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Bull Am Acad Psychiatry Law. 1993;21(3):263-75.

Misapplication of the Tarasoff duty to driving cases: a call for a reframing of theory.

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  • 1Program in Psychiatry and the Law, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA.


In the years since the original Tarasoff cases created a new duty for psychotherapists toward third parties harmed by patients' violence, a series of cases nationwide--so called "driving cases"--have applied Tarasoff-like reasoning to situations where a patient injured others while driving a car. Our thesis in this paper is that such application is inappropriate since it represents an unjustified and largely unexamined assumption that driving injury is an expression of the mental-illness-derived intended violence that justifies the Tarasoff duty and its inevitable associated breach of confidentiality. We suggest to the contrary that driving cases almost invariably result from a patient's negligent driving rather than intentional violence stemming from mental illness; that clinicians in most instances have almost no capacity, training, or clinical bases on which to predict a patient's future negligence, violence aside; and that the theory of driving cases should be revised.

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