The Tarasoff decision is discussed as a logical extension of evolving legal doctrine imposing a special duty on caretakers. The mental health professions are being held to a standard of negligence and perhaps even to a standard of strict liability. Tarasoff is viewed as a part of society's interest in using the information disclosed in confidential relationships as a means of social control. This in turn is seen as part of a disquieting trend to curtail First Amendment rights. The adversarial nature of the relationship between the 1974 Tarasoff decision and the constitutional rights of patients to privacy, confidentiality, and privilege is discussed. The author re-asserts: “As asepsis is to surgery, so is confidentiality to psychiatry” (Beigler, 1978, p. 255).