable that we encourage cit­ tution, because wholly unsuited to izens to get involved to help reduce American criminal law and procedure crime, they ought not be adjudicated as used in this State. ,,37 criminals themselves if they don't .... A scholarly opinion in Pope v. State, We cherish the right to mind our own in which Maryland rejected common business when our own best interests law misprision, explored the reasons that dictate."19 the crime does not seem to fit well in To summarize the situation under American jurisprudence. 18 The court state law, few states have statutes ad­ noted misprision's "undesirable and in­ dressing misprision of all felonies, al­ discriminating width," commenting that though most states require reporting of knowledge of a crime may be acquired child abuse, gunshot wounds, or other quite involuntarily from close friends specified evidence of crimes. Even states whom one would be loath to betray. with reporting statutes frequently ex­ Further, the actor is required to make empt privileged relationships, such as subtle and sophisticated judgments to that between a doctor or psychotherapist escape liability, such as (1) whether the and patient. In jurisdictions without offense is a felony (and therefore report­ statutes, the strong trend has been for able) or a misdemeanor (which need not courts to reject the common law crime be reported) and (2) when his or her of misprision. Thus, ,although absolute knowledge reaches a sufficient level of certainty is impossible, it seems very un­ certainty that a report is required. The likely that a therapist, particularly if act­ latter may be a particular problem in the ing for some beneficient end, need worrY therapeutic context, as in the case ex­ about facing a charge of misprision or a ample, where, under a common law def­ related criminal offense. inition of misprision with no act of con­ Discussion cealment required, the therapist must Misprision of a felony has long been judge when a schizophrenic patient's a legal anomaly. Dating back to medie-

228 Bull Am Psychiatry Law, Vol. 14, No.3, 1986 Therapists' Obligations Conceming Patients' Criminal Acts

val times in England, when the Norman tients is, in almost all cases, unwar­ COnquerors placed obligations on their ranted. Although good arguments could captive populace to help deter crimes be made for exempting psychotherapists against the hated rulers,39 misprision from a general obligation to report past represents a rare exception to Anglo­ felonies, no such general obligation ex­ American law's reluctance to place af­ ists. American law at the federal and firmative obligations relative to the con­ state levels rejects the imposition of duct of others on individual persons. criminal liability for mere failure to re­ The crime has rarely been invoked even port a crime and requires overt assist­ in England. 39 An affirmation ofthe com­ ance rendered to a felon for there to be mon law validity of the offense by the a criminal offense. House of Lords in 196640 was followed What are the appropriate parameters qUickly by legislation abolishing it. 41 of a therapist's behavior when a patient Reported cases in this country, espe­ reveals that a serious crime has been cially in the federal courts, suggest that committed? Although reporting a pa­ misprision usually has been used in an tient's crime is probably not required, effort to punish persons who have acted that conclusion does not respond to the at the margins of a criminal endeavor related question of whether reporting of but who could not be charged as a prin­ such a crime is permissible. Physicians, cipal in the crime itself. Whatever inde­ including psychiatrists, have at times Pendent utility the crime may have in been subject to pleas to reveal patients' such circumstances has been largely vi­ illegal behavior for the sake of the gen­ tiated by the requirement by the federal eral welfareY It must be kept in mind COUrts that active concealment have that reporting a patient's confession of a taken place. crime is a breach of confidentiality. If It is of interest that misprision is losing reporting were mandatory, this would llluch of its residual popularity at a time clearly serve as a defense to any potential when a new class of affirmative obliga­ civil liability to the patient arising from tions to control others' conduct-em­ the breach of confidence. However, bodied in the duty to protect, as enun­ when reporting is not mandatory, the ciated in TarasofJ2-is being imposed possibility of a civil suit cannot be dis­ on psychotherapists. This discrepancy counted. ~elates to the frequently divergent trends As a practical matter, permissive re­ In tort law and criminal law, with the porting of a patient's past criminal activ­ former's increasing emphasis on com­ ity is unlikely to result in liability for flensating victims, and the latter's con­ breach of confidentiality if the patient cern with protecting defendants' rights. has in fact committed the crime and is In any event, the concern of psychia­ convicted of it or pleads guilty to it. This :rists and other therapists about possible is not to say that "truth" is a legally egal risk simply for failing to report recognized defense to a lawsuit for Crim.es admitted to them by their pa- breach of confidentiality, but only that

aull Am Acad Psychiatry Law, Vol. 14, No.3, 1986 227 Appelbaum and Meisel

a jury is likely to be far less sympathetic who failed to reveal that his or her pa­ to a convicted criminal. If, as was true tient had actually committed the crime in the case example, the patient has not for which he was serving time is a spec­ in fact committed the crime, but there ulative, but intriguing, possibility. are reasonable grounds to believe that Reporting of a patient's confession in he or she has, the therapist who reports both these cases would appear to be is on weaker, but probably still firm, sanctioned by the Principles of Medical ground. Thus, before reporting, the psy­ Ethics.44 Annotation 8 to Section 4 of chotherapist is well advised to be as dil­ the Principles permits the release of con­ igent as possible in determining the va­ fidential data "in order to protect ... the lidity of the patient's confession. community from imminent danger." From an ethical perspective, there On the other hand, revelation of a crime might be circumstances in which the merely because the psychotherapist is therapist may feel an obligation to notify repelled by the type or magnitude of the the authorities. If the commission of a act (e.g., rape, murder), when future past crime provides reason to believe dangerousness is not at issue, would not that the patient may commit a future appear to be sanctioned by the princi­ violent act, therapists may feel an obli­ ples, which permit release of "confiden­ gation to take measures to protect future tial information only with the authori­ victims. In states that have adopted a zation of the patient or under proper Tarasoff-like duty, the failure to fulfill legal compulsion." this ethical obligation can leave thera­ The use of the information once the pists liable for harms suffered at their therapist reveals it may also be compli­ patients' hands.43 It should be noted, cated by other issues. In some states with however, that protection can be afforded very stringent psychotherapist-patient potential victims (e.g., by hospitalizing a (or physician-patient) privilege stat­ psychotic patient) without necessarily utes,4S a patient's confession to the ther­ reporting the previous crime or breach­ apist may be rendered inadmissible in a ing confidentiality in some way. criminal prosecution. Further, if the If the patient confesses to a crime for statute of limitations on prosecution of which someone else has been convicted the patient's crime has expired, the p~­ and sentenced, the clinician may also tient may escape any sanctions for hiS feel compelled to reveal his patient's act. , guilt. This obligation might be analo­ Clinically, the ideal way of handling gized to the duty to protect potential any case in which the therapist believes victims of violence, as in this case an that the patient's past behavior should actual victim is suffering significant be revealed involves the therapist raising harm as a result of the patient's failure this as an issue in the therapy, explaining to admit his crime. Whether the courts the basis for his feelings and encou~agin~ would support such an analogy in a civil the patient to report the crime hlmsel suit by a prisoner against a psychiatrist (preferably after obtaining legal reprc-

6 228 Bull Am Psychiatry Law, Vol. 14, No.3, 198 Therapists' Obligations Concerning Patients' Criminal Acts sentationt6 or to grant the therapist per­ 4. Us. v. Farrar, 38 F.2d 515 (D. Mass. 1930) 5. United State Code, Title 18, § 4 mission to report the crime, much as 6. Bratton v. Us., 73 F.2d 795 (10th Cir. 1934) might be done if the patient were threat­ 7. Neal v. Us., i02 F.2d 643 (8th Cir. 1939) ening to commit a crime rather than 8. Lancey v. Us., 356 F.2d 407 (9th Cir. 1966) 9. us. v. King, 402 F.2d 694 (9th Cir. 1968) 47 confessing one already committed. If 10. Us. v. Pittman, 527 F.2d 444 (4th Cir. 1975) the patient refuses both options, the II. Us. v. Johnson, 546 F.2d 1225 (5th Cir. 1977) therapist may decide to breach confiden­ 12. Us. v. Hodges, 566 F.2d 674 (9th Cir. 1977) tiality unilaterally, to preserve confiden­ 13. us. v. Gravitt, 590 F.2d 123 (5th Cir. 1979) tiality and continue with treatment, or 14. Us. v. Davila, 698 F.2d 715 (5th Cir. 1983) 15. United State Code, Title 18, § 2382 to terminate treatment because he or she 16. Perkins R, Boyce R: Criminal Law, 3 ed. feels unable to continue working with a Mineola, NY, Foundation Press, 1982, pp. 748-9 patient who is concealing a major 17. Us. v. Daddano, 432 F.2d 1119 (7th Cir. crime. 46 1970) In the case example described above, 18. Pope v. State, 396 A.2d 1054 (Md. 1979) 19. Ho/land v. State, 302 So. 2d 806 (Aa. App. the therapist, who had no legal obliga­ 1974) tion to report her patient's confession, 20. South Dakota Codified Laws, § 22-11-12 21. Ohio Revised Code, § 2921.22 was sufficiently concerned that, after 22. Ohio Opinions of the Attorney General, 80- consultation, she persuaded the patient 022 (1980) to contact the police. They confirmed 23. In re Stichtenoth, 425 N.E.2d 957 (Ohio App. 1980) that they now knew of the murder and 24. Massachusetts General Laws, Chap. 119 brought the patient in for questioning, 25. Revised Code of Washington, § 9.69.100 but ultimately concluded that he had 26. Louisiana Revised Statutes, Title 14, § 113 27. American Law Institute. Model Penal Code: not been involved. Official Draft (1962), reproduced in Voren­ In conclusion, factors other than con­ berg J, Criminal Law and Procedure: Cases and Materials. St. Paul, MN: West Publish­ cern about prosecution for misprision ing, 1975, pp. 909-80 ~hould ordinarily determine the behav­ 28. Maine Revised Statutes 1954, Chap. 135, § 12 IOr of therapists whose patients have re­ 29. New Jersey Statutes Annotated, Title 2A, § Vealed the commission of a serious 97-2 crime. 30. State v. Michaud, 114 A.2d 352 (Me. 1955) 31. State v. Graham, 182 So. 711 (La. 1938) Acknowledgments 32. 15A C.J.S. Common Law § II (1967) The authors wish to thank Ellen Amdur for her 33. State v. Flynn, 217 A.2d 432 (R.I. 1966) research assistance. 34. State v. Biddle, 124 A. 804 (Ct. Gen. Ses. 1923) 35. State v. Wilson, 67 A. 533 (Vt. 1907) 36. Commonwealth v. Lopes, 61 N.E.2d 849 References (Mass. 1945) ~. Menninger WW: Threatening the president. 37. People v. Lejkovitz, 293 N.W. 642 (Mich. Hosp Community Psychiatry 33:436-7, 1940) 1982 38. Mangeris v. Gordon, 580 P.2d 481 (Nev. 2. TarasojJv. Regents of the University (?fCali­ 1978) fornia, 551 P.2d 334 (Cal. 1976) 39. Glazebrook: Misprision offelony: Shadow or 3. Mills MJ: The so-called duty to warn: The phantom? Am J Legal History 8: 189-208, Psychotherapeutic duty to protect third par­ 283-302, 1964 ties from patients' violent acts. Behav Sci 40. Sykes v. Director of Public Prosecutions, 3 law 2:237-58, 1984 All E.R. 33 (1961)

8t.11 Am Acad Psychiatry Law, Vol. 14, No.3, 1986 229 Appelbaum and Meisel

41. Criminal Law Act of 1967, Chap. 58, § 1 and ciples of Medical Ethics-With Annotations 5 Especially Applicable to Psychiatry. Wash­ 42. Slovenko R, Usdin GL: Psychotherapy, Con­ ington, OC, American Psychiatric Associa­ fidentiality and Privileged Communication. tion, 1981 Springfield, Il, Thomas, 1966, p. 121 45. Pennsylvania Consolidated Statutes, Title 42, 43. Appelbaum PS: Implications of TarasotT for § 5944 clinical practice, in Beck J. ed. The Poten­ 46. Gutheil TG, Appelbaum PS: Clinical Hand­ tially Violent Patient and the TarasojJ Deci­ book of Psychiatry and the Law. New York, sion in Psychiatric Practice. Edited by Beck McGraw-Hill, 1982 J. Washington, OC, American Psychiatric 47. Roth lH, Meisel A: Dangerousness, confi­ Press, 1985 dentiality, and the duty to warn. Am J Psy­ 44. American Psychiatric Association: The Prin- chiatry 134:508-11, 1977

230 Bull Am Psychiatry Law, Vol. 14, No.3, 1986