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.
