The limits of confidentiality: duty to warn and legal disclosure
- Topic
Secrecy gives way when there is a serious risk to an identifiable person or when a law requires reporting.
What it is
Confidentiality is not absolute. The international reference is the Tarasoff case (California Supreme Court, 1976): a patient told his psychologist he would kill a young woman; the police were told, but she was not, and she was killed. The court held that the professional has a duty to protect the identifiable victim, which may include warning her or notifying the police. Tarasoff is not Colombian law: in Colombia the exceptions to secrecy are in article 38 of Law 23 of 1981, and other laws require reporting, such as child abuse (Law 1098 of 2006, art. 46 item 10).
Exceptions to secrecy in Law 23 of 1981, art. 38
| Item | To whom | Condition |
|---|---|---|
| a) | The patient | In what strictly concerns or suits them |
| b) | Relatives | If disclosure is useful for treatment |
| c) | Those responsible | For minors or people with mental incapacity |
| d) | Judicial or health authorities | In the cases provided by law |
| e) | Those concerned | If an irremediable physical defect or a serious contagious or hereditary disease endangers the life of the spouse or offspring |
In clinical practice
- A patient who describes a concrete plan to harm someone: assess the risk, get specialist help and protect the victim.
- Sexually transmitted infection with a partner at risk: first encourage the patient to tell; disclosure by the doctor is the last resort.
- Suspected child abuse: start the reporting pathway; secrecy does not protect the abuser.
- Before disclosing, if time allows, consult the institution's ethics committee or legal advisers.
Legal framework in Colombia
- Law 23 of 1981, art. 37 (secrecy yields in the cases set by law) and art. 38 (items a–e).
- Law 1098 of 2006, art. 46 item 10: train staff to detect abuse, exploitation and sexual violence against minors, and report them.
- Law 1751 of 2015, art. 10 k): confidentiality of health information, except access by relatives or authorities in the cases allowed by law.
- Tarasoff is an international reference, not a Colombian rule.
- Official texts checked on 2026-11-05 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
What did the 1976 Tarasoff case establish?
That a mental health professional has a duty to protect an identifiable victim from a serious threat, which may include warning her or notifying the police.
Which item of article 38 of Law 23 of 1981 allows disclosure to protect the spouse or offspring?
Item e): when an irremediable physical defect or a serious contagious or hereditary disease endangers the life of the spouse or offspring.
What question helps decide whether breaking confidentiality is justified?
Whether, without that information, an identifiable person or group is at high risk of serious harm. If not, the exception is rarely justified.
Which law requires health staff in Colombia to report abuse of minors?
Law 1098 of 2006, article 46, item 10.
Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Confidentiality (University of Washington, Department of Bioethics & Humanities, 2018); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Función Pública, Gestor Normativo, 1981); Ley 1098 de 2006, Código de la Infancia y la Adolescencia (Función Pública, Gestor Normativo, 2006); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Función Pública, Gestor Normativo, 2015).
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Representative model, for educational purposes only.