Doctor-Patient Sex

Doctor-patient sex is in the news again.

Here's a report from the Texas Medical Board about an action it took against Dr. Kenneth Baird, a family practitioner in Plano, Texas (see here and here for information about Dr. Baird)

On April 3, 2009, the Board and Dr. Baird entered into an Agreed Order requiring that, within one year, he complete the professional boundaries course offered by Vanderbilt University or the University of California San Diego Physician Assessment and Clinical Education (PACE) program; that for each of the next two years he obtain 10 hours of continuing medical education in ethics; and that within 180 days he pay an administrative penalty of $10,000. The action was based on Dr. Baird’s having had a sexual relationship with a patient.

Two things interested me about Dr. Baird's situation. First, he's not a psychiatrist! It's a relief not to have one more sorry example of misconduct from my own specialty. Second, the case points us to an important question - if sex between doctor and patient is seen as wrong, what makes it wrong?

The common answer is that sexual involvement harms the patient. We know from individual cases that this is often true. But even if doctor-patient sex is harmful in 99% of the cases, it's hard to see why it is always harmful. And if we can identify or imagine situations where it is not harmful, does that make those situations ethically acceptable?

In 2008 the Texas Medical Association rendered an opinion that appears to make use of emotions or insights derived from the doctor-patient relationship the key factor:

SEXUAL MISCONDUCT. Sexual contact that occurs concurrent with the patient-physician relationship constitutes sexual misconduct and is unethical. Sexual or romantic relationships with current or former patients or key third parties are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the professional relationship. Key third parties include, but are not limited to, spouses or partners, parents, guardians, or proxies.

Harm to the patient and exploiting the clinical relationship for personal gratification are clearly reprehensible. But since these factors are probably not present in every case they do not provide a basis for an absolute prohibition.

The Texas Medical Association would have done better if they had gone back to Hippocrates:

With purity and with holiness I will pass my life and practice my Art...Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.

Hippocrates based his prohibition of doctor-patient sex on the intrinsic responsibilities of the medical profession, not on the consequences of seducing male or female members of the house the physician entered. As a member of the medical profession the physician professes a set of values. Hippocrates' terms "purity," "holiness" and "for the benefit of the sick" hold up very well after almost 2500 years.

Developing a sexual relationship with a present or former patient tarnishes the profession itself, whatever its effect on the individual patient. Harm to the patient is a probable outcome of doctor-patient sex. But harm to the profession is an inevitable outcome. Patients, the public, and physicians themselves, will lose trust in and respect for the medical profession. Hippocrates explains what's wrong with doctor-patient sex better than the Texas Medical Board does. I hope this is part of the 10 hours of ethics education the Board directed Dr. Baird to take!