Skip to content

Consultation on Standard of Practice - Maintaining Professional Boundaries: Sexual & Personal

Thank you for taking the opportunity to provide feedback on our draft Standard of Practice.

Your input will inform the Standard of Practice and ensure that it:
  • reflects current practice issues,
  • embodies the duties of medical professionalism, and
  • is consistent with the College’s mandate to act in the public interest.
Please note: All feedback collected through this survey is anonymous.

A complete copy of the draft Standard of Practice can be found HERE. We encourage you to review the draft prior to completing this survey.
1.Which best describes you? (select all that apply)
2.The draft Standard of Practice states:

The College has issued a Standard of Practice which details the specific and limited circumstances in which a College Registrant may provide care to a member of their family, and/or someone with whom they are in an intimate relationship, so long as the personal relationship began before the College Registrant treated the individual. This Standard of Practice on Maintaining Personal Boundaries – Sexual & Personal is not intended to prevent a College Registrant from being able to treat family members or others close to them within the limitations set out in that Standard of Practice.

Are these expectations clear and reasonable?
3.The draft Standard of Practice states:

A "Patient" is defined as follows:

an individual who has formed a professional relationship with a College Registrant. Indicators include where the College Registrant has engaged in one or more of the following activities:
  1. gathered clinical information for the purpose of making an assessment;
  2. provided professional advice, treatment, counselling or a diagnosis for the individual;
  3. authored a medical record for the individual;
  4. charged or received payment for professional services to the individual;
  5. prescribed a drug to the individual; or
  6. provided other services which are typically associated with a professional relationship.
Are these expectations clear and reasonable?
4.The draft Standard of Practice states:

College Registrants must:
  • not engage in, attempt to engage in, or invite a patient to engage in, any form of sexual contact or activity.
  • not accept any form of sexual advance made by a patient.
  • not socialize or communicate with a patient for the purpose of pursuing an intimate relationship.
  • not terminate a professional relationship for the purpose of pursuing an intimate relationship with the patient.
  • not enter into an intimate relationship with a person with whom a patient has a significant interdependent relationship (examples include, but are not limited to parent/guardian of a minor patient, significant other of a patient, substitute decision maker of an incompetent patient).
  • not make sexual comments about a patient’s body, appearance, or clothing.
  • not engage in any behaviour, gesture, expression, or comment that is sexualized, seductive, or sexually suggestive to a patient.
  • not make comments to a patient regarding their own sexual experiences or preferences.
  • not ask questions or make comments about a patient’s sexual history, sexuality, gender identity, or performance except where it is pertinent to the medical care being provided. In circumstances where the patient may not understand why a question relating to these topics is pertinent to their medical care, the Registrant should explain the rationale for the question in advance of asking.
Are these expectations clear and reasonable?
5.The draft Standard of Practice states:

College Registrants must only examine or touch a patient’s genital area, perianal area, or breasts:
  • when it is medically necessary.
  • after first obtaining the informed consent of the patient.
  • using examination techniques which are generally accepted and recognized by the medical profession.
Are these expectations clear and reasonable?
6.The draft Standard of Practice states:

College Registrants must show sensitivity and respect for a patient’s privacy and dignity by:
  • providing privacy when a patient dresses or undresses.
  • providing a gown or drape during a physical examination or procedure if clothing needs to be removed.
  • only exposing the area of the patient’s body specifically related to the physical examination or procedure.
  • only assisting a patient with the adjustment or removal of clothing or draping if the patient agrees or requests the College Registrant to do so.
Are these expectations clear and reasonable?
7.The draft Standard of Practice states:

For the purposes of sexual boundary violations, an individual remains a “patient” for a reasonable period after the date the individual ceased to be under a College Registrants’ care. The College will presume that a professional relationship will persist for a minimum of one year from the date the patient ceased to be under the College Registrants’ care. Exceptions to this presumption may include circumstances where all the criteria below are met:
  • episodic care was provided;
  • a reasonable person would not expect that care would extend beyond the episode; and
  • there is a minimal risk of exploitation of any trust and dependence of the patient.
Are these expectations clear and reasonable?
8.The draft Standard of Practice states:

Some former patients may be considered vulnerable former patients. For some, the degree of vulnerability is such that they will always be considered a vulnerable former patient. For others, their degree of vulnerability may lessen with the passage of time after the termination of the professional relationship.

The following factors must be taken into consideration when assessing whether a former patient is a vulnerable former patient:
  • length and nature of the professional relationship;
  • nature of the patient’s health concerns;
  • extent to which the patient has confided personal and sensitive information; and
  • vulnerability that the patient had in the professional relationship.
A College Registrant must not engage in sexualized interactions with a patient who would reasonably be considered a vulnerable former patient.

Are these expectations clear and reasonable?
9.The draft Standard of Practice states:

A College Registrant who has had a significant psychotherapeutic relationship with a patient must not engage in sexualized interactions with that patient at any time during or after the relationship has ended.

Significant psychotherapeutic relationships include, but are not limited to:
  • a professional relationship between a psychiatrist and their patient;
  • any professional relationship between a College Registrant and their patient where the College Registrant has provided therapeutic counselling or treatment to the patient for mental health issues beyond what would reasonably be expected as supportive advice or comments related to the provision of medical care to the patient.
Are these expectations clear and reasonable?
10.The draft Standard of Practice states:

College Registrants must:
  • not give gifts to, or receive significant gifts from, a patient;
  • not enter into a business relationship with a patient;
  • not lend money to, or borrow money from, a patient;
  • not enter into financial or legal obligations for, or on behalf of, a patient (other than obligations related to the professional services provided by a College Registrant);
  • not solicit patients to make donations to charities or political parties;
  • not promote their own personal, political, or religious beliefs or causes to a patient in the context of a professional relationship; or
  • not engage in other conduct not specifically identified above but which, nonetheless, viewed from the perspective of the reasonable patient, crosses a personal boundary and is contrary to the spirit and intention of this Standard of Practice as a whole.
Exceptions

The College recognizes that living and practicing in a remote community can present unique circumstances. While avoiding every social and business interaction is not necessary, College Registrants who are in these circumstances must use their best judgment to manage relationships appropriately so that patient care is not compromised. College Registrants must be aware of the increased risk associated with managing dual relationships, including the potential for distorted professional judgment and/or unreasonable patient expectations, which can be difficult to navigate.

Are these expectations clear and reasonable?
11.Are there any gaps in the draft Standard which you think we should address?
12.Please share any additional comments and/or concerns you have about the draft Standard.
13.Please feel free to answer the following additional questions regarding your demographics.

Information collected will allow us to ensure we have reached a diverse group of survey respondents and identify any trends.

Optional Question 1: In which NL Health Services zone or geographic region do you practice?
14.Optional Question 2: How do you identify?
15.Optional Question 3: Which category includes your age?