Doctor dating a patient ethics

Sexual misconduct usually commences with violations of more minor boundaries:“The road to therapist–patient sex is paved with progressive boundary violations.Except when a patient is raped, the therapist who eventually sexually abuses a patient follows a remarkably predictable ‘natural history' of sexual misconduct.” Not all stages will take place in any one relationship, but the general stages include: gradual erosion of therapist neutrality; socialization of therapy; the patient is treated as ‘special'; doctor's self-disclosures begin; physical contact begins (e.g.Transference is “the unconscious assignment to others of feelings and attitudes that were originally associated with important figures” by the patient onto the doctor.Counter-transference is the doctor's reaction to this process and this can include erotic feelings.This is recognized within professional codes, for example by the New Zealand Medical Council which states that “the ethical doctorpatient relationship depends upon the doctor creating an environment of mutual respect and trust in which the patient can have confidence and safety”. It is an underlying principle of the concept of boundaries and it has been argued that it is the doctor's breach of fiduciary trust, not the patient's consent, which is the central issue regarding sexual misconduct. After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication.To create the necessary conditions of a safe, therapeutic haven for a patient, a strong fiduciary relationship has to be built. the personality characteristics of the physician independent of the disciplinary knowledge and skill that give rise to Aesculapian power”. Instead of receiving his azathioprine and corticosteroids, he was given a high dose of frusemide and captopril.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 “doctorpatient 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 doctorpatient 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.

‘Love in the supermarket', as opposed to ‘love transference', is based more in reality and not propelled to an artificial intensity by an unequal power structure.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 doctorpatient 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.personality disordered doctors), this group is very unlikely to re-offend with appropriate treatment.Therefore, unmet emotional needs of the doctor, overidentification with the patient and particularly intimate areas of medicine associated with long-term professional relationships with patients can all potentially enhance the strength of the transference–counter-transference relationship between doctor and patient.

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hugs, kissing); extratherapeutic contacts occur; dating begins; sexual intercourse occurs.

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