Physicans dating patients
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”.
On the basis of this evidence, it is argued that the circumstances in which such relationships are ethically permissible are extremely limited and that official ‘sanctioning' of these relationships should be very much the exception, not the rule.
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.
However, the crossing of boundaries does not necessarily mean that an unethical act occurred: after all, the crossing or erosion of boundaries is a normal part of the evolution of intimate relationships between human beings. Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors.
Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference–counter-transference dyad which occurs in varying degrees in every doctor–patient relationship.