Bioethicists have virtually assumed that Tarasoff generated a duty to warn the sexual partners of an HIV‐positive man that they risked infection. Yet given the views of sex and of AIDS that have evolved in the gay community, in many cases the parallels to Tarasoff do not hold. Bioethicists should at the least attend to the community's views, and indeed should go beyond doing mere “professional ethics” to participate in the moral self‐exploration in which these views are located.

Genetic testing reveals information about a patient's health status and predictions about the patient's future wellness, while also potentially disclosing health information relevant to other family members. With the increasing availability and affordability of genetic testing and the integration of genetics into mainstream medicine, the importance of clarifying the scope of confidentiality and the rules regarding disclosure of genetic findings to genetic relatives is prime. The United Nations International Declaration on Human Genetic Data urges an appreciation for principles of equality, (...) justice, solidarity and responsibility in the context of genetic testing, including a commitment to honoring the privacy and security of the person tested. Considering this global mandate and recent professional statements in the context of a legal amendment to patient privacy policies in Australia, a fresh scrutiny of the legal history of a physician's duty to warn is warranted. This article inquiries whether there may be anything ethically or socially amiss with a potential future recommendation for health professionals or patients to universally disclose particular cancer predisposition genetic diagnosis to genetic family members. While much of the discussion remains applicable to all genetic diagnosis, the article focuses on the practice of disclosure within the context of BRCA1/2 diagnosis. An ‘ethic of care’ interpretation of legal tradition and current practice will serve to reconcile law and medical policy on the issue of physician disclosure of genetic results to family members without patient consent. (shrink)

When environmental health researchers study hazards in the home, they often discover information that may be relevant to protecting the health and safety of the research subjects and occupants. This article describes the ethical and legal basis for a duty to warn research subjects and occupants about hazards in the home and explores the extent of this duty. Investigators should inform research subjects and occupants about the results of tests conducted as part of the research protocol only (...) if the information is likely to be accurate, reliable, and medically useful. Investigators should warn subjects and occupants about hazards they happen to discover while they are in the home, if a reasonable person would warn the subjects and occupants about those hazards. Investigators should not report illegal hazards discovered in the home to the authorities, unless those hazards constitute abuse or neglect of children or mentally disabled people living in the home. When investigators decide to warn research subjects and occupants about hazards in the home, they should take some steps to help them make effective use of this information, such as providing additional counselling or making a referral for remediation or medical treatment. Investigators should discuss these issues with research subjects during the informed consent process. (shrink)

Nurses who attend patients with psychiatric disorders often encounter ethical dilemmas and experience difficulties in making the right decision. The present study aimed to evaluate the decisions of psychiatric nurses regarding their duty to warn third parties about the dangerousness of the patient, the need for compulsory hospitalization, and the competence of patients. In total, 111 nurses working in the field of psychiatry in Turkey completed a questionnaire form consisting of 33 questions. The nurses generally assessed the decision-making (...) competency of the patient correctly. However, their decisions regarding whether the patient should be compulsorily hospitalized and their understanding of their duty to warn/protect were less consistent. A significant relationship was found between the decisions of the psychiatric nurses and their work experience, them having children, and them having postgraduate education in psychiatric nursing. The nurses stated their desire to be part of the team that decided on ethical problems in psychiatry. (shrink)

In certain cases of sudden death, forensic experts may discover during an investigation or autopsy that family members of the deceased are also at risk of harm—from genetic disease, for instance. But do they have a duty to warn them? Looking at similar duties of physicians and researchers to warn third parties of risk suggests they do.

This article presents the case of an HIV-positive client who reported having sexual relations with an unknowing partner. The issue raised is whether the therapist was required to warn the unknowing partner, similar to the Tarasoff mandate that is imposed on therapists. The case is analyzed from an ethical framework similar to that presented by Beauchamp and Childress. Two opinions are presented, each leading to different conclusions about whether the therapist should inform the unknowing partner. It is concluded that (...) although such analysis is valuable in aiding the therapist in his or her decision-making process, no clear professional standard for the management of the problem is evident. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 12-14, October 2012.

One of the principal aims of Kant’s Metaphysics of Morals, especially of the Doctrine of Virtue, is to present a taxonomy of our duties as human beings. The basic division of duties is between juridical duties and ethical duties, which determines the division of the Metaphysics of Morals into the Doctrine of Right and the Doctrine of Virtue. Juridical duties are duties that may be coercively enforced from outside the agent, as by the civil or criminal laws, or other social (...) pressures. Ethical duties must not be externally enforced (to do so violates the right of the person coerced). Instead, the subject herself, through her own reason and the feelings and motives arising a priori from her rational capacities -- the feelings of respect, conscience, moral feeling and love of other human beings, must constrain herself to follow them (MS 6:399-404).1 Among ethical duties, the fundamental division is between duties to oneself and duties to others. Within each of these two main divisions of ethical duty, there is a further division between duties that are strictly owed, requiring specific actions or omissions, and whose violation incurs moral blame, and duties that are wide or meritorious, the specific actions not strictly owed, but deserving of moral credit or merit. Kant treats these latter as ‘duties’ (eschewing any category such as ‘supererogation’) because the actions in question are conceived as fit objects of self-constraint – things we can make ourselves do through the exercise of reason and the moral feelings arising from the application of practical reason to our faculty of desire. Regarding duties to oneself, this division is between ‘perfect’ and ‘imperfect’ duty; regarding duties to others, the strict or narrow... (shrink)

Mental health professionals rightfully experience significant anxiety regarding their duty to protect when working with potentially dangerous individuals. This work dispels myths and provides readers with a resource addressing the situations where a duty to protect may apply.

Revelations of personal matters often have negative consequences for social-media users. These consequences trigger frequent warnings, practical rather than moral in nature, that social-media users should consider carefully what they reveal about themselves since their revelations might cause them various difficulties in the future. I set aside such practical considerations and argue that social-media users have a moral obligation to maintain their own privacy that is rooted in the duty to self-censor. Although Anita L. Allen provides a paternalist justification (...) of the duty that supports my position that social-media users are obligated to self-censor what they reveal about themselves, I justify the obligation through considerations that are more palatable to liberals than is paternalism. I accomplish this by arguing that the failure to self-censor often creates for others undue burdens that individuals are obligated morally not to create. In particular, social-media revelations often create undue burdens for those, such as employers and university personnel, who are obligated morally to respect individuals’ privacy in their decision-making processes. I also demonstrate that this argument is not for a broad duty to self-censor, but, rather, for a narrow duty that applies to particular circumstances such as certain uses of social media. (shrink)

Delmas successfully guides us to reconsider the traditional “wisdom” of civil disobedience. She also makes a strong case for expanding the notion of political obligation, which has been narrowly construed as mere obedience, to encompass a duty to resist. Principled disobedience, either civil or uncivil, includes a wide range of tools to tackle different forms of injustice, such as education campaigns, peaceful protests, graffiti street art, whistleblowing, vigilante self-defense, and political riots. We may question to what extent the violent (...) disobedience can be justified, as it is always good to be careful about violence that risks harming the innocent, but other forms of civil or uncivil disobedience may rightly be demanded in realistic circumstances. As I see it, these, along with the general warning to not unwittingly serve the status quo by dismissing social movements merely because of “incivility” and the proposal of the civic virtues of vigilance and open-mindedness, are significant contributions to the literature and could also benefit a politically interested general audience greatly. (shrink)

This paper develops and explores the idea of moral entanglements: the ways in which, through innocent transactions with others, we can unintendedly accrue special obligations to them. More particularly, the paper explains intimacy-based moral entanglements, to which we become liable by accepting another's waiver of privacy rights. Sometimes, having entered into others' private affairs for innocent or even helpful reasons, one discovers needs of theirs that then become the focus of special duties of care. The general duty to (...) class='Hi'>warn them of their need cannot directly account for the full extent of these duties, but does indicate why a silent retreat is impermissible. The special duties of care importantly rest on a transfer of responsibilities that accompanies the privacy waivers. The result is a special obligation of beneficence that, while grounded in a voluntary transaction, was never voluntarily undertaken. Impartialist views of beneficence cannot capture the relevant phenomena well. (shrink)

Healthcare professionals’ capacity to protect themselves, while caring for infected patients during an infectious disease pandemic, depends on their ability to practise universal precautions. In turn, universal precautions rely on the availability of personal protective equipment (PPE). During the SARS-CoV2 outbreak many healthcare workers across the globe have been reluctant to provide patient care because crucial PPE components are in short supply. The lack of such equipment during the pandemic was not a result of careful resource allocation decisions in the (...) global north, where the short supply could be explained through their high cost. Instead, they were the result of democratically elected governments prioritising low tax regimes over an adequate resourcing of their healthcare delivery systems. Such decisions were made despite global health experts warning about the high probability of pandemics like SARS-CoV2 occurring during our lifetimes. Avoidable allocation decisions by democratically elected political leaders resulted in a lack of sufficient PPE for healthcare professionals. After discussing and discounting various ethical arguments in support of a professional obligation to treat, even without or with suboptimal PPE, I conclude that these policy decisions were sufficiently grave that they provide a sound ethical rationale to justify healthcare workers’ refusal to provide care to infected patients. (shrink)

Recent events have revived questions about the circumstances that ought to trigger therapists' duty to warn or protect. There is extensive interstate variation in duty to warn or protect statutes enacted and rulings made in the wake of the California Tarasoff ruling. These duties may be codified in legislative statutes, established in common law through court rulings, or remain unspecified. Furthermore, the duty to warn or protect is not only variable between states but also (...) has been dynamic across time. In this article, we review the implications of this variability and dynamism, focusing on three sets of questions: first, what legal and ethics-related challenges do therapists in each of the three broad categories of states (states that mandate therapists to warn or protect, states that permit therapists to breach confidentiality for warnings but have no mandate, and states that give no guidance) face in handling threats of violence? Second, what training do therapists and other professionals involved in handling violent threats receive, and is this training adequate for the task that these professionals are charged with? Third, how have recent court cases changed the scope of the duty? We conclude by pointing to gaps in the empirical and conceptual scholarship surrounding the duty to warn or protect. (shrink)

Genetic testing has familial implications. Counsellors find themselves in (moral) conflict between medical confidentiality (towards the patient) and a potential right or even duty to warn at-risk relatives. Legal regulations vary between countries. English literature about German law is scarce. We reviewed the literature of relevant legal cases, focussing on German law, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This article aims to familiarise counsellors with their responsibilities, compare the situation between countries and (...) point out legally unresolved areas.According to the German Genetic Diagnostics Act (Gendiagnostikgesetz) in case of an ‘avoidable or treatable’ genetic disorder, geneticists ought to confine themselves to the obligated advice to the patient. Whether a breach of the duty of confidentiality can be justified in exceptional cases by ‘necessity as justification’ for actively informing relatives at risk remains legally unclear. In case of a ‘neither avoidable nor treatable’ genetic disease, geneticists should also refrain from actively informing relatives as the justifiable state of emergency does not permit to break the duty of confidentiality. (shrink)

This paper considers whether existing law could potentially be used to criminalize the transmission of genetic disease. The paper argues that even if an offence could be made out, the criminal law should not be involved in this context for many reasons, including the need to protect reproductive liberty and pregnant women’s rights. The paper also examines whether there might be scope for civil claims between reproductive partners for a ‘failure to warn’ of potential genetic harm and argues there (...) are strong policy grounds for resisting such claims. If such a duty were to exist, there might, in the future, be scope for a child to bring a claim under the Congenital Disabilities 1976. Such a claim could be for the failure by the child’s father to warn her mother, which in turn led to the loss of opportunity to have treatment in utero which could have prevented the disability. It is suggested that the same arguments which supported granting maternal immunity under the Act would also support paternal immunity and that, therefore the issue of the lack of paternal immunity under the Act should be revisited. (shrink)

Displaying her intellectual and literary abilities from a young age, 'Mrs Taylor of Ongar' enjoyed writing all her life. She had eleven children, of whom six survived to adulthood. Her published works began with advice books for her own daughters, produced when increasing deafness made ordinary conversation difficult for her. This book, published in 1818, follows her earlier works for young women with a guide to conduct and 'reciprocal duties' within the family. Stern warnings and cautionary tales are given to (...) show the importance of duty to and respect for parents by children, but the parental duties of care in rearing and especially in education are emphasised. Early discipline, lovingly applied, is seen as the key to successful parenting, and its absence is deemed disastrous. Like Ann Taylor's Practical Hints to Young Females, the book offers fascinating insights into the middle-class ideal of domestic happiness. (shrink)

I argue that Oruka’s sages, half of whom were described as arbiters and judges called upon to solve disputes, fulfill Plato’s ideal of a philosopher as a respected, wise thinker who works for the betterment of society. Although the sage has been sidelined in modern academia, even in Africa, Oruka suggests that twentieth-century rural Kenyan sages, with their devotion to community benefit and conversation about practical concerns, are role models for modern Western philosophy, because philosophers everywhere have a duty (...) to warn people about the implications of their actions. (shrink)

Background: When a genetic mutation is identified in a family member, internationally, it is usually the proband’s or another responsible family member’s role to disclose the information to at-risk relatives. However, both active and passive non-disclosure in families occurs: choosing not to communicate the information or failing to communicate the information despite intention to do so, respectively. The ethical obligations to prevent harm to at-risk relatives and promote the duty of care by genetic health professionals is in conflict with (...) Privacy laws and professional regulations that prohibits disclosure of information to a third party without the consent of the proband. In New South Wales, Australia, amendments to Privacy legislation permits such disclosure to living genetic relatives with the process defined under guidelines although there is no legal duty to warn. This study assessed NSW GHP’s awareness and experience of the legislation and guidelines. Methods: An online survey collected demographics; theoretical knowledge; clinical scenarios to assess application knowledge; attitudes; confidence; experience with active non-disclosure. A link to correct answers was provided after completion. Knowledge scores above the median for non-parametric data or above the mean for parametric data were classified as ‘good’ or ‘poor’. Chi square tests assessed associations between confidence and knowledge scores. Results: While many of the 37 participants reported reading the guidelines, there was limited awareness of their scope and clinical application; that there is no legal duty to warn; and that the threat does not need to be imminent to warrant disclosure. No association between confidence and ‘good’ theoretical or applied clinical knowledge was identified. Uncertainty of their professional responsibility was identified and in the several case examples of active non-disclosure that were reported this uncertainty reflected the need for further understanding of the guidelines in regard to the processes required before disclosure was initiated. Conclusions: There is a need for further education and training about the guidelines associated with the legislation that would be relevant to support disclosure. The findings may inform future strategies to support introduction of policy changes in other jurisdictions where similar regulatory regimes are introduced. (shrink)

In the context of deceased organ donation, donors are routinely tested for HIV, to check for suitability for organ donation. This article examines whether a donor’s HIV status should be disclosed to the donor’s next of kin.On the one hand, confidentiality requires that sensitive information not be disclosed, and a duty to respect confidentiality may persist after death. On the other hand, breaching confidentiality may benefit third parties at risk of having been infected by the organ donor, as it (...) may permit them to be tested for HIV and seek treatment in case of positive results.We conclude that the duty to warn third parties surpasses the duty to respect confidentiality. However, in order to minimize risks linked to the breach of confidentiality, information should be restrained to only concerned third parties, that is, those susceptible to having been infected by the donor. (shrink)

Medical personnel sometimes face a seeming conflict between a duty to respect patient confidentiality and a duty to warn or protect endangered third parties. The conventional answer to dilemmas of this sort is that, in certain circumstances, medical professionals have an obligation to breach confidentiality. Kenneth Kipnis has argued, however, that the conventional wisdom on the nature of medical confidentiality is mistaken. Kipnis argues that the obligation to respect patient confidentiality is unqualified or absolute, since unqualified policies (...) can save more lives in the long run. In this paper, I identify the form of Kipnis’s argument and present a challenge to it. I conclude that, as matters stand now, a qualified confidentiality policy is the more rational choice. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

This case explores the ethical landscape around recontacting a subject's relatives to return genetic research results when the informed consent form signed by the original cohort of subjects is silent on whether investigators may share new information with the research subject's family. As a result of rapid advances in genetic technology, methods to identify genetic markers can mature during the life course of a study. In this case, the investigators identified the genetic mutation responsible for the disorder after a number (...) of their original subjects had died. The researchers now have the ability to inform relatives of the subject about their risk of developing the same disease. Mark Rothstein, JD, from the University of Louisville School of Medicine, provides an overview of the medical/scientific, legal, and ethical issues underlying this case. Lauren Milner, PhD, and colleagues at Stanford University explore how the relationship between researcher and subject affect this debate. Seema Shah, JD, and colleagues at the National Institutes of Health and University of California, Los Angeles discuss whether and how requirements of the duty to warn are applicable in this case. (shrink)

An increasingly popular view in scholarly literature and public debate on implicit biases holds that there is progressive moral potential in the discomfort that liberals and egalitarians feel when they realize they harbor implicit biases. The strong voices among such discomfort advocates believe we have a moral and political duty to confront people with their biases even though we risk making them uncomfortable. Only a few voices have called attention to the aversive effects of discomfort. Such discomfort skeptics (...) class='Hi'>warn that, because people often react negatively to feeling blamed or called-out, the result of confrontational approaches is often counterproductive. To deepen this critique, I distinguish between awareness discomfort and interaction discomfort, developing a contextual approach that draws on recent research on negative affect and emotions to chart a more complete picture of the moral limits of discomfort. I argue that discomfort advocates risk overrating the moral potential of discomfort if they underestimate the extent to which context shapes the interpretation of affect and simple, raw feelings. (shrink)

There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public interest, whether to release information or issue warnings. In June 1992, routine surveillance detected patulin levels (a known carcinogen) in samples of apple juice exceeding safety (...) threshold. Remedial actions were promptly taken and it was planned to subsequently publish the information in the routine way. However, the media portrayed the handling of the problem as a conspiracy and there was a short term reduction in juice sales. In October 1995, the UK Committee on Safety of Medicines issued a warning about certain brands of the contraceptive pill, based on the interim results of three unpublished studies. The increased risk of thromboembolism was small, but the resulting scare led to an increase in unwanted pregnancies. The handling of the B.S.E. crisis in the U.K. also led to accusations of incompetence or conspiracy. Public health authorities have to handle uncertainty and frequently have to form judgements for public safety on the basis of evidence of poor quantity and quality. Their task is not helped by the sometimes conflicting agenda of scientists and media. The public also have differing perceptions and interpretations of risk. The series of scares and crises are having a detrimental effect on public confidence in public health authorities. (shrink)

The Intergovernmental Panel for Climate Change has over the past decade repeatedly warned that we are heading towards inevitable and irreversible climate change, which will negatively affect the lives, livelihoods, and well-being of millions of people around the world, both at present and in the future. In fact, many people, especially vulnerable and marginalized communities in low- and middle-income countries, already live with the effects of climate change in their daily lives. While adaptation – along with mitigation and compensation for (...) loss and damage as a consequence of climate change – was identified as the central pillars of a just climate policy in the Paris Agreement it is unclear whether this entails a right to adaptation – that some people are owed, as a matter of justice, to have the ability to adapt to climate change – and, if so, what such a right would look like. In this paper, I argue that individuals and communities who are or will be negatively affected by climate change through no fault of their own should have the right to adaptation. I argue that the right to adaptation should be specified through four questions: (i) who has a right to adaptation; (ii) what is it a right to; (iii) how much is it a right to; and (iv) who has the duty to uphold the right to adaptation? (shrink)

It is often challenging for mental health‐care providers and health organizations to perform their various roles and to meet their varied obligations. In complex mental health‐care circumstances the concurrent application of relevant ethical principles and values often leads to the emergence of completing obligations that need to be carefully weighed and balanced in the making of care‐related decisions. Although some clinical circumstances, such as those potentially triggering the duty to warn, are adequately guided by existing rules based on (...) legal precedents, there is a gap in decision‐making support in other mental health‐care domains. This article proposes that a set of targeted, decision‐making approaches be developed to assist in the handling of specific, challenging circumstances. By way of illustration, two novel approaches are introduced; that is, choosing to work within a moral relational space of optimal therapeutic engagement (at the micro level of clinical practice), and the use of a health policy development approach that instantiates deliberative engagement (at the meso and macro levels of health organization). (shrink)

Hospital-based professionals who manage cases of family violence are often unclear about the benefits and costs of particular interventions to their clients. Operating under conditions of potential lethality, both to them and family members, clinicians often experience conflict between legal and ethical recommendations or between strategies intended to provide safety to victims of domestic (spousal) violence and those meant to protect children from abuse. This article presents a situation of family violence and the dilemmas of decision-making confronting both social worker (...) and lawyer. It discusses such issues as professional role, reporting requirements, and duties to warn, emphasizing the difficulty of implementing a plan and of predicting its consequences. It recommends substantive and procedural guidelines that may help protect victims while allowing professionals to emotionally sustain themselves during the management ordeal. (shrink)

Hospital-based professionals who manage cases of family violence are often unclear about the benefits and costs of particular interventions to their clients. Operating under conditions of potential lethality, both to them and family members, clinicians often experience conflict between legal and ethical recommendations or between strategies intended to provide safety to victims of domestic (spousal) violence and those meant to protect children from abuse. This article presents a situation of family violence and the dilemmas of decision-making confronting both social worker (...) and lawyer. It discusses such issues as professional role, reporting requirements, and duties to warn, emphasizing the difficulty of implementing a plan and of predicting its consequences. It recommends substantive and procedural guidelines that may help protect victims while allowing professionals to emotionally sustain themselves during the management ordeal. (shrink)

In “Genetic Privacy, Disease Prevention, and the Principle of Rescue,” Madison Kilbride argues that patients have a duty to warn biological family members about clinically actionable adverse genetic findings. The duty does not stem from the special obligations that we may have to family members, she argues, but rather follows from the principle of rescue, which she understands as the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the (...) expected harm is serious and the cost or risk to oneself is sufficiently moderate. We doubt, however, whether the principle of rescue can ground a duty to warn in the cases Kilbride envisages, and we suggest that Kilbride may have underappreciated the role that special obligations could play in generating a duty to warn family members. (shrink)

Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first‐degree relatives—parents, children, and full siblings—are most likely to be affected. This is (...) especially true for genetic mutations—like those in the BRCA1 and BRCA2 genes—that are associated with a dramatically increased risk of disease. Fortunately, people are usually willing to share results with their at‐risk relatives. Occasionally, however, a patient refuses to disclose her findings to anyone outside her clinical team. Ethicists have written little on patients’ moral duties to their at‐risk relatives. Moreover, the few accounts that have been advanced are problematic. Some unnecessarily expose patients’ genetic information to relatives who are unlikely to benefit from it, and others fail to ensure that patients’ most vulnerable relatives are informed of their genetic risks. Patients’ duty to warn can be defended in a way that avoids these problems. I argue that the duty to share one's genetic results is grounded in the principle of rescue—the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate. When these two criteria are satisfied, a patient will most likely have a duty to warn. (shrink)

This book discusses and provides insight on the legal and ethical dilemmas of managing those with Fetal Alcohol Spectrum Disorder (FASD). This book provides a clear perspective for those clinicians and legal professionals who are working with those with this disorder, and correspondingly increases their understanding when arranging effective supports for this population. Historically, the primary focus on FASD has been on children. However, this is a lifelong disorder, and the implications of this disorder become even more prominent and complex (...) in adulthood. Those with this condition can struggle with impulsiveness, and a host of cognitive difficulties. This correspondingly impacts their independence and employability, and produces an elevated risk for homelessness and other residential issues, involvement in substance use, being exploited, development of behavioural issues, and subsequent legal difficulties. Their cognitive difficulties result in challenges for legal systems around the world to understand their issues, and to design appropriate remedial strategies, recommendations for treatments and supports, and even for understanding the failure of many of these individuals to be able to change their behaviours effectively. This produces various legal and ethical dilemmas, which are discussed in detail in this volume by 28 authors from Europe, New Zealand, and North America. These include discussions regarding the rights of the unborn child, the alcohol industry's duty to warn, whether small amounts of alcohol during pregnancy can be condoned, and even the current use of involuntary hospitalization for addicted mothers. Other chapters discuss the need for training on FASD for front line officers, use of lies during interrogation of those with FASD, medical and legal interventions for offenders with FASD, access to diagnostic services and follow-up supports, and whether FASD can be considered a mitigating factor for sentencing. Furthermore, caregivers also provide their stories regarding the daily dilemmas that are faced in raising those with FASD. (shrink)

Therapists treating adolescent gang members face unique ethical dilemmas. These dilemmas arise directly from clinical issues that inevitably emerge in the treatment of this population. Clinical issues related to the adolescent gang member having great difficulty trusting, having experienced and observed much violence, and usually having participated in criminal activities are central to the treatment process. In this article I discuss the ethical problems that subsequently emerge: maintaining confidentiality, discharging one's duty to warn or protect, and imposing one's (...) personal values. Suggestions for future research are offered. (shrink)

Too often, the limits of our language are the limits of our thinking. “If thought corrupts language, language can also corrupt thought,” warned George Orwell. How we label something too often controls how we think about it. We get particular concepts in our head and they are hard to change. They govern how we think and how we act. “Disease” and “death” used to be considered as “God's will,” and it took hundreds of years and no small number of martyrs (...) to get that corrected. It was very hard to develop modern medicine when so many subjects were thought of as outside of human control. Similarly, the number of children a woman had was thought to be “God's will,” and that has made the development of contraception controversial to this day. Human control over any part of human destiny is usually opposed vigorously. Humankind has the tendency to confuse the familiar with the necessary. (shrink)

Mandatory reporting laws, which vary slightly from state to state, require reporting by helping professionals when there is reasonable cause to suspect child abuse. Institutional Review Boards (IRBs) require researchers to warn subjects of this duty to report, which may have a chilling effect on subject rapport and candor. Certificates of confidentiality, in conjunction with other precautions, may reduce some barriers to valid research. Attempts to resolve problems created by reporting laws must produce the most valid research, while (...) minimizing harm and distress to research participants, their families, and the researcher and meeting local and federal legal requirements. (shrink)