They may work out in films but in real life, such a relationship may not just be messy, but could be manipulative too.

Sexual relationships between doctors and patients Warnings from Indian Psychiatric SocietyImage for representation
news Medical ethics Friday, September 09, 2016 - 19:01

There are plenty of films with cozy doctor-patient relationships which end in happily-ever-afters. But in real life, such a relationship may not just be messy, but could be manipulative as it could involve power dynamics. As a response to this, the Indian Psychiatric Society and Bangalore Declaration Group have come up with a set of guidelines

The draft ‘Guidelines for Doctors on Sexual Boundaries’ address the possible power imbalance in a doctor-patient relationship which often blurs the definition between manipulation and consent. For instance, on sexual conduct, the guidelines say that even consensual sexual activity “in a power imbalanced relationship like that of a doctor and patient is not truly consensual”.

A taskforce of the IPS headed by Dr Ajit V Bhede, Head of the Ethics Committee in the IPS, and Dr Sunita Simon Kurpad, who has worked on sexual and non-sexual boundaries at the Bangalore Declaration Group, prepared the draft. The Bangalore Declaration Group says it got the Medical Council of India to incorporate the topic in the revised UG MBBS syllabi for 2013.

Here are the major takeaways from the draft:

  • They apply to doctors of any gender and protect patients of all genders.
  •  A relationship would change the “therapeutic nature of the doctor patient dynamic”.
  • Doctors must not touch patients inappropriately in the guise of medical examination or sexual therapy for his/her own sexual gratification. Where patients are to be sedated, a chaperone or nurse must be present when anaesthesia is administered and upon recovery.  
  • If doctors and patients want to get into a personal relationship, it may be permissible only at least one year after the professional relationship has been terminated. But the end of treatment sometimes does not coincide with the end of the medical relationship due to the “multiple issues involved, including relapse rates of illnesses.”
  • Recognizing that they are emotional beings, doctors are advised transfer the patient’s medical care to another practitioner. They must also consult a senior to ensure they are not getting into the relationship due to their own vulnerabilities.
  • It warns to use social media carefully so as to not blur professional boundaries.
  • Volations must first be taken up by the IPS’ Ethics Committee. If required, it would be transferred to the Internal Complaints Committee, regardless of the gender of the persons involved. If a law is found to be broken, the matter would be escalated to the police.
  • While the rules are written with patients in mind, they would also apply to their families as well as students, colleagues and other professionals – essentially, anyone who is in a ‘power imbalanced relationship.  
  • While false allegations may occur, doctors must turn to seek their colleagues for support which does not amount to covering up the issue. However if the allegations are found to be true, “the colleague should be supported to the face the consequences of his or her behavior” and steps must be taken to ensure that something untoward does not happen again.
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