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Only for the Good of my Patients

Only for the Good of my Patients
by Dr. Christina J. Johns
Law, Power and Justice Syndicate

December 29, 2001

The better part of my adult life has been spent as a university professor. During that time I have been really surprised by the number of male faculty members who engage in sexual relations with their students. I have been shocked by the failure of most of these men to see their behavior as unethical and exploitative.

Most universities discourage sexual relationships between students and faculty, and a few prohibit them outright. Even though Yale University prohibited consensual relationships between its students and teachers in 1997, most universities fail to adequately deal with the issue, treading lightly on what is often considered (usually by male faculty and administrators) as consensual behavior between adults.

But, as Bernice Sandler, with the National Association for Women in Education, has written: "From the point of view of the person who has the power, it may be consensual, but it may not be for the student who is feeling pressured."

Most professional codes of ethics at least discourage sexual contact between professionals and their clients, students, subordinates and/or patients because inequality of power so easily translates into coercion. Some organizations go so far as to make policy on the basis that inequality of power constitutes coercion.

Sexual relationships should be conducted between equals, not between unequal partners where one has the power to coerce or damage the other. Professionals, by definition, have power over students, clients, subordinates and patients and they cannot just ignore the vulnerabilities of those in subordinate positions.

As unprincipled and unethical as it is for professors to sexually exploit students and junior colleagues, it is far more serious when one considers other types of professionals. Dr. Richard Irons writes about physicians and psychologists: "...the professional-patient relationship is facilitated by inherent disparity in position, education and power. Yet . . . the healing profession has been shadowed by abuse of privilege." Schneider, Irons and Cooley write in the Journal of Sex Education and Therapy: "A particularly egregious type of betrayal of the primary relationship occurs when a physician, psychotherapist, of clergy person embarks upon a sexual relationship with a patient, client, or other person with whom he or she has a fiduciary relationship. Such relationships are expressly forbidden by their professional associations, and in at least a dozen states they are considered felony crimes."

The American Psychological Association code of ethics forbids sexual relations between psychologists and their patients because sexual intimacies "are so frequently harmful to the patient" and because they " "undermine public confidence in the psychological profession." Just think of the damage that can be caused by a mental health practitioner, dealing with an emotionally fragile person who betrays the position of trust by sexually exploiting the patient.

The American Medical Women’s Association passed a resolution in 1988 opposing "sex between physician and patient and sexual exploitation of the patient by the physician." And, the Hippocratic oath reads in part: "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially free from the pleasure of love with women or with men."

One usually thinks of sexual exploitation and abuse as brought to light in the medical setting. People show up in emergency rooms with bruises and abrasions, and broken bones. They show up after suicide attempts. Doctors are supposed to at least ask questions and try to uncover hidden abuse and exploitation. But who is going to expose the psychological and physical damage if the predator is a doctor?

Patients place themselves in the care and trust of the physician. A sexual relationship is the ultimate breech of that trust. A physician has to be privy to intimate details of the patient’s lives and through the role of care taker the unscrupulous physician can build a sexual relationship on the patient’s need for continued medical care. In this manner, the physician can create a dependency that serves to bind the patient into the relationship. The patient becomes afraid to terminate the relationship in fear that their health may become jeopardized.

Physicians are also in a particularly powerful position when trying to cover up sexual relations with patients and junior staff. They are in the position to prescribe psychiatric medication that may numb the victim into submission or into not reporting the abuse. They are in the position to fix broken bones, write explanations for injuries in charts, and excuse work absences. They are also in the position of enlisting colleagues to help cover up abuse.

As employers they are in the position to fire or have fired, uncooperative targets, to refuse to write employment recommendations, to demand work outside normal business hours, and in smaller communities to prevent a subordinate from working in the field entirely through spreading rumors of mental instability and/or incompetence.

Physicians are bound, both ethically and legally, to report the abuse of a patient - any patient. All of us are morally bound to report evidence that a physician is coercing a patient or subordinate into sexual relations, physically or sexually abusing a patient or subordinate, or practicing medicine on a person with whom she or he is having sexual relations. Anyone knowing of such behavior should notify The State Board of Medical Examiners. Members of the Medical community, including physicians, nurses, and hospital administrators who know about or have information about such situations and do nothing can be legally liable.

For those in the Tallahassee Area:

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You can contact Dr. Johns through www.lawpowerandjustice.com and read more articles about sexual abuse by professionals. Articles cited in this column can be found at www.prckansas.org.

Supplementary Material:

For Articles about Students and Faculty Members:

Blair, Julie (1998) On College Campuses, A Gradual Move Toward Addressing Faculty-Student Sex. The Chronicle of Higher Education. 12/16/98.
Dziech, Billie Wright (1998) The Abuse of Power in Intimate Relationships. The Chronicle of Higher Education.

Articles about Physicians and Mental Health Workers:

APA Code of Ethics
Jorgenson, Linda and Pamela K. Sutherland () Liability of Physicians, Therapists and Other Health Professionals for Sexual Misconduct with Patients.
American Medical Women’s Association.

Books about Physician Sexual Misconduct:

Physician Sexual Misconduct (opens Amazon.com site)
Sexual Exploitation of Patients by Health Profess ionals (opens Amazon.com site)
Breach of Trust : Sexual Exploitation by Health Care Professionals and Clergy (opens Amazon.com site)