Information sheet– Professional Boundaries

The underlying basis of all therapeutic relationships is that the welfare of the patient is paramount and as such, health practitioners should dedicate themselves to meeting the needs of the patient above all.

Although boundary breaches often occur between practitioner and patient, it is also important to consider the need to maintain professional boundaries with colleagues, particularly those who are subject to supervision because of the intrinsic disparity of power in that relationship.

Guidelines for practitioners

The National Boards for almost all health practitioners publish a Code of Conduct, which indicates the standards expected generally in the profession including the expectations regarding professional boundaries.

Professional boundaries with patients

It is accepted without contention that there is an inherent power inequality between a health practitioner and a patient. The vulnerability of a patient may derive from a number of sources including:

• Their mental and physical health, particularly where they have a history of abuse
• Their having entrusted their welfare to the professional
• The fact that they have divulged sensitive personal and confidential information during the therapeutic relationship
• The possibility that physical examinations including intimate examinations may have been carried out

Examples of practitioner-patient boundary breaches:

• Having a personal and/or sexual relationship with a patient (even a former patient)
• Entering into a business venture with a patient
• Lending or giving money to a patient
• Becoming friends with patients on social media websites
• Using home visits as a way to pursue a relationship with another individual who lives there
• Expressing personal beliefs during a consultation to persuade a patient about a particular viewpoint not relevant to the therapeutic relationship or which may distress the patient
• Disclosing confidential or personal information to impress a patient
• Treating or prescribing to family members on an ongoing basis
• Off duty interaction with patients outside of the clinical setting, out of hours
• Seeking references from patients for personal gain such as to respond to a complaint or to solicit further patients/clients.

Temporary departure or more serious transgression

Issues regarding professional boundaries are frequently raised across all health professions and are usually classified into one of the following categories:

1. Boundary crossings: a practitioner oversteps the mark and departs from accepted professional practice in a way that is not of itself exploitative. Multiple transgressions may be the start of a “slippery slope” to inappropriate behaviour which is ultimately not in the patient’s best interests
2. Boundary violations: deliberate behaviours that are exploitative, unprofessional and harmful to the patient. The behaviour will almost certainly undermine the public’s trust in the profession and is likely to result in compromised ongoing care and psychological harm to the patient.

Professional boundaries with colleagues

The expectations around professional boundaries don’t just apply as between practitioners and patients. They extend to professional relationships between practitioners who hold supervisory roles because of the potential to exploit the power imbalance when teaching, mentoring and even writing employment references. In this regard the Australian Medical Association Code of Ethics (2004) expressly states that doctors should “refrain from exploiting students or colleagues under your supervision in any way”.

Patient consent to a relationship

From a heath practitioner’s point of view, there is a common misconception that if a patient consents to a personal or sexual relationship that there can be no moral or ethical wrongdoing. This is not how the regulators view it. In many cases, the patient lacks the objectivity or self-awareness to identify the exploitation. Even where patients have insight, inappropriate relationships are deemed to reduce the trust and confidence held by the public in a profession. As such, regulation in this area derives from the assumption that upholding the integrity of the practitioner-patient relationship is something that warrants external supervision and therefore consent will not be enough to absolve the practitioner.

Is it ever OK to have a personal or sexual relationship with a former patient?

Although personal and sexual relationships between practitioners and patients are viewed in the most serious terms, there is recognition that, in limited circumstances such as in smaller communities such as rural towns, relationships with former patients may be acceptable.

Some of the factors relevant to whether a relationship is perceived as inappropriate include:

• The duration of the professional relationship
• The length of time since the professional relationship was terminated
• The nature of the professional relationship
• The vulnerability of the patient both currently and at the time of the professional relationship
• Any continuing therapeutic relationships with other family members

How can we help?

If you are looking for information or help involving professional boundary issues, we can help you navigate the process.   Our health law team is highly respected in the area, with specialist knowledge accumulated over 25 years.

Our team can assist you by providing expert advice and legal support regarding your options. Contact us today on (02) 4929 3995 or info@catherinehenrylawyers.com.au or visit  www.chpartners.com.au

*The material provided in our information sheets is for general knowledge only and is not a substitute for independent legal advice. For further information about the issues affecting you, please contact one of our experienced and professional lawyers for expert advice.