Doctors and sex

Issue: BCMJ, vol. 47 , No. 1 , January February 2005 , Pages 4-6 Editorials

At a 2004 meeting of the Canadian Bar Association, the attendees voted against official censure of any member who participated in a sexual relationship with a client. The thinking apparently is that there is a far different potential power differential between lawyers and clients than there is between physicians and patients. I believe that there was an admonition to lawyers that if there was recognizable power differential between themselves and a vulnerable client, the Bar expected the member to do the “honorable thing.” In the instance where a lawyer acted injudiciously on a predatory urge, there seems to be some sense that the Bar would not like this and some action of some sort might result.

This approach is somewhat different than that of the College of Physicians and Surgeons of BC (CPSBC) and their affiliates around the country as they collectively have made it clear that there is no wiggle room for physicians who enter into a sexual relationship with a past or present patient. The ethical/moral basis for this is obvious and the fact that there seems to be no acceptable time line for a “past patient” is also understandable, but less so when made as a general policy statement with no “exceptional” caveats.

The one-physician town has been trotted out many times as a possible exception to this universal proclamation. Disagreeing physicians continue to argue that where the town doc sees everyone in the town professionally at some point there seems to be little thought given to the kind or number of professional interactions between the physician and the patient. It also seems that short shrift is given to the possibility that the town’s only doc could be a morally/ethically centred physician, and he or she is summarily directed not to establish a personal relationship with any town resident irrespective of the type of professional interaction between the two. The suggestion is that the doc should travel to another town and establish a relationship. However, I doubt that our ethical shepherds spent much time on the logistics of establishing a lasting, loving, physically compatible relationship over a long weekend. Call me a pessimist but I doubt this has worked out satisfactorily in many instances. In very isolated communities it is often extremely difficult to “get out” and get coverage, especially in the winter, so what does the young, healthy professional do? Perhaps the answer (besides becoming very skilled at sublimation) is to ensure that only happily married docs with at least one child should be allowed to work in small, isolated communities. However, what if they divorce, the spouse dies, or the doc decides to move to another small town but the spouse decides to remain behind (permanently) for whatever reason and resides in the only nearby town? Obviously, this is all suggested with a large component of tongue in cheek, but we shouldn’t ignore the likelihood that more unattached young physicians will be moving into our smaller rural communities in the next few decades if the new medical school site at UNBC is as successful at solving our rural communities’ medical personnel crisis as everyone hopes. These kinds of dilemmas will likely become more commonplace as more homegrown, unattached, young physicians begin their practice-life fully committed to the lifestyle offered by their rural communities of choice. It is in everyone’s best interest that we have the rules properly and prudently thought out before the Canadian Human Rights Commission has to figure it all out for us.

Pondering all the permutations and combinations of this question is about to give me a three-Excedrin headache. However, the bits I find most interesting are the possible scenarios where lawyers and doctors interact professionally. For instance, what about the scenario where a lawyer is acting as a physician’s legal counsel and he or she responds to an amazingly high concentration of ambient pheromones by salving a natural drive with repetitive peccadilloes? The scenario at this point certainly wouldn’t make the Canadian Bar Association mad as there doesn’t appear to be any power inequity between the two, but what if at some point the lawyer had bronchitis and sought the professional advice and followed the recommended treatment of the same physician? The whole ethical situation now changes and the physician member of this duet is in contravention of a code of conduct and is liable for official censure. What if, in addition, the relationship sours for whatever reason and passion is replaced by acrimony. At this point, the lawyer can go to the CPSBC and lay an official complaint against the physician who would be forced to hire another lawyer in order to defend the action. Whether the action would be successful is immaterial as just the notice of the action can be extremely stressful for most physicians. The physician could try laying a similar complaint against the lawyer, I suppose, but the Canadian Bar Association—per their latest directive on this matter—would be quite unlikely to take it any further in the absence of any evidence of unprofessional conduct on the part of the lawyer.

At first glance this professional inequity seems patently unfair, but perhaps the lawyers have it right. Most legislation is crafted by lawyers and most legislation these days seems to have a modicum of common sense. I wonder if we should take a page out of the our legal colleagues’ book and look at this question again and perhaps add some common sense to the ethical rigidity of the existing conduct directive. This kind of approach just may keep a future young doctor in a community—a community that desperately needs a long-term commitment by a properly trained rural physician who won’t have to fear that someone will find out about the relationship with the local lawyer and report it to the College.

—JAW

James A. Wilson, MD. Doctors and sex. BCMJ, Vol. 47, No. 1, January, February, 2005, Page(s) 4-6 - Editorials.



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