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The obligation to serve the common good and protect public health originated in the late 19th and early 20th centuries. Initially focused on reporting infectious diseases, this obligation now includes mandatory reporting of gunshot, knife injuries, icepick injuries, and burn injuries, and the notification of sexually transmitted diseases to at-risk partners, child abuse, elder abuse, and intimate partner violence.[3] The duty to warn encompasses physical harm and harm caused by drug effects, medical illnesses, and infectious diseases.[18] The term confidentiality is not the same as privilege. Confidentiality is an ethical principle that requires clinicians to keep patient information private. This information can only be disclosed if: The patient or a legally appointed surrogate decision-maker provides consent for the information to be disclosed A court order is issued by a judge requesting the release of data The minimum necessary information must be communicated for continued treatment of the patient, such as in cases of civil commitment Mandatory reporting is required, such as in suspected child abuse or the Tarasoff warning.[26] The term privilege is a legal concept referring to a patient's right to withhold communication with their clinician from court proceedings, provided the communication is confidential and free from the presence or knowledge of third parties.[26] As a result, clinicians are prohibited from testifying in court about such communications unless the patient waives their right to privilege. However, there are several exceptions to this rule, including legal proceedings where the defendant raises the issue of their mental health, involuntary hospitalizations, and situations where a judge orders an evaluation.[10]

The term privilege is a legal concept referring to a patient's right to withhold communication with their clinician from court proceedings, provided the communication is confidential and free from the presence or knowledge of third parties.[26] As a result, clinicians are prohibited from testifying in court about such communications unless the patient waives their right to privilege. However, there are several exceptions to this rule, including legal proceedings where the defendant raises the issue of their mental health, involuntary hospitalizations, and situations where a judge orders an evaluation.[10] The Hippocratic Oath mandates that healthcare providers have the ethical duty to foster an obligation of privacy and autonomy to their treating patients.[3][1] The HIPAA also advocates ensuring that therapeutic communication is privileged. Confidentiality is paramount, and violation of the same invariably undercuts the trust, hampering the functionality of the fiduciary relationships between a healthcare provider and the patient in the future.[1] However, nonmaleficence and therapeutic privilege are not absolute and can be breached when there is a foreseeable danger to reliably identifiable third parties.[1] Confidentiality plays a critical role in patient care; however, there may be special circumstances where confidentiality must be breached to ensure the patient's safety and protect third parties. Confidentiality does not always trump obligations to others.[21][16] Therapeutic privilege cannot be a defense against negligence following failure to warn.[28] The protective privilege ends where the public peril begins.[3]