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Law & Psychiatry: Privilege in the Federal Courts: Should There Be a "Dangerous Patient Exception"?

Dr. Appelbaum, who is editor of this column, is the Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, Department of Psychiatry, Columbia University, New York City. Send correspondence to him at New York State Psychiatric Institute, 1051 Riverside Dr., Unit 122, New York, NY 10032 (e-mail: psa21{at}columbia.edu).

Although a 1996 U.S. Supreme Court decision affirmed that therapists cannot be compelled to testify in federal proceedings about patients' disclosures, a footnote could be interpreted as creating a "dangerous patient exception" when there is a serious threat of harm. This column describes circuit courts' differing views about whether such an exception exists and the value of an exception. Although the footnote appears to indicate the Supreme Court's inclinations to create an exception to psychiatrist-patient privilege in some cases, opponents have made strong arguments that a dangerous patient exception would inhibit help seeking by those in whose treatment society has the strongest interest—people who have harmed or are likely to harm others.

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