Samuel Knapp, EdD, ABPPDirector of Professional Affairs
How should psychologists respond if they have a patient who has been drinking and who intends to drive home after a therapy appointment? After reasonable efforts to dissuade the patient from driving have failed, does the psychologist have an obligation to warn the police about the potential danger? Alternatively, does confidentiality prevent the psychologist from doing so?
This dilemma arises intermittently for practicing psychologists. Of course, psychologists have a legal duty to report impaired drivers to the Pennsylvania Department of Transportation (Baturin, Knapp, & Tepper, 2003). However, this requirement does not help resolve the immediate safety issue. Nuances in the interpretation of this mandated reporting law are covered in the article cited above on that topic on the PPA website.
In dealing with the immediate problem of a drunken patient who wants to drive home, much of the decision-making of the psychologist will account for situational factors. The extent of the patient's impairment from alcohol may be difficult to determine. This may be similar to evaluating pornography, in that it can be hard to define, but easy to recognize. In many cases, individual psychologists may observe the same patient and differ in their interpretation of their degree of impairment. I know of no rule of thumb or quick evaluation tool for psychologists to rely upon. However, in many other cases, everyone would agree that staggering, slurred speech, affect, and other behaviors would indicate that this person is too drunk to drive.
Psychologists should try to dissuade an impaired patient from driving, and consider options such as getting a taxi for the patient, calling a relative or friend to drive the patient, or other alternatives. Another option might be to inform them that you will call the police if they drive away from your office drunk. Furthermore, this behavior needs to be a part of the calculation in a decision to notify the Department of Motor Vehicles concerning their competency to drive.
The true dilemma arises when a patient you determine to be too drunk to drive insists upon driving anyway. What are the ethical or legal obligations that you have? Are you legally liable if the patient harms others?
In discussions with different psychologists on this exact question, I have learned that several psychologists have called the police on a drunken patient who insisted upon driving home from a therapy session, and no complaints were filed against them. Others have worked with patients who were too cognitively impaired with neuropsychological problems and have similarly notified the police.
There is not, to my knowledge, any court case in Pennsylvania that deals specifically with the legal liability of psychologists in these situations. However, the regulations of the State Board of Psychology permit such disclosures “when there is clear and imminent danger to an individual or to society, and then only to appropriate professional workers or public authorities” (49 Pa. Code §41.61, Principle 5 (b) (1)). I think this can be interpreted to justify notifying the police when a patient is too drunk to drive. In addition, when there is ambiguity in laws or regulations, psychologists should interpret them in light of overarching ethical principles that, in this case, would mean notifying the police if we thought a driver was dangerous to the public. Safety trumps privacy and we do need to live with ourselves. Of course, drug and alcohol facilities in Pennsylvania are governed by special federal and state regulations that have a stricter level of confidentiality.
Reference
Baturin, R., Knapp, S., & Tepper, A. (2003, November). Legal and practical issues related to the treatment of impaired drivers. Pennsylvania Psychologist, 5-6.
