Patients are often accompanied by third parties who play an integral role in the patient-physician relationship, including, but not limited to, spouses or partners, parents, guardians, or surrogates. Sexual or romantic interactions between physicians and third parties such as these may detract from the goals of the patient-physician relationship, exploit the vulnerability of the third party, compromise the physician’s ability to make objective judgments about the patient’s health care, and ultimately be detrimental to the patient’s well-being.

CME course: Boundaries for physicians

This e-learning module will help physicians identify and understand how to maintain boundaries with their patients as well as boundaries for treating family, self and colleagues. 

Third parties may be deeply involved the in the clinical encounter and in medical decision making. The physician interacts and communicates with these individuals and often is in a position to offer them information, advice, and emotional support. The more deeply involved the individual is in the clinical encounter and in medical decision making, the stronger the argument against sexual or romantic contact between the physician and a key third party. Physicians should avoid sexual or romantic relations with any individual whose decisions directly affect the health and welfare of the patient.

For these reasons, physicians should refrain from sexual or romantic interactions with key third parties when the interaction would exploit trust, knowledge, influence, or emotions derived from a professional relationship with the third party or could compromise the patient’s care.

Before initiating a relationship with a key third party, physicians should take into account:

  1. The nature of the patient’s medical problem and the likely effect on patient care.
  2. The length of the professional relationship.
  3. The degree of the third party’s emotional dependence on the physician.
  4. The importance of the clinical encounter to the third party and the patient.
  5. Whether the patient-physician relationship can be terminated in keeping with ethics guidance and what implications doing so would have for patient.
AMA Principles of Medical Ethics: I, II

Code of Medical Ethics: Sexual boundaries

Visit the Ethics main page to access additional Opinions, the Principles of Medical Ethics and more information about the Code of Medical Ethics.

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