Duty to Protect: Tarasoff in Alaska and the Role of the Board
Dr. B, a psychologist in Anchorage, has been treating a 32-year-old man with paranoid schizophrenia. The client has recently become fixated on a former coworker, Mr. X, and has made statements like 'I know where he lives, and I'm going to make him pay.' The client refuses to consider voluntary hospitalization and insists he is fine. Dr. B assesses that the client poses a serious risk of violence to Mr. X. The client has a gun and has been off his medication for two weeks. Dr. B is unsure whether Alaska has a mandatory duty to protect or warn, and whether to contact the police or Mr. X. Dr. B also worries about breaching confidentiality.
1. What is Dr. B's legal and ethical duty in this situation?
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Alaska does not have a specific statute that mandates a duty to protect or warn (unlike California's Tarasoff). However, Alaska case law (e.g., Poulsen v. Superior Court? Actually, Alaska has not adopted a broad Tarasoff duty; see R.E. v. State? Better to be cautious) and the APA Ethics Code (Standard 4.05) permit disclosure to protect the client or others from harm. The Alaska Board of Psychologists expects psychologists to take reasonable steps to protect potential victims. Dr. B should: (1) arrange for immediate evaluation for hospitalization, possibly by contacting mobile crisis or police for a welfare check; (2) warn Mr. X if feasible; (3) notify law enforcement about the threat and the gun; (4) document all actions. Dr. B should also consider consulting with a colleague or attorney. The ethical principle of nonmaleficence and the duty to protect outweigh confidentiality when there is a serious threat. Dr. B may disclose the minimum information necessary.
2. What are the potential consequences if Dr. B fails to act and the client harms Mr. X?
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Dr. B could face civil liability for negligence if it can be shown that a duty existed and was breached. Alaska courts have not clearly established a Tarasoff duty, but they may consider the foreseeability of harm and the special relationship between therapist and client. Dr. B could also face disciplinary action by the Alaska Board of Psychology for violating ethical standards (e.g., failing to protect the public). The APA Ethics Code (Standard 4.05) allows disclosure to protect others, and failing to do so could be seen as unethical. Dr. B should document the risk assessment, the rationale for actions taken, and any consultations. If Dr. B is unsure, consultation with the Board or an ethics committee is advisable, but action should not be delayed.