Ethics physicians dating patients
Only in very particular circumstances could such relationships be ethically permissible.the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community. One such area is whether sexual relationships with patients are ever ethically permissible and, if so, under what circumstances.Sexual misconduct usually commences with violations of more minor boundaries:“The road to therapist–patient sex is paved with progressive boundary violations.
Secondly, three aspects of the doctor–patient relationship are explored: the general characteristics which promote health care; the importance of trust and the fiduciary relationship; and the role of power and authority in the relationship.Transferences of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable (see following sections). [the] special confidence reposed in one who in equity and good conscience is bound to act in good faith and with due regard to the interests of one reposing the confidence”. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy (e.g. To help understand these four types of power, and the relationships between each type, consider the following incident from my personal experience as a first year house surgeon in Australia in the mid-1980s.It is important in the doctor–patient relationship that a ‘neutral, safe space' is established which allows a therapeutic alliance to grow. Three salient features describe the circumstances in which this type of relationship occurs: there is an expectation of trustworthiness, an unequal power relationship exists and the interaction occurs under conditions of privacy. Although it does not involve the sexualization of the doctor–patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment.Doctors are more vulnerable to counter-transference when the doctor unconsciously or subconsciously overidentifies with the patient's situation, so much so that one author comments:“The power of the subconsciously driven countertransference to create rationalisations that the sexual relationship with the patient is ‘special and the exception' to the usual rules of professional conduct should never be underestimated.” Such ‘overidentifiers' are often ‘situational reactors' who are responding to particular triggers such as marital discord, loss of important relationships and a professional crisis in their own lives.Whilst situational reactors are certainly an at-risk group, unlike other categories of doctors who offend (e.g.