Patterns of Egregious Physician Sexual Misconduct Require Ethical Response
June 1, 2022 4 minutes read
Multiple egregious cases of physician sexual misconduct have occurred at prominent public and private institutions in recent years.1,2 In a recent paper, Kunal Sindhu, MD, a New York City-based radiation oncologist, and colleagues offered recommendations to prevent physician sexual misconduct.3
If the perception is highly publicized cases of sexual misconduct go unpunished, Sindhu says this could erode public trust of physicians generally. When physicians take advantage of vulnerable patients, Sindhu says this is a violation of nonmaleficence, beneficence, and autonomy. Likewise, physicians’ fiduciary responsibilities to patients are compromised. Sindhu notes although those accused of sexual misconduct are entitled to due process and the presumption of innocence until proven guilty, all cases must be taken seriously and investigated thoroughly.
Ethical arguments against physicians engaging in sexual misconduct “have been understood since at least the time of Hippocrates,” says Patricia King, MD, PhD, professor of medicine at the Larner College of Medicine at the University of Vermont and past chair of the Federation of State Medical Boards (FSMB).
Sexual misconduct has been a central topic of FSMB annual educational conferences since the 1980s. “A 2020 report featured the largest number of recommendations ever put together by the FSMB, demonstrating the determination of the FSMB and its member boards to address physician sexual misconduct,” says King, who co-authored a paper outlining the group’s recommendations.4,5
King recommends clinicians report instances of misconduct when they witness them, have a reason to believe misconduct has occurred, or if patients may be at risk. Hospital administrators should report instances of sexual misconduct to state medical boards, addressing allegations swiftly and transparently. Ethicists can help physicians understand their ethical duties in relation to sexual misconduct by “translating” ethical principles into what it means for the physician’s practice.
“If a physician is able to express the implications of sexual misconduct for patient autonomy, beneficence, nonmaleficence, and informed consent, the hope is that they will be less likely to engage in such misconduct and more likely to contribute to its elimination,” King explains.
Suggestions for preventing sexual misconduct often include encouraging patient reporting and allowing anonymous staff complaints. However, such well-meaning approaches are ethically problematic because it places more burden on the victims, according to Gianna McMillan, DBe, acting graduate director and program administrator of the Loyola Marymount University Bioethics Institute. “Healthcare providers must hold themselves and their colleagues to the highest standard of ethical behavior, and state medical boards must consistently and assertively hold wrongdoers accountable,” McMillan says.
This does not always happen, in part because state medical boards are independent. These boards define terms differently, assign different weights of culpability to behaviors, and do not confer with each other on the complaint records of state-licensed physicians. “In other words, each state does not necessarily know if their physicians have had complaints lodged against them in other states,” McMillan explains.
James M. DuBois, DSc, PhD, has studied more than 100 cases of sexual abuse by physicians.6 “Sadly, most cases involve abuse of multiple patients across several years. It is very hard to prevent an initial incidence, but we can do much better at preventing repeated incidences,” says DuBois, who helped develop recommendations for improving physician training and oversight.7
Too many institutions have allowed an individual to resign quietly without conducting an investigation. How the incident is reported matters as well.
“When abusive behavior is reported to the National Practitioner Data Bank or other bodies, reporting needs to be specific,” says DuBois, executive director of the Bioethics Research Center at Washington University School of Medicine in St. Louis.
Often, institutions report egregious wrongdoing using vague terms or checking boxes stating “other” without specifying the behavior at issue. “This is harmful insofar as it allows perpetrators to move to new locations and continue old patterns of abuse,” DuBois notes.
Sadly, education alone will not prevent abusers from committing sexual misconduct initially. “But education can prepare colleagues to be vigilant and to speak up,” DuBois says.
Colleagues, especially those who may serve as chaperones, must be trained on what constitutes appropriate care, how to establish and maintain a line of sight, how to speak up if they observe something questionable, and where to report concerns. “Ethicists could play a role in teaching some of these things, as well as reminding professionals about the importance of consent,” DuBois offers.
REFERENCES
- Rabin RC. After years of sexual abuse allegations, how did this doctor keep working? The New York Times. Oct. 11, 2021.
- Dolan J, Mejia B, Christensen K. These doctors sexually abused patients. The medical board gave them their licenses back. Los Angeles Times. Dec. 15, 2021.
- Sindhu KK, Schaffer AC, Cohen IG, et al. Honoring the public trust: Curbing the bane of physician sexual misconduct. J Law Biosci 2022;9:lsac007.
- King PA, Chaudhry HJ, Staz ML. State medical board recommendations for stronger approaches to sexual misconduct by physicians. JAMA 2021;325:1609-1610.
- Federation of State Medical Boards. Report and recommendations of the FSMB workgroup on physician sexual misconduct. May 2020.
- DuBois JM, Walsh HA, Chibnall JT, et al. Sexual violation of patients by physicians: A mixed-methods, exploratory analysis of 101 cases. Sex Abuse 2019;31:503-523.
- DuBois JM, Anderson EE, Chibnall JT, et al. Preventing egregious ethical violations in medical practice: Evidence-informed recommendations from a multidisciplinary working group. J Med Regul 2018;104:23-31.
If the perception is highly publicized cases of sexual misconduct go unpunished, this could erode public trust of physicians generally. Although those accused of sexual misconduct are entitled to due process and the presumption of innocence until proven guilty, all cases must be taken seriously and investigated thoroughly.
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