Abstract

The rise in terrorist acts around the world has called for greater attention for health care professionals to predict and report those who may commit such violence. This focus raises significant ethical questions regarding the certainty with which such predictions can be made and concurrently, problems regarding breaches of confidentiality. In some jurisdictions, we see the increasing attention paid to mandatory disclosure when there is a reasonable suspicion of harm to self or others, even before an act of terror has occurred. The questions that need to be explored are (1) whether it is possible to make an accurate prediction of future use of violence; (2) if so, what are the potential outcomes of such disclosures; and (3) what are the ethical concerns for the health care profession in general as well as the individual professional? The European Union has passed laws under the collective heading of “Prevent” to identify those who have the potential to become part of a terrorist cell. Does such mandatory reporting actually stop and prevent terrorist acts from occurring, or, in a broader sense, does mandatory reporting actually reduce the potential for violence. To answer these questions, we will examine the ability to predict who will commit future violence using scientific research on risk assessment. Prediction of future violence using clinical interview methods alone has been found to be inaccurate more often than accurate prompting the development of structured interviews and ‘actuarials’ using data from researching violent offenders (Shapiro and Noe in Handbook of behavioral criminology. Springer, New York, 2018). Ethical considerations of whether the science of risk assessment yields sufficiently high enough accuracy to warrant violation of the patient’s privacy are explored. Does the violation of human rights especially in those where the predictions are inaccurate create an ethical crisis in health care?