Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we'll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel's 2019 book, :
Rita is a 57-year-old woman in outpatient therapy with a veteran psychiatrist, Roy Stockmann, MD. Rita reveals to Stockmann that she has had only one fulfilling romantic relationship in her entire life. Fifteen years ago, she had gone to a different outpatient psychiatrist, Dan Praetorius, MD, for treatment of social anxiety.
After a month of weekly therapy with Stockmann, she relates to him that Praetorius told her, "I can't continue to treat you, because I find you too attractive. But I would love to start seeing you romantically." The pair then dated clandestinely for two years, until Praetorius broke off the relationship. Rita believes that he "fell in love" with another patient, although she cannot prove this.
She has no regrets about her relationship with Praetorius, except that it ended, and demands that Stockmann not share her secret.
Sexual relationships between psychiatrists and patients or former patients are considered malpractice and often result in the physician losing his or her license. Praetorius was a leading psychiatrist in the community, but he has recently retired and no longer sees patients. Nevertheless, his license remains active and he continues to serve on various committees and advisory boards.
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases:
Refuse Treatment for Dictator?