I’m in my mid-60s and part of a childless friend group whose members depend on one another. One friend, who lives hours away, is married to a man with severe mental-health issues — bipolar disorder and escalating paranoia.

They both have mobility challenges. The husband, believing his car has been tampered with, won’t drive, so I’ve cared for him post-surgery and driven him to his appointments. His paranoia is extreme. He believes a former employee of his has hacked into his life and is somehow controlling him. He won’t carry a phone, believing his ‘‘hacker’’ will find him. While driving, if my GPS suggests an unfamiliar route, he thinks we’re being controlled, or deliberately sent off course. He’s easily triggered and often breaks down emotionally.

Though he uses a cane, he’s strong and quick to anger. He’s spoken of killing his hacker and recently said he would kill his wife too if she colluded with this person. He’s angry about not having access to money his wife has inherited, which he wants to use to hire a contract killer.

I’ve informed his wife that he said he would kill her if he learned that she was part of the conspiracy against him. She has unsuccessfully tried to have him institutionalized (in certain contexts, he behaves rationally). But she’s afraid to leave him. I fear for her safety and, increasingly, my own. I’ve considered reporting his threats, but no crime has been committed. I feel helpless watching this situation deteriorate. What ethically can I do to protect my friend and myself? — Name Withheld

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From the Ethicist:

First, it’s not completely clear that no crime has been committed. The relevant statutes will vary from state to state, but the general point is that violent threats or plans don’t necessarily have to be carried out to be unlawful. So you should report what you know to the police. Even if he hasn’t broken the law, you’ll want to have your concerns on the record. If the situation takes a turn, this could be part of the case for, say, seeking a restraining order.

In the meantime, document everything you can; his wife should do the same. That may include recording your conversations with him without his consent (if it’s legal to do so in your state). In normal circumstances, this sort of evidence gathering wouldn’t be ethical in your relations with other people. But when you’re dealing with somebody driven by paranoid delusions to contemplate murder, you’ve got an overriding duty to protect yourself and your friend. Consulting with an attorney who has the relevant expertise could be helpful as well. So could consulting with mental-health services. Yet there’s no skirting the paradox: The measures people may reasonably take toward someone gripped by paranoia may, if the person learned of them, reinforce the paranoia.

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