Should a psychiatrist report a bus driver's alcohol and drug abuse? An ethical dilemma

Denial of alcohol or drug abuse, and of its possible consequences, can comp licate medical and psychiatric care. We present the case of an HIV-positive bus driver with substance abuse who initially denied ongoing use of alcoho l and of other drugs, but later admitted to both. The psychiatrist's duty t o protect the patient's confidentiality, coupled with concerns about public safety, created an ethical dilemma. In discussing this dilemma we stress t he importance of preserving confidentiality, both to facilitate treatment a nd also to further the safety of others. (C) 2001 Elsevier Science Inc. All rights reserved.