Therapeutic privilege

A therapeutic privilege (or therapeutic exception) refers to an uncommon situation whereby a physician may be excused from revealing information to a patient when disclosing it would pose a serious psychological threat, so serious a threat as to be medically contraindicated.[1] The therapeutic privilege is an exception to the general rule of informed consent, and only applies when disclosure of the information itself could pose serious and immediate harm to the patient, such as prompting suicidal behavior.[2] The exception of therapeutic privilege does not apply when disclosure will merely lead to refusal of care that the physician thinks beneficial.[1]

The current AMA Code of Medical Ethics rejects the therapeutic privilege. It states: "Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable."[3]

Abdelhak et al. state:[4]

Some state laws severely restrict access to mental health records. Some require attending physicians to document in the record that they believe that access to the information contained in the medical record would harm their patients. Under the HIPAA privacy rule, if a licensed health care professional has determined, in the exercise of professional judgement, that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person, the facility may then refuse such a request; however, this is a reviewable decision that affords the patient an appeal option.