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Thread: Making a judgement on risk

  1. #1

    Making a judgement on risk

    A lot of people talk about wanting to kill people for a variety of reasons (revenge, jealosy, financial gain, etc.). Most never act upon these fantacies.

    What about in the case below...would there be a credible risk (this is NOT a real person. I'm making this up as an example to better understand the topic).

    Patient is seeing dr. for another reason (say, work stress resulting from demanding job). Talk of killing people comes up almost as an aside. The patient has never killed anyone although they do have a criminal past (no violent offences).

    When asked, the patient says that he would readilly kill someone because he feels it is exciting, thrilling, and an experience he would like to have. He says he has not killed anyone yet, because he has not had sufficient opportunity.

    The patient has a good job (executive) and does not want to risk his freedom and material wealth by commiting a major felony. He is looking for reasons why he wants to kill people and tips for not following through if the opportunity does present itself.

    The patient does not present symptoms of another disorder (there is no talk of voices telling him to kill, he does not lie about other topics, etc.).

    If he honestly wants to murder people for the experience and thrill of it, but has no other disorders or violent history, is there much chance he would do it?

    In this case, the patient would have a lot to loose if the Dr. acted on a "hunch." So, how would the Dr. make the call?

    Thanks.

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  3. #2

    Re: Making a judgement on risk

    Quote Originally Posted by WS
    A lot of people talk about wanting to kill people for a variety of reasons (revenge, jealosy, financial gain, etc.). Most never act upon these fantacies.
    Yes, that's probably true -- in the heat of anger or a conflict, probably a large number of people have made comments to the effect of "I wish you were dead" or "I could kill you", but even at the time there is no real intent to kill anyone. That's why in my previous posts I used terms like "credible evidence".

    Quote Originally Posted by WS
    What about in the case below...would there be a credible risk (this is NOT a real person. I'm making this up as an example to better understand the topic).

    Patient is seeing dr. for another reason (say, work stress resulting from demanding job). Talk of killing people comes up almost as an aside. The patient has never killed anyone although they do have a criminal past (no violent offences).

    When asked, the patient says that he would readilly kill someone because he feels it is exciting, thrilling, and an experience he would like to have. He says he has not killed anyone yet, because he has not had sufficient opportunity.

    The patient has a good job (executive) and does not want to risk his freedom and material wealth by commiting a major felony. He is looking for reasons why he wants to kill people and tips for not following through if the opportunity does present itself.

    The patient does not present symptoms of another disorder (there is no talk of voices telling him to kill, he does not lie about other topics, etc.).

    If he honestly wants to murder people for the experience and thrill of it, but has no other disorders or violent history, is there much chance he would do it? In this case, the patient would have a lot to loose if the Dr. acted on a "hunch." So, how would the Dr. make the call?
    The worrisome part of your example is the part I have highlighted. Most people who make non-credible threats or entertain a fleeting fantasy of harming someone else aren't talking in terms of "exciting, thrilling, and an experience he would like to have" or implying that the only reason it hasn't already happened is lack of opportunity.

    "If he honestly wants to murder people for the experience and thrill of it, but has no other disorders or violent history, is there much chance he would do it?" -- No one can answer that question with a definite 100% "yes" or "no" but I would say there is certainly some credible risk that he might act on the urge to kill, yes. As noted previously, the other issue is that current laws in many jurisdictions state quite explicitly that once there is a credible risk, the therapist does not have discretion beyond that point. If you are a therapist with this sort of information and fail to act on it, and the individual does go out and kill someone, you can and will be held liable for withholding the information.

  4. #3

    Making a judgement on risk

    Would the dr have a responsibility to tell the patient first before telling authorities?

    If not a "responsibility" do you think the Dr. would be likely to warn that patient that the authorities would be notified?

  5. #4

    Making a judgement on risk

    Quote Originally Posted by WS
    Would the dr have a responsibility to tell the patient first before telling authorities?

    If not a "responsibility" do you think the Dr. would be likely to warn that patient that the authorities would be notified?
    I would think so, yes.

    I have information about limits to confidentiality printed on a "client agreement" form that each new client signs. I also go over confidentiality issues verbally and if a client starts to tell me something that seems to be heading in the direction of information that I would deem reportable, I will again often remind the client.

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