Balancing Confidentiality and Duty to Protect: A Case Report of Schizophrenia and Comorbid Cannabis Use Disorder with Homicidal Thoughts

This is a report of a 29-year-old female with a history of Schizophrenia and Cannabis Use Disorder who presented with auditory hallucinations that asked her to kill her immediate supervisor. She presented the ethical dilemma many healthcare providers face in balancing the principles of patient confidentiality with the duty to protect and beneficence. The clinicians breached the patient’s right to confidentiality to protect her supervisor by informing the supervisor, their manager, and the police. However, they also ensured her job security, which she risked in an environment where mental illness is highly stigmatized.
This case highlights the importance of considering the ethical principles of disclosing confidential information, such as the Tarasoff I and II, and beneficence (as her job was protected) in making clinical decisions. It also summarizes the legal precedents established by the Tarasoff cases and the implications for clinical practice.