Are Physician-Patient Relationships Ethical? Ethicists Say No, But Some Docs Disagree

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According to the American Medical Association Code of Medical Ethics, romantic or sexual relationships between physicians and patients are unethical.
According to the American Medical Association Code of Medical Ethics, romantic or sexual relationships between physicians and patients are unethical.

According to the American Medical Association (AMA) Code of Medical Ethics, romantic or sexual relationships between physicians and patients are unethical. The brief entry reads in part that “A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient.”1

In the United Kingdom, the General Medical Council changed its stance on physician and former patient relationships in 2013,2 although it updated its guidelines to include factors that physicians should consider before embarking on such a relationship. Some physicians feel that context is key: for example, primary care physicians regularly see their patients, rendering a relationship inappropriate. Of less concern may be a potential relationship between an emergency or specialist physician who the patient may see only once.3

The AMA's insistence that the professional relationship end before a more personal relationship is pursued seems to be the general consensus. An article published in the Canadian Medical Association Journal on the topic4 addresses the question of a physician who is the only practicing physician in a rural area and whether or not it would be unethical for a person in that position to begin a romantic relationship with a patient in the community. The article concluded that the best course of action in this case would be to terminate the professional physician-patient relationship and refer the patient to another physician in a different community.

Yet even with shifting opinions concerning intimate relationships between physicians and patients, there is increasing conversation about the issue of sexual misconduct on the part of physicians. Because of the power dynamics in a professional physician-patient relationship that turns romantic, there is the worry that patients in such a scenario could be exploited.

In a more intimate field such as psychiatry, the patient is in an incredibly vulnerable position. The American Psychiatric Association, for example, states in its Principles of Medical Ethics5 that “sexual activity with a current or former patient is unethical.” As psychiatrist Dr Mona Gupta explained in an article for the Canadian Medical Association Journal, physicians are also often expected to bear the stress and hardships of their work without seeking aid.4 This can make physicians vulnerable as well, allowing for inappropriate behavior on the part of both parties.

The ethics of physician-patient relationships is not a clear-cut issue; there have long been arguments both approving and condemning such relationships. Recent opinion has shifted slightly toward the former, which has led to a renewed discussion of the power dynamics at play. While the AMA Code of Medical Ethics is clear in its guidelines for physician-patient relationships that become romantic or sexual, it can be argued that exceptions and grey areas concerning the issue still exist.

References

  1. AMA Code of Medical Ethics. Romantic or sexual relationships with patients. Code of Medical Ethics opinion 9.1.1. www.ama-assn.org/delivering-care/romantic-or-sexual-relationships-patients. Accessed September 20, 2018.
  2. General Medical Council. Good medical practice. www.gmc-uk.org/-/media/documents/good-medical-practice---english-1215_pdf-51527435.pdf. Published March 25, 2013. Updated April 29, 2014. Accessed September 20, 2018.
  3. Minemyer P. Majority of docs say dating a patient crosses ethical line. Fierce Healthcare. January 5, 2017. www.fiercehealthcare.com/practices/majority-docs-say-dating-a-patient-crosses-ethical-line. Accessed September 20, 2018.
  4. Collier R. When the doctor-patient relationship turns sexual. CMAJ. 2016;188(4):247-248.
  5. American Psychiatric Association. The principles of medical ethics with annotations especially applicable to psychiatry, 2013 edition. Accessed September 20, 2018.

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