Informed Consent for Sex Between Health
Professional and Patient or Client
S. Michael Plaut, Ph.D.
University of Maryland School of Medicine
One of the most frequent justifications used for a sexual
relationship with a patient is that it was consensual. Patients have
free will, some argue, and both participants have a constitutional
right to free association. If a patient can consent to a medical
procedure, why can't he or she consent to sex with a physician? Many
doctors are married to former patients. It is paternalistic for the
state or the profession to prohibit such relationships. And so on.
Such arguments tend to ignore a few important points, including the
potentially coercive nature of a trust-based relationship (Feldman-Summers,
1989; Peterson,
1992; Rutter,
1989), and the risk of harm that can result from a violation of that
trust (Edelwich
& Brodsky, 1991; Luepker,
1989; Pope,
1994). The possibility of "successful" relationships
notwithstanding, one may indeed question whether the consent given
in such relationships is truly informed, even to the extent
typically expected for medical procedures. The following document is
an example of what one might use to elicit such informed consent. I
originally wrote this document as a tongue-in-cheek response to an
attorney with whom I was informally debating this issue. Initially,
I was reluctant to share it with victim/survivors, fearing that they
might see it as traumatic or offensive. I found, however, that the
document reflected the reality for many who had experienced such a
sexual relationship, and I have been encouraged to disseminate it
more widely. Read it, and ask yourself how many health
professionals might be willing to solicit consent for a sexual
relationship in this manner, and how many patients so informed might
sign such a document.
| STATEMENT OF INFORMED CONSENT FOR A
SEXUAL RELATIONSHIP BETWEEN A HEALTH PROFESSIONAL AND A
CLIENT OR PATIENT
I, __________________, hereby consent to a sexual
relationship with _____________________ (Provider), a
licensed _________________, whose client/patient I am or
have been for the purpose of _________________.
In granting this consent, I understand that, although
some such relationships are successful, all relationships
between health care professionals and patients or clients
carry great risk. Such involvement may be accompanied by
personal degradation by the Provider, criticism of my
relationship with-my current partner, and encouragement to
isolate myself from other personal involvements. I
understand also that the Provider may not be in a monogamous
relationship with me and that he/she is likely to suddenly
terminate the relationship.
I understand that my entering this relationship may
involve the forsaking of moral values to which I have
previously adhered with strong conviction. I
understand that my feelings toward this Provider may be
based on a symbolic attraction, also known as transference,
in that these feelings may be less related to my knowledge
and understanding of him/her as a person than to his/her
representation to me as a powerful, trustworthy, dependable,
parental figure who can provide for my physical and/or
emotional needs. I understand also that the Provider's
feelings toward me may be based on a similar symbolic
attraction, also known as countertransference. I
understand that my dependence on this Provider may
compromise my ability to fully understand the basis of my
feelings toward him/her or my ability to terminate the
relationship even after I am no longer comfortable with it.
I understand that by engaging in this sexual relationship
with me, this Provider may be violating his/her code of
professional ethics as well as certain laws of the state in
which he/she is licensed.
I understand that a sexual relationship with this
Provider may ultimately have extremely damaging consequences
for me including, but not necessarily limited to, feelings
of betrayal, helplessness, anger, confusion, guilt, and
depression, that these feelings could result in a need for
psychiatric care beyond that which may have been necessary
in the past, and that these feelings could possibly result
in my suicide.
I understand that the anger and distrust that I may
develop toward this Provider may generalize to other health
care providers or even to all people of the same gender as
this Provider.
In expressing these feelings to others, I may find that I
derive little understanding or sympathy from present or
future partners, members of my family, my friends,
co-workers, or even helping professionals. I understand
further that disclosure of my sexual involvement with this
Provider may result in my estrangement from some or all of
these people, further increasing my feelings of loneliness,
confusion, and guilt.
I understand that all of the aforementioned risks have
been documented in previous sexual relationships between
health care providers and their clients/patients.
I assert that these risks have been fully explained to me
by a knowledgeable health professional other than the
Provider, that I am willing to accept these risks, and I
freely and willfully give my informed consent to said sexual
relationship.
Signed this _____ day of _____________, ____.
__________________________ |
REFERENCES
- Edelwich, J., & Brodsky, A. (1991). Sexual
dilemmas for the helping professional, revised and
expanded edition. New York: Brunner/Mazel.
- Feldman-Summers, S. (1989). Sexual contact in fiduciary
relationships. In G. 0.Gabbard (Ed.), Sexual
exploitation in professional relationships (pp.
193-209).Washington, DC: American Psychiatric Press.
- Luepker, E.T. (1989). Sexual exploitation of clients by
therapists: Parallels with parent-child incest. in G. R.
Schoener, J. H. Milgrom, J. C. Gonsiorek, E. T. Luepker, &
R. M. Conroe (Eds.), Psychotherapists'
sexual involvement with clients: Intervention and prevention
(pp. 73-79). Minneapolis, MN: Walk-In Counseling Center.
- Peterson, M.R. (1992). At
personal risk: Boundary violations in professional relationships.
New York: W.W. Norton & Co.
- Pope, K.S. (1994). Sexual
involvement with therapists: Patient assessment, subsequent
therapy, forensics. Washington, DC: American
Psychological Association.
- Rutter, P. (1989). Sex
in the forbidden zone. New York: Fawcett Crest.
---
Copyright © 1995, American Association of Sex Educators,
Counselors, and Therapists.
Reprinted from the Journal of Sex Education and Therapy, 1995, with
the Author's permission.
Address correspondence to S. Michael Plaut, Ph.D., Department of
Psychiatry University of Maryland School of Medicine 22 S Greene St
-- Box 351 Baltimore MD 21201
410-706-7476 Fax: 410-706-8311 mplaut@som.umaryland.edu
|
Disclaimer
Exploitation
