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Rules for romance
Conduct and compassion Books Software Doctoring the risk society
Science Photo Library
Jabs & Jibes
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Joal Hill e-mail: [email protected]
440
Conduct and compassion
Rules for romance r Amato is the subject of a disciplinary investigation based on the complaint of the mother of a 6-year-old patient under her care for the past year. Mr and Mrs Romanus have been divorced for 3 years and share custody of their only child, whose prognosis after treatment for leukaemia is excellent. Mrs Romanus has credible evidence of a romantic relationship between Dr Amato and Mr Romanus during the past 4 months. It is unclear whether sexual intimacy has occurred. Some of Dr Amato’s colleagues maintain that she has crossed the ethical boundary that separates professional and personal involvement. Others believe she may have made an error of etiquette but not of ethics, since Mr Romanus was not her patient and has publicly stated that he initiated the relationship, that both he and the doctor are “consenting adults”, and that no medical errors have occurred. Which line has Dr Amato crossed? Would it make a difference if the patient were Mr Romanus’s parent instead of his child? Does it matter who initiated the romantic involvement or whether they have been sexually intimate? Should Dr Amato have transferred the child’s care before engaging in the romance? Prohibition of sexual relationships between physicians and patients goes back to the Hippocratic Oath. This case arguably falls within the scope of that proscription: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all . . . mischief and in particular of sexual relations with both
D
female and male persons”. It remains metaphorically true that in the care of patients, especially of children, physicians “enter the houses” of patients in the sense that practice entails a web of communication, trust, and moral engagement with family members. Thus, many variables that underlie the impropriety of romantic or sexual involvement with patients can be applied to
clear consensus is lacking. Although some would extend a zero tolerance policy to involvement with key parties, others point out that in isolated settings such proscription would make it difficult for practitioners to establish a normal social life. Other specialty groups, such as paediatricians and family practitioners, do not maintain that romantic
Romantic involvement with third party: points to consider ■ ■
■ ■
Degree of involvement in medical decision-making Extent to which personal relationship involves information, trust, or emotions stemming from the professional encounter Length of professional involvement Importance of the medical encounter to patient’s well-being
lose family members: possible exploitation of knowledge or influence, compromise of professional objectivity that could affect a patient’s well-being, and effect of the inherent power imbalance on meaningful consent (panel). Moreover, the anxiety and helplessness parents usually feel for critically ill children may make them more vulnerable to exploitation than if they were patients themselves. Resolution of such cases, however, is highly variable. This issue has not received the same depth of analysis as romantic or sexual involvement with patients. The American Medical Association’s 1998 Opinion 8·145 (“Sexual or Romantic Relations Between Physicians and Key Third Parties”) was promulgated 12 years after its statement on sexual misconduct with patients. Of note is inclusion of non-family members, such as proxies or guardians, whose decisions guide medical care. Among psychiatrists and psychologists,
relationships with adult family members are always unethical, although they generally recommend “avoiding” such entanglements, or transferring a patient’s care before entering the relationship. The UCLA School of Medicine Honor Code explicitly addresses and forbids them: “I will not use my professional position to engage in romantic or sexual relationships with patients or members of their families.” Based on this lack of clear consensus, we could expect some range of opinion about the propriety of Dr Amato’s relationship with Mr Romanus and what sanctions, if any, should be imposed. Any resolution should encompass the same questions that apply to allegations of misconduct with patients. The more closely resolution of Dr Amato’s situation parallels those cases, the less likely it is that relevance will be attached to the fact that Mr Romanus initiated the romance, or that the patient has done well medically.
THE LANCET • Vol 361 • February 1, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Science Photo Library
Jabs & Jibes
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
Joal Hill e-mail: [email protected]
440
Conduct and compassion
Rules for romance r Amato is the subject of a disciplinary investigation based on the complaint of the mother of a 6-year-old patient under her care for the past year. Mr and Mrs Romanus have been divorced for 3 years and share custody of their only child, whose prognosis after treatment for leukaemia is excellent. Mrs Romanus has credible evidence of a romantic relationship between Dr Amato and Mr Romanus during the past 4 months. It is unclear whether sexual intimacy has occurred. Some of Dr Amato’s colleagues maintain that she has crossed the ethical boundary that separates professional and personal involvement. Others believe she may have made an error of etiquette but not of ethics, since Mr Romanus was not her patient and has publicly stated that he initiated the relationship, that both he and the doctor are “consenting adults”, and that no medical errors have occurred. Which line has Dr Amato crossed? Would it make a difference if the patient were Mr Romanus’s parent instead of his child? Does it matter who initiated the romantic involvement or whether they have been sexually intimate? Should Dr Amato have transferred the child’s care before engaging in the romance? Prohibition of sexual relationships between physicians and patients goes back to the Hippocratic Oath. This case arguably falls within the scope of that proscription: “Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all . . . mischief and in particular of sexual relations with both
D
female and male persons”. It remains metaphorically true that in the care of patients, especially of children, physicians “enter the houses” of patients in the sense that practice entails a web of communication, trust, and moral engagement with family members. Thus, many variables that underlie the impropriety of romantic or sexual involvement with patients can be applied to
clear consensus is lacking. Although some would extend a zero tolerance policy to involvement with key parties, others point out that in isolated settings such proscription would make it difficult for practitioners to establish a normal social life. Other specialty groups, such as paediatricians and family practitioners, do not maintain that romantic
Romantic involvement with third party: points to consider ■ ■
■ ■
Degree of involvement in medical decision-making Extent to which personal relationship involves information, trust, or emotions stemming from the professional encounter Length of professional involvement Importance of the medical encounter to patient’s well-being
lose family members: possible exploitation of knowledge or influence, compromise of professional objectivity that could affect a patient’s well-being, and effect of the inherent power imbalance on meaningful consent (panel). Moreover, the anxiety and helplessness parents usually feel for critically ill children may make them more vulnerable to exploitation than if they were patients themselves. Resolution of such cases, however, is highly variable. This issue has not received the same depth of analysis as romantic or sexual involvement with patients. The American Medical Association’s 1998 Opinion 8·145 (“Sexual or Romantic Relations Between Physicians and Key Third Parties”) was promulgated 12 years after its statement on sexual misconduct with patients. Of note is inclusion of non-family members, such as proxies or guardians, whose decisions guide medical care. Among psychiatrists and psychologists,
relationships with adult family members are always unethical, although they generally recommend “avoiding” such entanglements, or transferring a patient’s care before entering the relationship. The UCLA School of Medicine Honor Code explicitly addresses and forbids them: “I will not use my professional position to engage in romantic or sexual relationships with patients or members of their families.” Based on this lack of clear consensus, we could expect some range of opinion about the propriety of Dr Amato’s relationship with Mr Romanus and what sanctions, if any, should be imposed. Any resolution should encompass the same questions that apply to allegations of misconduct with patients. The more closely resolution of Dr Amato’s situation parallels those cases, the less likely it is that relevance will be attached to the fact that Mr Romanus initiated the romance, or that the patient has done well medically.
THE LANCET • Vol 361 • February 1, 2003 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.