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.


  1. Bash v Board of Medical Practice, 579 A d 1145 (Sup Ct 1989)

Boston, Mass.