Dr. MacIntyre is a Fellow in the Forensic Psychiatry Fellowship Program, University of California, Los Angeles, California. Dr. Appel is Assistant Professor of Psychiatry and Medical Education, Director of Ethics Education in Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Acad Psychiatry Law. 2020 Jun;48(2):166-175. doi: 10.29158/JAAPL.003911-20. Epub 2020 Feb 12.
When a patient reports a sexual relationship with a prior provider during treatment, a psychiatrist or therapist must balance conflicting ethics principles of autonomy, confidentiality, and social justice in deciding whether to report this behavior to the proper authority. Many states have statutes regarding such reporting that are unclear or ambiguous; others lack laws entirely. We surveyed state laws and contacted state medical boards to clarify each state's position on mandatory reporting of sexually exploitive psychiatrists, specifically when the patient reveals the exploitation during treatment. Our results showed that only 5 state legislatures have explicitly addressed this matter. Of the remaining states, 18 require reporting through a patchwork of laws and policies, and the other 27 states and the District of Columbia have no laws that require reporting a colleague if a patient discloses a past sexual relationship. In this article, we examine the different approaches and considerations taken by state legislatures and medical boards in addressing this concern.
当患者在治疗过程中报告与之前的提供者存在性关系时，精神科医生或治疗师必须在平衡自主、保密和社会公正等相互冲突的伦理原则的基础上，决定是否将这种行为报告给适当的当局。许多州都有关于此类报告的法规，但这些法规并不明确或存在歧义；还有一些州完全没有法律规定。我们调查了州法律，并联系了州医疗委员会，以澄清每个州在强制报告性剥削精神科医生方面的立场，特别是当患者在治疗过程中透露这种剥削行为时。我们的结果表明，只有 5 个州立法机构明确解决了这个问题。在其余的州中，有 18 个州通过法律和政策的拼凑要求报告，而另外 27 个州和哥伦比亚特区没有要求报告同事的法律，如果患者披露过去的性关系。在本文中，我们研究了州立法机构和医疗委员会在解决这一问题时所采取的不同方法和考虑因素。
