Published in August 2002

The Ethics Bureau recently addressed the case of a doctor charged with the sexual harassment of a woman who was his patient.

The court protocol indicated that, “as the complainant was leaving the clinic, after she began to open the door with one hand and sent the doctor a kiss with the other hand, the defendant kissed the complainant on the mouth and with one of his hands held her breast, without her consent.”

The court sentenced the doctor to six months conditional discharge for three years, a fine of 1,500 NIS or 20 days imprisonment, monetary compensation in the sum of 2,000 NIS to The Fund for Sexual Assault Victims and 100 hours community work.

The members of the Ethics Bureau maintained that disciplinary measures should also be imposed from an ethical perspective on a doctor found guilty by the court of sexual harassment of a patient. A committee comprised of three members was selected, met with the doctor and heard his version of the case. Upon completing the meeting and after deliberating the issue the committee decided by majority vote to punish the doctor. The Ethics Bureau plenum approved the committee recommendations as follows:
 

1. The convicted doctor will be expelled from the IMA for a period of three months.
2. The court’s decision, as well as the Ethics Bureau’s disciplinary measures, will be publicized.
3. The name of the convicted doctor will not be publicized.

In its decision, the Ethics Bureau set an important precedent, despite the seemingly light punishment it imposed on the doctor. The Bureau’s decision sent out a message that the medical profession condemned such behavior and that it would not hesitate to remove from its midst doctors charged with sexual offences in their relations with their patients.

Concomitant with and following this case, the Ethics Bureau plenum conducted a fundamental discussion regarding sexual relations between a doctor and a patient, also addressing cases in which the relations do not have an element of “assault”, but rather purported “agreement” on the part of the patient.

The basic assumption is that with respect to the doctor-patient relationship, there cannot be, in fact, full and genuine agreement on the part of the patient to have sexual relations with the doctor, since the balance of power between them is not equal. There is unilateral dependence of the patient on the doctor. This is particularly so in psychiatry and gynecology, where emotional or physical intimacy is created between doctor and patient. Studies indicate that approximately 10% of the doctors report conducting sexual relations with a patient. Other studies clearly show emotional harm caused to patients as a result of such a relationship.

In a well-known study, psychiatrists were asked about patients currently in their care, who were exposed to sexual relations with a doctor in the past. An absolute majority of the doctors maintained that these prior relations harmed the patient, but only a small minority reported the matter to the authorized entity. As a matter of course, doctors defend their colleagues.

As members of the medical profession in Israel, we must set appropriate standards with respect to the intimate dimension between doctor and patient. We must ensure that these rules are widely publicized and, if necessary, to enforce them. The rules formulated by the IMA Ethics Bureau with respect to sexual relations between doctor and patient aim to meet this need.
 

1. A sexual relationship between a doctor and a patient in his care is unethical, may cause harm to the patient, and is therefore prohibited.
2. Sexual relations between a doctor and a patient that was under his care in the past may also be unethical and cause harm to the patient. Therefore, a cooling-off period of at least one year is required prior to conducting a sexual relationship between a doctor and a patient that was under his care.
3. A sexual relationship between a doctor and a patient that was in his care is unethical at any time if, during the course of the treatment, the doctor abuses trust, information, feelings or influence acquired during the professional relationship between the doctor and the said patient.
4. Prior to conducting a romantic or sexual relationship with a patient that was in his care, a doctor must consider the potential negative effect of this relationship on the patient’s emotional state. In case of doubt, it is recommended that the doctor consult a colleague.
5. Should a doctor become aware of a sexual relationship, as specified in clause 3, between a patient in his care and another doctor, he must report the matter to the relevant authority, subject to receiving the approval of the patient to reveal the matter. The doctor should encourage the patient to report the sexual relationship conducted with the other doctor at his own initiative.
    

*  For the reader’s convenience, the text is written in the masculine, but applies equally to both men and women.