This paper explores ethical and legal complexities related to confidentiality and risk assessment in young adults with cannabis use disorder and schizophrenia. Drawing from case law, professional ethical codes, and contemporary research, the article evaluates the justification for breaching confidentiality when the individual displays signs of verbal aggression and possible psychotic relapse. It also discusses the limits of foreseeability in predicting harm and outlines standards such as the Appelbaum test for assessing decision-making capacity. The analysis integrates statutory mandates, including HIPAA, FERPA, and New York State’s Mental Hygiene Law, and addresses the central ethical dilemma of autonomy versus safety in clinical decisions.
References
[1]
Bloomfield, M.A.P., Morgan, C.J.A., Egerton, A., Kapur, S., Curran, H.V. and Howes, O.D. (2014) Dopaminergic Function in Cannabis Users and Its Relationship to Cannabis-Induced Psychotic Symptoms. BiologicalPsychiatry, 75, 470-478. https://doi.org/10.1016/j.biopsych.2013.05.027
[2]
Novak, G. and Seeman, M.V. (2022) Dopamine, Psychosis, and Symptom Fluctuation: A Narrative Review. Healthcare, 10, Article 1713. https://doi.org/10.3390/healthcare10091713
[3]
American Counseling Association (2014) ACA Code of Ethics.
[4]
Palmer, B.W. and Harmell, A.L. (2016) Assessment of Healthcare Decision-Making Capacity. ArchivesofClinicalNeuropsychology, 31, 530-540. https://doi.org/10.1093/arclin/acw051
[5]
Zgoba, K.M., Reeves, R., Tamburello, A. and Debilio, L. (2020) Criminal Recidivism in Inmates with Mental Illness and Substance Use Disorders. Journal of the American Academy of Psychiatry and the Law, 48, 209-215.
[6]
Castrén, E. (2013) Neuronal Network Plasticity and Recovery from Depression. JAMAPsychiatry, 70, 983-989. https://doi.org/10.1001/jamapsychiatry.2013.1
[7]
Swanson, J.W., Van Dorn, R.A., Monahan, J. and Swartz, M.S. (2006) Violence and Leveraged Community Treatment for Persons with Mental Disorders. AmericanJournalofPsychiatry, 163, 1404-1411. https://doi.org/10.1176/ajp.2006.163.8.1404
[8]
Dellazizzo, L., Potvin, S., Athanassiou, M. and Dumais, A. (2020) Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis. FrontiersinPsychiatry, 11, Article 567887. https://doi.org/10.3389/fpsyt.2020.567887
[9]
Pope, K.S. and Vasquez, M.J.T. (2016) Ethics in Psychotherapy and Counseling: A Practical Guide. 5th Edition, Wiley.
[10]
Douglas, K.S., Hart, S.D., Webster, C.D. and Belfrage, H. (2013) HCR-20V3: Assessing Risk for Violence: User Guide. Mental Health, Law, and Policy Institute, Simon Fraser University.
[11]
Henquet, C., Krabbendam, L., Spauwen, J., Kaplan, C., Lieb, R., Wittchen, H., et al. (2004) Prospective Cohort Study of Cannabis Use, Predisposition for Psychosis, and Psychotic Symptoms in Young People. BMJ, 330, 11. https://doi.org/10.1136/bmj.38267.664086.63
[12]
van Os, J., Linscott, R.J., Myin-Germeys, I., Delespaul, P. and Krabbendam, L. (2008) A Systematic Review and Meta-Analysis of the Psychosis Continuum: Evidence for a Psychosis Proneness-Persistence-Impairment Model of Psychotic Disorder. PsychologicalMedicine, 39, 179-195. https://doi.org/10.1017/s0033291708003814
[13]
Di Forti, M., Quattrone, D., Freeman, T.P., Tripoli, G., Gayer-Anderson, C., Quigley, H., et al. (2019) The Contribution of Cannabis Use to Variation in the Incidence of Psychotic Disorder across Europe (EU-GEI): A Multicentre Case-Control Study. TheLancetPsychiatry, 6, 427-436. https://doi.org/10.1016/s2215-0366(19)30048-3
[14]
Koocher, G.P. and Keith-Spiegel, P (2008) Ethics in Psychology and the Mental Health Professions: Standards and Cases. Oxford University Press.
[15]
Tarasoff v. Regents of the University of California, 17 Cal. 3d 425, 551 P.2d 334, 131 Cal. Rptr. 14 (Cal. 1976).
[16]
Gulley-Ross, S.S. (2025) A Qualitative Case Study: Exploring Cybersecurity Vulnerabilities and Privacy Protection for Staff and Students in High Schools. Ph.D. Thesis, National University.
[17]
Tovino, S. (2004) Use and Disclosure of Protected Health Information for Research under the HIPPA Privacy Rule, The: Unrealized Patient Autonomy and Burden-Some Government Regulation. Scholarly Works, 78, 447-502.
[18]
Office for Civil Rights (OCR) (2008) Are the Health Records of an Individual Who Is Both a Student and an Employee of a University at Which the Person Receives Health Care Subject to the Privacy Provisions of FERPA or those of HIPAA? U.S. Department of Health and Human Services. https://www.hhs.gov/hipaa/for-professionals/faq/521/are-health-records-of-student-employees-subject-to-ferpa-or-hipaa/index.html
Ipp Panel, Review of the Law of Negligence: Foreseeability, Standard of Care, Causation and Scope of Liability (Commonwealth Treasury 2002). https://treasury.gov.au/sites/default/files/2019-03/R2002-001_Foreseeability.pdf
[22]
Appelbaum, P.S. and Grisso, T. (1988) Assessing Patients’ Capacities to Consent to Treatment. NewEnglandJournalofMedicine, 319, 1635-1638. https://doi.org/10.1056/nejm198812223192504
[23]
Calcedo-Barba, A., Fructuoso, A., Martinez-Raga, J., Paz, S., Sánchez de Carmona, M. and Vicens, E. (2020) A Meta-Review of Literature Reviews Assessing the Capacity of Patients with Severe Mental Disorders to Make Decisions about Their Healthcare. BMCPsychiatry, 20, Article No. 339. https://doi.org/10.1186/s12888-020-02756-0
[24]
Boggs v. New York City Health & Hosps. Corp., 132 A.D.2d 340, 521 N.Y.S.2d 57 (1st Dep’t 1987).
[25]
Christie, K.N., Dean, M.A. and Lyman, I.M. (2021) Misconceptions in the Medical Profession Regarding the Doctrine of Informed Consent. BeijingLawReview, 12, 1299-1319. https://doi.org/10.4236/blr.2021.124067