Case and Commentary
Jan 2005
Objectivity plays an important part in good clinical judgment. Previous sections of this chapter have identified how financial considerations can compromise physician objectivity; personal relationships may also undermine physician objectivity and, consequently, diminish the quality of patient care. Clinical relationships with family members and romantic and/or sexual relationships with patients are especially likely to jeopardize patient care. The Code addresses both of these:
Opinion 8.19, "Self-Treatment or Treatment of Immediate Family Members"
...Professional objectivity may be compromised when an immediate family member of the physician is the patient; the physician's personal feelings may unduly influence his or her professional medical judgment...Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member....Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents.
...In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available.
Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members.
Opinion 8.14, "Sexual Misconduct in the Practice of Medicine"
Sexual contact that occurs concurrent with the patient-physician relationship constitutes sexual misconduct. Sexual or romantic interactions between physicians and patients detract from the goals of the patient-physician relationship, may exploit the vulnerability of the patient, may obscure the physician's objective judgment concerning the patient's health care, and ultimately may be detrimental to the patient's well-being.
...At a minimum, a physician's ethical duties include terminating the physician-patient relationship before initiating a dating, romantic, or sexual relationship with a patient.
...Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship.
Physician expertise and collaborative decision making are cornerstones of contemporary medical practice. Strong emotional connections to family members or significant others can alter physician judgment in ways the physician may be unable to recognize.
A second concern is that the power imbalance of the patient-physician relationship may be intensified in close personal relationships, inhibiting the family member or significant other from challenging, questioning, or disagreeing with the physician.
The ethical prohibition against romantic relationships or sexual contact with patients is not meant to be a bar to other kinds of non-sexual touching of patients by physicians. In addition to its role in physical examination, non-sexual touching may be therapeutic or comforting to patients. However, even non sexual contact with patients (beyond the appropriate touching of the physical examination) should be approached with caution.
It is of course possible for a physician and a patient to be genuinely attracted to or have genuine romantic affection for each other. However, any relationship in which a physician is (or risks) taking advantage of the patient's emotional or psychological vulnerability is unethical. Therefore, before initiating a dating, romantic, or sexual relationship with a patient, a physician's minimum duty is to terminate his or her professional relationship with the patient. These restrictions are more strict for psychiatrists, but all physicians should be aware of possible problems that can arise from these relationships.
