A therapist who gratifies his or her own needs by exploiting a patient's vulnerability destroys the trust essential to treatment." The APA seems to imply that all sexual relationships are inherently exploitative. From the administrative justice standpoint, a "no overlap" rule is simple to administer and superficially unassailable. As a credentials reviewer, I've seen this clause invoked far more often by scorned lovers than by innocent parties.

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Mental health professionals set even stricter standards.

For psychiatrists, it is a violation to cross the "patient-lover boundary" with any person who has ever been in the other role.

According to the American Psychiatric Association: "Sexual activity with a current or former patient is unethical....

Sexual or romantic interactions between physicians and patients detract from the goals of the physician-patient 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....

Sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician-patient relationship.

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." Note that this last statement leaves open the possibility that such relations might not be unethical if the physician doesn't exploit aspects of the former relationship.

Also, the AMA is silent here about former lovers becoming current patients. Colorado's Medical Practice Act specifies a six-month "waiting period" after a professional relationship has ceased before a sexual one may begin.

The subject of physician-patient boundaries illustrates how well-intentioned policy can be written in a way that is simply too shallow to serve the goals of ethics.

If you've sat on a credentials committee, disciplinary panel, or medical-licensing board, you surely reviewed cases of physician-patient sexual involvement.

Our contemporary attitude toward such encounters is to label them, categorically, as "unprofessional conduct." Given that there is no surveillance of this behavior, physician-patient sex comes to the attention of regulatory agencies only when the patient complains. The nominal standard establishes a rule of "no overlap": a physician-patient relationship must not coexist with a romantic-sexual relationship.

The AMA says: "Sexual contact that occurs concurrent with the physician-patient relationship constitutes sexual misconduct.