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Since the revelation that Dr. Martin Orne had released the tapes of his therapy sessions with Anne Sexton to her biographer, Diane Middlebrook, a considerable epistolary storm has roiled the psychiatric and literary world. Volleys of articles and letters to the editor have been discharged. Outrage against Dr. Orne has been the signature of most of these, particularly from therapists; others, many from the literary world, have defended him. The question at issue is a large one transcending the facts of this case. Stated simply, this question is “What are the limits of confidentiality in a psychotherapeutic relationship?” Is such confidentiality an absolute value to be abrogated only under such sanctions as a court order (and there are those who would defy a court order), or, are there less extreme conditions under which confidentiality can be infringed without violating ethical standards? In the language of moral philosophy the former position can be termed an absolutist or deontological one, whereas those who are more flexible about the issue can be seen as arguing from a utilitarian point of view. The degree of credence one attaches to Dr. Orne's interpretation of Anne Sexton's statement that he should use the tapes in any way he thought would be helpful will be strongly influenced, I believe, by one's position on this deontological/utilitarian spectrum. There would be, of course, a considerable shift in the balance between the two sides in this argument if Dr. Orne had obtained specific written permission from Anne Sexton to release the tapes to her biographer. Such permission is now required under the principles of medical ethics promulgated by the APA. However, Dr. Orne's actions long predated the publication of these principles and took place at a time when such legal niceties were not in the consciousness of psychiatrists as much as they are in today's litigious climate. It needs also to be stated in Dr. Orne's behalf that he has been supported by Anne Sexton'