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Two years after the zero tolerance policy was adopted, the New Zealand Medical Council released a further policy statement in which it stated that whilst complaints regarding sexual relations with former patients will be considered individually, it will be presumed to be unethical if the “doctor–patient relationship involved psychotherapy, or long-term counselling and support; the patient suffered a disorder likely to impair judgement or hinder decision-making; the doctor knew that the patient had been sexually abused in the past; [or] the patient was under the age of 20 when the doctor–patient relationship ended”.This paper presents evidence from international medical and ethical literature to examine the validity of this position taken by the New Zealand Medical Council regarding the sexualization of relationships with former patients.Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not.‘Love in the supermarket', as opposed to ‘love transference', is based more in reality and not propelled to an artificial intensity by an unequal power structure.Thirdly, a discussion of the role of autonomous choice and consent is presented.On the basis of this evidence, it is argued that the circumstances in which such relationships are ethically permissible are extremely limited and that official ‘sanctioning' of these relationships should be very much the exception, not the rule.
These include boundaries of role, time, place and space, money, gifts and services, clothing, language and physical contact.
However, the crossing of boundaries does not necessarily mean that an unethical act occurred: after all, the crossing or erosion of boundaries is a normal part of the evolution of intimate relationships between human beings. Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors.
Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference–counter-transference dyad which occurs in varying degrees in every doctor–patient relationship.
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First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn.