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Summary The Tarasoff I and Tarasoff II cases were decided by the California Supreme Court in 1974 and 1976, respectively. These cases involved the murder of a young woman by her ex-boyfriend, who had been a patient at a University counseling center. The parents of the young woman sued, alleging negligence. Tarasoff I set forth a “duty to warn” on the part of psychotherapists. Upon rehearing in Tarasoff II, the decision was upheld but modified. The court ruled that when a therapist determines, or should have determined, that a patient presents a serious danger of violence to another, the therapist has a “duty to protect” that other person. In this article, we address subsequent cases that have arisen under the “duty to protect” doctrine, and analyze some of the legal issues that these cases have raised.

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.