Abstract
To the Editor
The College has released a policy stating that it will not allow reinstatement of any fellow, trainee or affiliate who has been expelled following the imposition of ‘… registration/removal conditions by [a] Medical Board because of a proven sexual boundary violation’ (Royal Australian & New Zealand College of Psychiatrists, 2011). The rationale for this so-called ‘zero tolerance policy’ is far from clear and its wisdom is dubious.
Australasian medical boards, councils and tribunals may remove a doctor’s registration or place conditions upon that registration to protect the general public. Though there is no clear statement that sets out the College’s rationale for the new policy, its intent is also apparently protective. The document reaffirms that the College is ‘… working … to achieve the best attainable quality of psychiatric care …’ and ‘… seeks to cultivate and maintain the highest ethical standards’. The policy is ‘… intended to raise conscious awareness amongst psychiatrists about the significant unethical nature of conduct associated with committing boundary violations …’ (Royal Australian & New Zealand College of Psychiatrists, 2011).
There are strong arguments to support the notion that sexual boundary violations with current or former patients are unethical (Ryan and Anderson, 1996). The College was already unambiguous about this (Royal Australian & New Zealand College of Psychiatrists, 2010). Few psychiatrists can be ignorant of the College’s position and it seems very unlikely that many new instances of patient–therapist sex could be sheeted home to such ignorance. Even to the extent that ignorance may be an issue, the release of such a policy with little or no fanfare seems an ineffectual awareness-raising exercise.
The medical boards will allow doctors to continue to practise with conditions or restart practice after suspension if there is good reason to believe that the public is protected from further professional misconduct. It is hard to see why the College’s criterion for reinstatement of membership should be different. Surely, those of our colleagues who have fallen from grace but who are now deemed unlikely to reoffend will be less likely still with the added protection College membership affords?
The zero tolerance policy is wrong. It claims to raise awareness but will have no such effect. It risks using medical board findings in a punitive manner for which they are not intended. Far from protecting patients it may place them at higher risk. Possibly most disturbing of all though, it contributes to the prevalent and comfortable notion that patient–therapist sexual contact is the problem of irredeemably bad apples that require detection and rooting out. The reality, of course, is much more complicated. This simplistic, hard-line policy prevents the College from addressing individual cases with utility, subtlety or compassion. It should be abandoned.