Sexual Boundary Violations

College of Physicians and Surgeons of Alberta Are You Up to Standard?, Messenger Leave a Comment

It’s an old rule and an important one: physicians have a trust-based relationship with their patients that demands professional objectivity. The fallout when this trust is breached by a sexual boundary violation can be emotionally devastating to the patient, and professionally devastating to the physician.

This is true whether the breach involves a caring, emotional connection between a physician and patient or, at the other end of the spectrum, purely self-serving behaviour.

Why is a consensual personal relationship between a physician and patient taboo?

While not intentionally exploitive, the relationship is inherently unequal. By default, the physician has power over the patient. This obligates the physician to prove there is power equality before engaging in any intimate or personal relationship – irrespective of whether there is sexual intercourse. This is also why it is always in the patient’s best interest to end the physician-patient relationship in this situation.

Patients generally accept the power imbalance because they have trust in the physician’s medical knowledge, skills and professionalism. For this reason, if a physician signals personal attraction a patient may be confused, or feel it would be disrespectful to rebuff the physician. If acted upon, feelings of shame or guilt will often arise and the patient may lose their ability to trust any medical practitioner. Loss of reputation and discipline by the College are likely outcomes for the physician.

A physician who becomes aware of a strong personal attraction to or from a patient (reciprocal or not) should assess the risk. It may be possible to maintain an appropriate physician-patient relationship if both parties recognize and respect the physician’s professional boundaries. In other cases, managing the situation responsibly may require the physician to arrange for the patient to transfer to another physician’s practice.

Most physicians accept the prohibition on personal relationships with current patients. However, the College is sometimes asked if there is a time limit for entering a relationship with a former patient who is a consenting adult.

  • If the physician-patient relationship was psychotherapeutic, a personal relationship must never be allowed to happen.
  • Other situations are considered in context against a very high standard justified by the exceptional trust awarded medical practitioners.

If you are uncertain or need advice, consult with the Registrar. Further details are also provided in the Boundary Violations standard.

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