Sleeping with the past: the ethics of post-termination patient-therapist sexual contact

Psychiatry and online social media: potential, pitfalls and ethical guidelines for psychiatrists and trainees

OBJECTIVE

This paper proposes ethical guidelines for psychiatrists and psychiatry trainees when interacting with social media.

METHODS

A three-stage process was followed in the development of these guidelines. A literature review provided situations and possible broad rules as to how social media could be ethically engaged. A roundtable discussion by a panel of invited psychiatrists, psychiatry trainees, psychologists, e-health practitioners, lawyers and consumers was held to discuss the situations and to better formulate the ethical principles upon which psychiatrists could act. These vignettes and principles were then broadly discussed at a seminar held at the 2011 RANZCP Congress. Finally, this paper was circulated to the original invitees for final comment.

RESULTS

A set of recommendations for working with social media were developed.

CONCLUSIONS

The new social media provides important avenues for communication, education and treatment. These avenues pose ethical and practical dilemmas that can be resolved by the application of established ethical principles. Practical recommendations for navigating social media are proposed.

Sex, honesty and the supervisory relationship: a response to Ryan

OBJECTIVE

An argument has been presented in this journal for a generally permissive attitude to consensual sexual relations between psychiatrists and trainee psychiatrists except in circumstances where there is a direct supervisory relationship. This paper challenges that view.

METHOD

The arguments are reviewed. A developmental perspective of training is used to show that the autonomy of trainees is restricted in a manner similar to a student in relation to a teacher. This confers on psychiatrists a duty of care.

RESULTS

On the basis of respect for autonomy, the strength of argument for a prohibition on consensual sexual relationships is strong for a young trainee, and weakens as a person proceeds through training and approaches the status of a colleague. A policy of restraint would facilitate the development of a general atmosphere of trust, which is an important requirement for good supervision and the basis of professional relationships. An ethical judgement cannot be made, however, without the consideration of other relationships and commitments existing outside the supervisory relationship for each person involved.

CONCLUSIONS

In order to create a secure and unambiguous training environment that maximises trust, a general principle of prohibition on sexual relationships between psychiatrists and trainees is preferred, although circumstances exist where such relationships are not unethical.

Sex, lies and training programs: the ethics of consensual sexual relationships between psychiatrists and trainee psychiatrists

OBJECTIVE

The aim of this paper is to chart the ethical territory surrounding the issue of consensual sexual relationships between psychiatrists and doctors training in psychiatry.

METHOD

The arguments for and against the prohibition of such relationships are critically examined both in general and in a number of specific circumstances.

RESULTS

There should not be a general prohibition against such relationships, but a prohibition should apply in certain special circumstances. Such circumstances include occasions when the psychiatrist is currently supervising the trainee, when a particular psychiatrist has repeated sexual relationships with trainees and when a group of psychiatrists voluntarily pledge to abstain from such relationships.

CONCLUSIONS

Institutions involved in psychiatric training should develop guidelines for dealing with such relationships, adopting a generally permissive attitude toward them with clear exceptions in special cases.