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As states take more steps to connect patients' gun ownership to their mental health, psychiatrists are being asked to provide mental health information after clinical interviews as well as after confiscation. This move into the patient-physician relationship raises new questions about how psychiatrists should obtain informed consent when interviews may result in reports to legal authorities. Consent warnings are already practiced more in the breach than in the observance and informed consent is imperfect at its best. In communities torn by controversies surrounding gun control, vehement political views will further influence these established themes to result in unprecedented pressures on patient confidentiality. This analysis draws on new movements in ethical theory and behavioral medicine that go beyond balancing principles to question the use of psychiatry in firearm reporting, and support a vigorous practice of informed consent to protect both individuals and the communities they live in., (Copyright © 2015 John Wiley & Sons, Ltd.)

The therapeutic and legal protections afforded by California's psychotherapist-patient privilege have become increasingly eroded in such recent cases as People v. Wharton and Menendez v. Superior Court. In another capital case, People v. Webb, the California Supreme Court further erodes this privilege in regard to the private (confidential) treatment records of a prosecution witness. The Webb case and its possible implications are explored.

As a result of recent decisions by the United States and California Supreme Courts, therapists now have been placed in a position in which they can be forced to testify in death penalty cases for the only purposes of achieving a conviction and a death penalty verdict. Zeal for the death penalty seems to have overcome any concern for the ethics of psychiatrists or even for the welfare of society. In California, therapists can now be forced to testify against their own patients in capital cases even if the patient does not tender his mental state as an issue, despite the presence of a psychotherapist-patient privilege in the state for criminal matters. In California, the only option for therapists who wish to treat potentially dangerous patients may be to conduct the therapy under the umbrella of attorney-client privilege. Otherwise they may not be able to avoid serious ethical problems and personal danger if the patient actually does kill someone during or after therapy. They may be unable honestly and ethically to treat such patients without obtaining truly informed consent to therapy under these potentially "undercover policeman" circumstances. Hopefully, professional organizations will take a more activist position, and courts will appreciate the folly of these decisions and reverse them. Otherwise, they may spread to other states, for which California frequently sets precedents.

Some recent interpretations of the child abuse laws are creating serious and unprecedented erosions of therapist/patient confidentiality. In contrast to the Tarasoff decisions and laws, the child abuse statutes introduced a new element of mandatory reporting which permits no discretionary alternatives and presents prospects of criminal penalties for failure to report. A recent development suggests a possible requirement for therapists to violate confidentiality for the sole purpose of punishing perpetrators. Overinterpretations of the laws by some child protective services have led to recommendations that long past child abuse must be reported, even when no current child is in danger. The California Attorney General's Office has issued a clarification stating that the child abuse statute refers to children and not to adults molested as children. A survey of forensic psychiatrists and psychologists shows that most perceived an ethical problem in reporting adults molested as children when no child is presently in danger, and the purpose of the report is solely for maximal legal self-protection. The survey indicates that fears induced by rigid and intimidating child abuse laws can influence therapists to act in ways most consider unethical. Recommendations are made for improving the current child abuse laws so that they accomplish their goals more effectively.

The acquired immune deficiency syndrome (AIDS) crisis has raised many clinical and forensic dilemmas for the health-care system. Psychiatrists may encounter particular problems when evaluating and treating human immunodeficiency virus (HIV) infected patients. The authors present a case of an HIV seropositive, bipolar, intravenous drug abusing patient who participates in unsafe sexual practices to illustrate clinicolegal dilemmas involving dangerousness, involuntary hospitalization, confidentiality, and Tarasoff-like duty.

Legal constraints upon therapeutic flexibility, resulting in breaches of confidentiality, can promote counterproductive effects upon patients and society. Conflicts can be created for mental health professionals who sometimes must choose between maximum self-protection and doing what they believe is ethical. A survey of forensic psychiatrists indicated that most believe they face ethical problems created by some ambiguities in current reporting statutes if they are interpreted to mandate reporting and warning. Emphasis is given: (1) to the ethical choice faced by therapists as to whether rigidly to report and warn to limit liability in all Tarasoff-type situations and in some ambiguous child abuse situations, or to take an alternative action when it is clinically indicated for the benefit of a patient and/or society; (2) to the importance of understanding the distinction between potential criminal liability for failure to report under many child abuse laws, and the risk only of civil liability in Tarasoff-type cases; and (3) to appreciate the flexibility permitted by current "Tarasoff" laws. Our case histories demonstrate that mandated erosion of therapeutic confidentiality can present serious problems for patients and others. Suggestions are included for modifications in the current reporting statutes, focusing on the perspective that clinical flexibility is an essential adjunct to community protection as well as to effective therapy.