The report on the Georgia duty-to-warn case in the March 3 issue highlights a problem that I have encountered too frequently in consulting on the duty to warn. The problem occurs when clinicians ask attorneys for advice. Attorneys give legal advice, and too often the advice is clinically wrong. They do not understand, nor should we expect them to, the clinical issues involved in deciding whether to breach confidentiality.

Clinicians in doubt about whether to breach confidentiality should consult both an experienced forensic psychiatrist and an attorney. In cases where the advice conflicts, the clinician should always do what seems clinically appropriate. In the rare case where violence occurs, defending a decision reached after a thoughtful clinical assessment is straightforward. Defending a decision that has grown out of consultation on a purely legal analysis can be, as it was in this case, problematic. Potential violence in a clinical setting is always a clinical issue first, and a legal issue second.

James C. Beck, M.D., Ph.D.

Cambridge, Mass.