Health care providers ethical use of risk assessment to identify and prevent terrorism [Fournisseurs de soins de santé utilisation éthique de l’évaluation des risques pour identifier et prévenir le terrorisme]

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 in order to prevent them from occurring. This article compares actions taken in Europe and the U.S. around the violation of confidentiality that occurs when providers are mandated to disclose personal health care information should an individual be reasonably suspected of using violence to harm him or herself or others, which is the usual standard used to make such a disclosure. The questions 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? To answer these questions, health care professors from Italy and the U.S. compare the legal system requirements with the ability to predict who will commit future violence using scientific research on risk assessment by mental health professionals. Prediction of future violence using clinical interview methods alone has been found to be wrong more often than right prompting the development of structured interviews and “actuarials” using data from researching violent offenders (Shapiro et al., 2018). Comparison with their use in various legal settings in the U.S. and potential to identify a radicalized individual in a terrorist cell under the European Prevent Act is explored. 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 as some have suggested in the U.S. around psychologists interrogating and treating detained terrorists or the E.U. mandate under “Prevent” to deradicalize those known to be captured by terrorist communities? And finally, the article questions whether mandatory reporting of those at risk of further violence actually stops and prevents terrorist acts from occurring at all.