Ethical Considerations in Maintaining Confidentiality with Dangerous Clients.

This paper discusses ethical considerations involved in breach of confidentiality in counseling dangerous clients, i.e., those who have the potential to inflict bodily harm on others. The ethical basis for confidentiality is presented in a model for decision making in ethical dilemmas which encompasses three evaluative levels or tiers: ethical rules, ethical principles, and ethical theories. Each of these levels, from the most concrete (rules) to the most abstract (theories), is discussed as it supports confidentiality. Limits on confidentiality, the effects of breaching confidentiality, and the difficulty in predicting dangerousness are discussed. Options for dealing with dangerous clients, exclusive of the duty to warn others of the client's dangerousness are proposed, presented in order of degree of severity of violations of the client's autonomy and confidentiality: (1) releasing the client on his/her own recognizance with counselor support; (2) releasing the client to parents/spouse/friends with counselor support; (3) holding and treating, by moving the client, using force if necessary, to a locked treatment facility for extended evaluation. (MCF)