Psychiatrist dating former patient
Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable.In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor–patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.hugs, kissing); extratherapeutic contacts occur; dating begins; sexual intercourse occurs.This has been documented extensively in the literature, with no counteracting reports of successful relationships and non-abusive consequences being published.
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.
In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner. As attempts were made to rapidly infuse intravenous fluids and rescue his remaining renal function, the specialist cried ‘I realized that they were the wrong pills but !
The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. the power that a physician possesses by virtue of her training in the discipline and the art or craft of medicine”. ' Despite having the Aesculapian power of a doctor, and the Social power of a hospital specialist, in addition to considerable Charismatic power (he was a well-liked and respected colleague), none of these were sufficient to counteract his lack of Hierarchical power by being a patient.
Two years after the zero tolerance policy was adopted, the New Zealand Medical Council released a further policy statement in which it stated that whilst complaints regarding sexual relations with former patients will be considered individually, it will be presumed to be unethical if the “doctor–patient relationship involved psychotherapy, or long-term counselling and support; the patient suffered a disorder likely to impair judgement or hinder decision-making; the doctor knew that the patient had been sexually abused in the past; [or] the patient was under the age of 20 when the doctor–patient relationship ended”.
This paper presents evidence from international medical and ethical literature to examine the validity of this position taken by the New Zealand Medical Council regarding the sexualization of relationships with former patients.