Protecting Patients From Clinician-Patient Sexual Contact
SIR: A recent court decision, Bash v Board of Medical Practice [1],
reflects an important, and in our opinion, alarming trend in the current
debate as to what is the most appropriate preventive measure to protect
patients from the harms that accompany clinician-patient sexual contact.
The decision in question affirmed a medical board’s decision to require,
in the conditions for reinstatement of a psychiatrist found guilty of
exploiting the physician-patient relationship for his own sexual gratification,
a permanent restriction prohibiting him to treat females.
While such categorical restrictions might be appropriate in other contexts,
such as the treatment of patients with pedophilia, they do little to
address the underlying failures of self and clinical management that
characterize patient-clinician sexual contact.
In our forensic psychiatric experience, as well as in the experience
of our colleagues, cases where such contact has occurred are also characterized
by other serious breeches of the standard of care, such as the failure
to focus on the development of a therapeutic alliance essential for treatment
to proceed. Until the offending clinician demonstrates that such failures
have been remedied, we are concerned that the clinician who cannot be
considered as competent to treat women should be considered as competent
to treat men. Moreover, we are concerned that such categorical half-way
measures perpetuate the traditional stereotypes of women as “the weaker
sex,” stereotypes that in themselves have all too often limited the scope
of therapeutic efficacy. A professional who subscribes to the stereotype
of women as either objects to be exploited or protected is seriously
impaired in treating both women and men.
REFERENCE
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Bash v Board of Medical Practice, 579 A d
1145 (Sup Ct 1989)
HAROLD J. BURSZTAJN, M.D.
THOMAS G. GUTHEIL, M.D.
Boston, Mass.