Dating a patient ethics
Nor is love in the supermarket based upon a fiduciary relationship (see later discussion).In addition, ‘love transference' can be extremely capricious, often hiding a destructive hate transference that frighteningly erupts and engulfs the therapist and patient.This does not mean that no such type of relationship may exist, but it has not been researched.This suggests that the overwhelming outcome for most, if not all, patients is negative. the specific impact of a particular boundary crossing can only be assessed by careful attention to clinical context”., the analysis has to examine other factors.First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn.
Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference–counter-transference dyad which occurs in varying degrees in every doctor–patient relationship.Transferences of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable (see following sections). [the] special confidence reposed in one who in equity and good conscience is bound to act in good faith and with due regard to the interests of one reposing the confidence”. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy (e.g. To help understand these four types of power, and the relationships between each type, consider the following incident from my personal experience as a first year house surgeon in Australia in the mid-1980s.It is important in the doctor–patient relationship that a ‘neutral, safe space' is established which allows a therapeutic alliance to grow. Three salient features describe the circumstances in which this type of relationship occurs: there is an expectation of trustworthiness, an unequal power relationship exists and the interaction occurs under conditions of privacy. Although it does not involve the sexualization of the doctor–patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment.Thirdly, a discussion of the role of autonomous choice and consent is presented.On the basis of this evidence, it is argued that the circumstances in which such relationships are ethically permissible are extremely limited and that official ‘sanctioning' of these relationships should be very much the exception, not the rule.
However, there is also the question of whether this type of power would be accentuated further in a fee-for-service situation, as exists in general practice in Australasia, as opposed to free public hospital treatment.) This differential is exacerbated further by any imbalances arising from the other three sources of power.