Legal and ethical duties of the clinician treating a patient who is liable to be impulsively violent.

This paper reviews published tort cases that arose after a patient impulsively hurt or killed someone. Plaintiffs alleged breach of the duty to protect (Tarasoff) or negligent release from hospital. There are sixteen cases involving a variety of facts and diagnoses. As a matter of law courts typically hold that impulsive violence is not foreseeable. One jury found a defendant negligent but that verdict was ultimately overturned. Statutes on duty to protect do not imply a duty to act on the fact patterns of impulsive violence in this sample. The author concludes that the ethical duty to do careful clinical work is essentially identical to the legal duty to use due care in these cases. The law imposes no additional burden on the clinician in these cases.