Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.     

Actuarial risk assessment: Reflections on an emerging social-scientific tool

The purpose of this paper is to highlight recent developments in the practice of empirical social research, paying particular attention to the relationship between social-science practice, social-control strategies, and the role of interpretive frame-works. The essay describes how the social-scientific emphasis on quantification within a value-neutral framework corresponds to an overall reluctance within the social sciences to evaluate the phenomena of social life within an historical and moral context. Within this framework, it is argued that actuarial risk assessment, as a social science practice, meets the managerial needs of advanced industrial societies by legitimating interpretive frameworks which focus primarily on prediction as the main criterion in understanding social processes and by producing concrete technologies which facilitate the management effort. This essay calls upon quantitative social scientists to reflect upon the ways in which our practices and products may inadvertently project value positions that ought not be promoted without critical evaluation. This essay won first place in the 1998 American Society of Criminology Graduate Student Paper Competition sponsored by the Division on Critical Criminology. I wish to thank Drs. Patrick Akard, Henry J. Steadman, and John Monahan for commenting on an earlier draft of this essay.     

Assessing the Violent Offending and Violent Victimization Overlap Among Discharged Psychiatric Patients

Prior studies have documented linkages between mental disorder and both offending and victimization. However, few studies have examined the violent offending–violent victimization overlap among mentally disordered individuals and none have examined the factors that are jointly related to their covariation. Here, we assess this overlap during the first ten weeks following hospital discharge among a large sample of psychiatric patients from three large cities. Findings indicate that: (1) violent offending and violent victimization show substantial covariation; (2) although each of the two outcomes were predicted by a few unique risk factors, several risk factors were similarly predictive of both outcomes; and (3) even after adjusting for demographic, clinical, and social risk factors, the correlation between violent offending and violent victimization remained robust. Implications for theory, research, and policy are highlighted.     

Trends in Mortality of the Soviet Population

Two prominent American demographers present an up-to-date study of trends and countertrends in mortality of the Soviet population; discussed are variations (by republic and over time) in life expectancy, infant mortality, and mortality in the working ages. Analyzing trends since 1959, the authors highlight problems relating to the quality and interpretation of pertinent statistical data of Soviet origin. Distinguishing real trends from pseudotrends, they evaluate mortality differences among regions and illustrate a more favorable long-term trend in mortality than suggested by official figures (nonetheless, because of error in official statistics, actual rates are generally higher). Journal of Economic Literature, Classification Numbers: 052, 123, 841.     

Power,National Security and Transparency: Judicial Decision Making and Social Architecture in the Federal Courts

Even in a democratic society, the need for transparency must be balanced with an important countervailing interest: the occasional, legitimate need for government secrecy. This article, based on an examination of opinions in federal cases dealing with national security and transparency, explores how judges identified the main legal issues presented by a case and the legal factors or mode of legal interpretation used to reach or justify their conclusions. The article concludes that many of these opinions are as much about judges’ attempts to balance the judicial branch's power with the powers of the executive and legislative branches as they are about national security and transparency. Furthermore, the article contends these opinions have created an “architecture of power” that determines how national security information is controlled. The final section also suggests that judges should be mindful of the original architecture of power established by the Constitution and the First Amendment when writing their opinions.     

Regulating technology: Can administrative agencies cope with technological change?

The debate over scientific issues has made a difficult transition from the scientific community to the public-polity process. The traditional view of scientists undertaking “pure” science in their laboratories did not envision government intervention into scientific and technological discovery through administrative agency regulation of risks associated with the results of such research. Yet examples of government regulation of technological risks abound as the nation grapples with nuclear power issues, new-drug testing, and environmental issues, to name a few. This paper considers whether the presently constituted regulatory apparatus is capable of responding to dramatic advances in technology in a timely and effective way. Concluding that it is not, the paper examines the circumscribing characteristics of the regulatory process. Then it discusses alternate approaches for regulating the risks posed by science and technology without doing too much violence to due process or the notion of public participation in the regulatory function.     

Patient termination of a life-sustaining medical device: Suicide or natural death?

Medical technology has made tremendous strides in extending the lives of patients who have suffered organ failure. Machines can now replace the function of the kidneys, the heart, and other vital organs. Much has been written about a patient's right to refuse or direct the withdrawal of medical treatment, especially at the end of life, under the guise of “death with dignity.” However, little attention has been paid to the situation where a patient elects to deactivate their life-sustaining medical device without a physician's involvement. This raises the challenging question of whether the patient's manner of death should be classified as suicide or natural. Surprisingly, common law, statutes, medical ethics, and public health practice are not in alignment on the answer. This article will explore the ramifications and far-reaching impact that such divergence has on the survivors and the medical community, as well as recommend corrective actions and practical approaches for the medical and legal practitioner.