email page print pageAll Topic Reviews
Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst Moral ResponsibilityAgency and AnswerabilityAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAging, Biotechnology, and the FutureAlbert Schweitzer's Reverence for LifeAlphavilleAltruismAltruismAmerican EugenicsAmerican PsychosisAn Anthology of Psychiatric EthicsAn Introduction to EthicsAn Introduction to Evolutionary EthicsAn Introduction to Kant's Moral Philosophy And a Time to DieAnimal LessonsAnimal RightsAnimals Like UsApplied Ethics in Mental Health CareAre Women Human?Aristotle on Practical WisdomAristotle's Ethics and Moral ResponsibilityAssisted Suicide and the Right to DieAutonomyAutonomy and the Challenges to LiberalismAutonomy, Consent and the LawBabies by DesignBackslidingBad PharmaBad SoulsBasic Desert, Reactive Attitudes and Free WillBeauty JunkiesBefore ForgivingBeing AmoralBeing YourselfBending Over BackwardsBending ScienceBernard WilliamsBetter Humans?Better Than WellBeyond ChoiceBeyond GeneticsBeyond HatredBeyond Humanity?Beyond LossBeyond LossBeyond Moral JudgmentBeyond the DSM StoryBias in Psychiatric DiagnosisBioethicsBioethicsBioethics and the BrainBioethics at the MoviesBioethics Beyond the HeadlinesBioethics Critically ReconsideredBioethics in a Liberal SocietyBioethics in the ClinicBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical Research and BeyondBiosBioscience EthicsBipolar ChildrenBluebirdBodies out of BoundsBodies, Commodities, and BiotechnologiesBody BazaarBoundBoundaries and Boundary Violations in PsychoanalysisBraintrustBrandedBreaking the SilenceBuffy the Vampire Slayer and PhilosophyCapital PunishmentCase Studies in Biomedical Research EthicsChallenging the Stigma of Mental IllnessCharacter and Moral Psychology Character as Moral FictionChild Well-BeingChildrenChildren's RightsChoosing ChildrenChoosing Not to ChooseClinical Dilemmas in PsychotherapyClinical EthicsCloningClose toYouCoercion as CureCoercive Treatment in PsychiatryCognition of Value in Aristotle's EthicsCognitive Disability and Its Challenge to Moral Philosophy Comfortably NumbCommonsense RebellionCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentComprehending CareConducting Insanity EvaluationsConfidential RelationshipsConfidentiality and Mental HealthConflict of Interest in the ProfessionsConsuming KidsContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Social PhilosophyContentious IssuesContesting PsychiatryCrazy in AmericaCreating CapabilitiesCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCritical Perspectives in Public HealthCritical PsychiatryCrueltyCultural Assessment in Clinical PsychiatryCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDisability BioethicsDisability, Difference, DiscriminationDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting RealGluttonyGood WorkGoodness & AdviceGreedGroups in ConflictGrowing Up GirlGut FeminismHabilitation, Health, and AgencyHandbook for Health Care Ethics CommitteesHandbook of BioethicsHandbook of PsychopathyHappinessHappiness and the Good LifeHappiness Is OverratedHard FeelingsHard LuckHardwired BehaviorHarmful ThoughtsHeal & ForgiveHealing PsychiatryHealth Care Ethics for PsychologistsHeterosyncraciesHistorical and Philosophical Perspectives on Biomedical EthicsHoly WarHookedHookedHow Can I Be Trusted?How Propaganda WorksHow to Do Things with Pornography How to Make Opportunity EqualHow Universities Can Help Create a Wiser WorldHow We HopeHow We Think About DementiaHuman BondingHuman EnhancementHuman GoodnessHuman Identity and BioethicsHuman TrialsHumanism, What's That?Humanitarian ReasonHumanityHumanizing MadnessI am Not Sick I Don't Need Help!I Was WrongIdentifying Hyperactive ChildrenIf That Ever Happens to MeImproving Nature?In Defense of FloggingIn Defense of SinIn Love With LifeIn Our Own ImageIn the FamilyIn the Land of the DeafIn the Name of IdentityIn the Wake of 9/11In Two MindsInformed Consent in Medical ResearchInnovation in Medical TechnologyInside Assisted LivingInside EthicsIntelligence, Race, and GeneticsIntensive CareIs Human Nature Obsolete?Is Long-Term Therapy Unethical?Is There a Duty to Die?Is There an Ethicist in the House?Issues in Philosophical CounselingJudging Children As ChildrenJust a DogJust BabiesJust CareJustice for ChildrenJustice for HedgehogsJustice in RobesJustice, Luck, and KnowledgeJustifiable ConductKant on Moral AutonomyKant's Theory of VirtueKids of CharacterKilling McVeighLack of CharacterLack of CharacterLaw and the BrainLearning About School ViolenceLearning from Baby PLeaving YouLectures on the History of Political PhilosophyLegal and Ethical Aspects of HealthcareLegal Aspects of Mental CapacityLegal ConceptionsLegal InsanityLegalizing ProstitutionLet Them Eat ProzacLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberal EugenicsLife After FaithLife at the BottomLife, Sex, and IdeasListening to the WhispersLiving ProfessionalismLosing Matt ShepardLostLuckyMad in AmericaMad PrideMadhouseMaking Another World PossibleMaking Babies, Making FamiliesMaking Genes, Making WavesMaking Sense of Freedom and ResponsibilityMalignantMasculinity Studies and Feminist TheoryMeaning and Moral OrderMeaning in LifeMeaning in Life and Why It MattersMeans, Ends, and PersonsMeans, Ends, and PersonsMedical Enhancement and PosthumanityMedical Research for HireMedicalized MasculinitiesMedically Assisted DeathMeditations for the HumanistMelancholia and MoralismMental Health Professionals, Minorities and the PoorMental Illness, Medicine and LawMerit, Meaning, and Human BondageMetaethical SubjectivismMill's UtilitarianismMind FieldsMind WarsMind WarsModern Theories of JusticeModernity and TechnologyMoney ShotMonsterMoral Acquaintances and Moral DecisionsMoral BrainsMoral ClarityMoral CultivationMoral Development and RealityMoral Dilemmas in Real LifeMoral DimensionsMoral EntanglementsMoral FailureMoral LiteracyMoral MachinesMoral MindsMoral OriginsMoral Panics, Sex PanicsMoral ParticularismMoral PerceptionMoral PsychologyMoral Psychology: Volume IVMoral RealismMoral RelativismMoral RepairMoral Responsibility and Alternative PossibilitiesMoral Status and Human LifeMoral StealthMoral Theory at the MoviesMoral TribesMoral Value and Human DiversityMoral, Immoral, AmoralMoralismMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMorals, Rights and Practice in the Human ServicesMorals, Rights and Practice in the Human ServicesMore Than HumanMotive and RightnessMovies and the Moral Adventure of LifeMurder in the InnMy Body PoliticMy Brain Made Me Do ItMy Sister's KeeperMy Sister's KeeperMy WayNano-Bio-EthicsNarrative MedicineNarrative ProsthesisNatural Ethical FactsNatural-Born CybogsNaturalized BioethicsNeither Bad nor MadNeoconservatismNeonatal BioethicsNeurobiology and the Development of Human MoralityNeuroethicsNeuroethicsNeuroethicsNew Takes in Film-PhilosophyNew Waves in EthicsNew Waves in MetaethicsNietzsche on Ethics and PoliticsNo Child Left DifferentNo Impact ManNormative EthicsNormativityNothing about us, without us!Oath BetrayedOf War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSex, Family, and the Culture WarsSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpeech MattersSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe End of Stigma?The Essentials of New York Mental Health LawThe Ethical BrainThe Ethical Dimensions of the Biological and Health SciencesThe Ethics of BioethicsThe Ethics of ParenthoodThe Ethics of SightseeingThe Ethics of the FamilyThe Ethics of the Family in SenecaThe Ethics of the LieThe Ethics of TransplantsThe Ethics ToolkitThe Evolution of Mental Health LawThe Evolution of MoralityThe FamilyThe Fat Studies ReaderThe Forgiveness ProjectThe Form of Practical KnowledgeThe Fountain of YouthThe Freedom ParadoxThe Future of Assisted Suicide and EuthanasiaThe Future of Human NatureThe Good BookThe Good LifeThe Great BetrayalThe Handbook of Disability StudiesThe Healing VirtuesThe High Price of MaterialismThe History of Human RightsThe HorizonThe Idea of JusticeThe Ideal of NatureThe Illusion of Freedom and EqualityThe Immortal Life of Henrietta LacksThe Importance of Being UnderstoodThe Insanity OffenseThe Joy of SecularismThe Language PoliceThe Last Normal ChildThe Last UtopiaThe Limits of MedicineThe LobotomistThe Love CureThe Lucifer EffectThe Manual of EpictetusThe Mark of ShameThe Meaning of NiceThe Medicalization of SocietyThe Merck DruggernautThe Mind Has MountainsThe Modern Art of DyingThe Modern SavageThe Moral ArcThe Moral BrainThe Moral Demands of MemoryThe Moral FoolThe Moral MindThe Moral Psychology HandbookThe Moral, Social, and Commercial Imperatives of Genetic Testing and ScreeningThe Most Good You Can DoThe Myth of ChoiceThe Myth of the Moral BrainThe Nature of NormativityThe New Disability HistoryThe New Genetic MedicineThe New Religious IntoleranceThe Offensive InternetThe Origins of FairnessThe Oxford Handbook of Animal EthicsThe Oxford Handbook of Ethics at the End of LifeThe Perfect BabyThe Philosophy of NeedThe Philosophy of PornographyThe Philosophy of PsychiatryThe Politics Of LustThe Portable Ethicist for Mental Health Professionals The Power of Religion in the Public SphereThe Price of PerfectionThe Price of TruthThe Problem of PunishmentThe Prosthetic ImpulseThe Psychology of Good and EvilThe Psychology of Good and EvilThe PsychopathThe Purity MythThe Pursuit of PerfectionThe Relevance of Philosophy to LifeThe Right Road to Radical FreedomThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Rules of InsanityThe Second SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtue of Defiance and Psychiatric EngagementThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
For most mental health professionals today, one of the most perplexing and stressful issues encountered in their working life, is that of their legal and ethical obligations regarding situations where their client is at risk of harming others or themselves. Ever since the Tarasoff case (Tarasoff v. Regents of the University of California, 1976) when the term "Duty to Warn" was first defined, the legal obligations of these MHPs (Mental Health Professionals) has grown increasingly confusing due to the vagueness and constant changes of the law regarding the limits of MHP/client confidentiality. Without a definitive protocol on how to deal with these dilemmas in a mental health care setting, many MHPs are going to continue to be at risk of malpractice liability or of unethical conduct whenever the duty of confidentiality is breached. Thus it is paramount that the legal and ethical duties of these practitioners is clearly defined, to ensure minimization of these unfortunate events.
This anthology is edited by Werth, Welfel and Benjamin, was written for Clinicians, Supervisors and Trainers. It seeks to define and clarify the Duty to Protect, offer suggestions for the requisite assessments steps, and recommend subsequent interventions to reduce risk. Their position is distinctly in favor of a newer Duty to Protect, compared to the older Duty to Warn. The editors hope that by reading this, the readers "realize that the concept and application of the duty to protect allows for significantly more possibilities for assessment and interventions than an overly narrow focus on a duty to warn." (p.7). The aim of this book is thus to recommend for a shift towards a Duty to Protect legislation, as well as helping mental health providers to understand their options and obligations concerning this; by giving them tools "to evaluate whether a duty-to-warn or a duty-to-protect context has arisen and, in light of the evaluation, whether a particular intervention is necessary." (p.9)
The book consists of 16 original essays, by leading professionals in their field, and is split into four sections. The first section, entitled, "Foundational Issues", begins with an essay by Welfel, Werth and Benjamin, and introduces the concept of the Duty to Protect, as well as stressing the necessity of each individual mental health professional to "know ( and not assume) what the legal language in the state(s) or province(s) in which one practices" (p.7) due to the huge variations in the legal language from region to region. The second essay by Benjamin, Kent and Sirikantrapornn outlines a 5 step process "to establish a reasonable course of action while meeting any duty to protect" (p.20), based on "(a) disclosure and informed consent before evaluation and treatment begins, (b) therapeutic alliance, (c) assessment of the threat, (d) peer consultation, and (e) documentation." (p.20). The remaining two essays in this section compare differing ethics codes of various bodies in different countries, highlighting the huge variation between them, as well as commenting on their pro's and con's.
Section 2, entitled "Harm to Others" is made of six chapters, each dealing with a different issue with potential for confidentiality breaches (and as a result, risk of malpractice liability or ethical breaches), and recommendations on how to deal with these cases in light of a Duty to Protect. The six issues addressed are Homicide, Intimate Partner Violence, Stalking Offenders, Threats against Public Officials, Impaired Driving and Operation of Equipment, and Communicable Diseases. Each chapter in this section stresses the continual evolution of health care practices, for as Rosenbaum and Dowd say in their chapter on Intimate Partner Violence "Although current risk assessments are flawed, and models of treatment are less effective than we would like, it is imperative to continue to intervene and protect to the best of our ability while striving to learn more effective ways to do so." (p.91) The chapter on "Working with the stalking offender" by Rosenfeld, Fava and Galietta is particularly insightful in highlighting the difficulty in designing effective assessment tools for for risk analysis of potential harm doing. This is shown with the comment they make that, "It should be noted that although, in general, asking the client to make the disclosure of violence risk may be a good intervention, this is not true in the case of stalking. In fact, it is probably illegal in most instances (give the frequent existence of a no-contact order)." (p.100).
In the chapter on "Threats against public officials", Randazzo and Keeney highlight the benefit in new and novel techniques for risk assessment concerning such a threat; particularly that of gaining the client's consent to speak with other persons familiar with the clients current functioning. As Randazzo and Keeney say, "This option is not one that clinicians generally pursue in traditional therapeutic contexts because of the need to maintain confidentiality and the integrity of the therapeutic relationship" (p.116); however given the client's consent this is very beneficial in providing the MHP with a more informed assessment of the clients level of dangerousness for more accurate risk assessment. Another novel technique Randazzo and Keeney discuss, is highlighted through a case in which law enforcement professionals passed on information they had detailing a clients wish to harm a public official to the clients therapist, thus preventing the harm from occurring. Even though the client had refused to give consent for the therapist to release any information about her, there was no breach in confidentiality in the law enforcement professionals passing on information they had concerning the client's wish, to the therapist. Thus this illustrates how a "partnership between mental health and law enforcement professionals can be mutually beneficial in a threat case even when the treating clinician cannot release any information about his or her client." (p.123).
The chapter on "Driving and operating other equipment", by Knapp and Vandecreek, highlights the complexities of applying a duty to protect in a setting where an impaired operator of equipment is placing others at risk, as "a traditional duty-to-protect obligation typically does not arise unless the client expresses intent to harm an identifiable victim" (p.136). The remaining chapter on Communicable diseases highlights this also, as a person with a communicable disease who does not intend any harm, but can infect anyone she passes on the street, can be thought of as a similar case to a bus driver with impaired vision.
The third section "Harm to Self" deals with the threes issues of suicide, self injury, and end of life decisions. Jobes and O'Connor in their chapter on suicide stress the importance of a thorough assessment of a client's risk, given the gravity of a false negative in this instance. In the chapter on self injury, Walsh argues that although a typical "duty to protect exceeds proper legal usage" (p.188) here, that there are rare situations in which it can apply; those where the self injurious behavior is directed to the face, eyes, breasts and genitals, due to the "severe level of bodily harm, and, thereby potential risk to life." (p.188); and thus in line with this, a duty to protect could entail informing the parents of a minor about their self injurious behavior, or psychiatric hospitalization until the client is stabilized. In end of life cases, as addressed in the chapter by Werth and Richmond, the non-judgmentality of the clinician when dealing with a client considering ending their life early is reinforced. When dealing with a terminally ill, yet fully mentally capable patient who expresses a wish to hasten their death, there is no ground for hospitalization of the client, and thus no invocation of the duty to protect needed, because there is no mental illness or impaired judgment causing his/her desire for death. Thus even if after working through the client's reasons for wanting to end their life early, the client wishes to still prematurely end their life, the clinician should not intervene in any way to prevent them from hastening their death; as to Werth and Richmond, only in instances of impaired judgment should the duty to protect be invoked.
The final section of the book serves to draw together all the previous chapters in a comprehensive guide for the MHP and policy makers. The first chapter in this section deals with self-care of the clinician, in regards to "any emotional sequelae of working with clients who threaten them, other people, or themselves." (p.225) and strategies to help improve this. To Brems and Johnson this is extremely important as it is only by protecting your own health, that you can best help others. This however is complicated by the fact that the clinician has a duty to "protect the client from harm, protect third parties from harm, and in the process keep him or herself physically safe and mentally focused." (p.224) The penultimate chapter by Welfel, deals with emerging issues in the duty to protect - issues that have either just recently arisen due to technological advances (e.g genetic risks to family members), or issues that have are now becoming increasingly risk assessable (e.g., the risk of homicide coupled with suicide) by new techniques. The recommendations Welfels draws, are for the clinician to stay as much abreast of recent developments as possible, as any new technological advances can very rapidly change their clinicians legal and ethical obligations.
The final chapter of the book is by Werth, Welfel, Benjamin and Sales, gives some final recommendations concerning practice and policy responses, outlining seven "key practice considerations related to clinical work with clients, some of whom may be dealing with issues that engender the duty to protect. These considerations are," (p.252), those of "(a) the importance of informed consent; (b) the crucial need for thorough, contemporaneous assessment and documentation; (c) the importance of consultation; (d) the realization that context matters; (e) the understanding that, legally malpractice has four components; (f) the recognition that good clinical care is the best protection against possible legal action; and (g) a summary of recommended practices.: (p.252). This chapter concludes with warning about expanding the duty to protect too aggressively, since "the more clinicians become worried about possible liability or licensure board complaints, the less they will be able to focus on the issues and needs of their clients." (p.258).
Their recommendation is that the APA become more ".actively involved in policy development regarding issues of confidentiality" (p.258) and that the "APA should articulate a clear recommended policy rationale for the duty to protect to encourage consistent legislation across jurisdictions." (p.258). To the editors, "the interpretation of the duty has expanded so broadly and so inconsistently across jurisdictions that clinicians often find themselves in an untenable position when clients represent a risk to themselves or others. On the one hand, clinicians must maintain the therapeutic alliance to be most effective, on the other hand, the vagaries of many clinical contexts may trigger actions that would impair the alliance." (p.251). Thus to them the Duty to Protect must be more clearly defined, consistent, and in line with pragmatic clinical considerations, not just a rigidly cold application of the law with no regard to its clinical implications. Consistent with this they have a final recommendations for professional associations and licensing boards, to better educate their members about their legal and ethical obligations, as the better informed a clinician is of their legal and ethical duties, the less likely they are to breach them.
Overall, the book aims to encourage a move to a more defined, consistent, and fair, duty to protect legislation. Bearing in mind that this was published by APA and written by clinicians, it is understandable that the views represented in this book are all based around protecting the clinician from further malpractice suits, and thus at times does not always present a balanced viewpoint surrounding the debate and how to change the current duty to protect legislation. The viewpoints represented in the book are thus quite critical of judicial activism in regards to expanding the duty to protect, since in most cases it raises the level of responsibility for the clinician. This is not so much a criticism of the collection of essays on the part of the editors, but rather an understandable justification for their decision to do so, since the APA is there to represent its member's interests. One additional minor criticism is that a lot of the essays, contain clear examples of self referencing, some of the authors of the articles citing up to 13 of their own separate papers in the one article, perhaps this is just by coincidence, but this still is quite unprofessional in a field with so many authors in the one subject area, thus reducing the justification for self referencing.
As an addition to the policy debates surrounding the duty to protect, this is a very useful book, containing many enlightening and useful viewpoints and arguments concerning the issues surrounding the duty to protect. Written by clinicians themselves, who have experienced firsthand what issues and dilemmas a duty to protect actually raises, this is a very valuable book for policy makers, enabling them to maker better informed decisions. Unless the duty to protect is more clearly defined and legislated in a manner that is fair to all parties concerned, the mental health services are at risk of becoming less valuable to society. In conclusion, this book is a very valuable addition to the literature concerning the duty to protect, and recommended reading for anyone who practices, supervises, trains, or legislates on matters concerning mental health.
© 2010 Roger Chao
Roger Chao is a contemporary moral philosopher working in a diverse range of fields. His interests include legal and political philosophy, the role of ethics in the formation public policy, bioethics, health-care ethics, and the ethical considerations that face many professionals today. His main interest is in how emerging technologies give rise to new ethical dilemmas, and how these can be analyzed by being broken down into its individual moral elements.