Ethical Perspectives: Sexual Boundary Issues and the Chiropractic Paradigm
Authors Stahl, Michael J and Foreman Stephen M Published by Lippincott Williams and Wilkins
Reviewed June 15, 2005 by Bill Moreau, DC, DACBSP
This important book is relatively brief at 123 pages and 13 chapters, but it is not short on timeliness or importance of content. The text references the alarming high statistics of professional boundary violations within the chiropractic profession. Fortunately this reference also provides a number of answers to the questions that need to be asked in regards to professional boundary violations.
The writers do a fine job of logically organizing the materials and presenting a very readable fashion. Ethical Perspectives provides an objective analysis of the literature available sexual boundary issues within the chiropractic profession. The authors provide insight into possible reasons why the incidence of boundary infractions is higher within our profession. Some of the reasons presented for the increased incidence offered included physical contact with patients, length of time of the office visit and the number of patient encounters or office visits. Another very interesting element identified in the text is related to the terms “transition zone”. The transition zone is the location and timing within the treatment area where most infractions occur. The transition zone timing occurs when the actual care for the office visit is completed and the location is between the treatment table and the door of the treatment room.
The ethics of doctors dating or having relationships with current or former patients is a subject that Drs. Stahl and Foreman identify as meriting serious consideration. Most if not all doctors correctly identify sexual relationships with patients as an unethical and unprofessional activity. Regulatory boards have not identified a uniform time when the balance of power is restored and it is acceptable for a doctor and a former patient to date. The discussion of when the imbalance of power between a doctor and a former patient is equalized in relation to dating and sexual contact was an interesting appraisal. The authors’ offer a weighted system of evaluating if a relationship between a doctor and a former patient is acceptable or inappropriate.
The chapter devoted to preventing false allegations and actual boundary violations from occurring provides concise information readers can immediately apply for safer practices and procedures in their offices. Several interesting facts and ideas are offered. It was surprising that 70% of sexual misconduct is initiated by the patient and not surprising that the doctor is always responsible for preventing inappropriate activities from occurring. The no nonsense approach to a doctors behavior will assist the reader in quickly derailing inappropriate advances from a patient.
As previously mentioned the high incidence of boundary violations within the chiropractic profession alone makes this text a must read for all chiropractic students, chiropractic faculty and doctors of chiropractic. This very readable concise reference also provides a method of reducing these violations by providing meaningful suggestions and recommendations that should be applied by all practitioners involved in health care.