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Running Head: Ethical Issues

Running head: ETHICAL ISSUES




Ethical Issues of Sexual Misconduct



Table of Contents

Sexual Misconduct and Dual Sexual Relationship……………………………….1

            Specific settings and classifications to consider………………………….3

Sexual Misconduct Reality………………………………………………………….4

Unethical Violations for Sexual Misconduct……………………………………….6

The Victims……………………………………………………………………………7



Ethical Issues of Sexual Misconduct

Increasing cases of sexual exploitations and harassment prevailing in all aspects of the professional field is alarming. Different companies and organizations are holding sexual harassment trainings to educate employees about the prevalent causes of such acts. This paper will generally focus on the ethical issues surrounding sexual misconducts. A thorough definition and description will be identified to provide an understanding on what constitutes a sexual misconduct and how it is related to dual sexual relationships and sexual harassment. This paper will focus mainly on ethical concerns about sexual misconduct on the relationship between therapists and patients. This paper will also study the prevalence of such misconduct in the medical field and identify the ethical standards that serve as guides for both patients and therapists. A short enumeration of several ways to identify and avoid this sexual misconduct will also be provided.

Sexual misconduct is generally defined as a range of behaviors that includes sexual harassment, sexual assault and any kind of conduct which is sexual in nature (Yale University Website, 2008). Sexual misconduct generally refers to any unaccepted sexual conduct imposed by a person to another person without any consensus. Sexual misconduct is often described in legal terms as unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct which is sexual in nature (Yale University Website, 2008). It is a known fact that sexual activity is done by people who express consent over a sexual act. However, sexual misconduct is an act that constitutes any sexual activity that is not permitted by any of the two parties involved. Sexual misconduct is also being described as the sexual contact without consent by an acquaintance or a stranger. This may be committed by a person who is not directly related to the victim and is done through an act of force. This forcible act is not only expressed through physical contact but is also expressed verbally such as threats, intimidations or favors.

One of the most unacceptable relationships between a medical practitioner and a patient or client is that of sexual in nature (Gabriel, 2005, p. 22). Dual relationship between a therapist and a client happens when the therapist's professional role is overlapping with the personal relationship with his client (Gabriel, 2005, p. 22). This occurs when a therapist starts showing behaviors or acts beyond the professional limits. An example of this would be when a therapist tries to engage a client into sexual conversations, which are not relevant or related to the therapy session. There is a fine line between helping a patient in a therapist- client relationship and in engaging in a dual relationship, which are often associated with sexual relationships.

Both sexual misconduct and dual sexual relationship are unacceptable practices in the counseling and therapy profession. Based on the given definitions, the difference between sexual misconduct and dual sexual relationship is that dual relationship may eventually lead to dual sexual relationship from which the therapist goes beyond the limits of professional relationship with a client.

Sexual misconduct is often a result of blatant disregard of ethics, limitations and genuine care for the patient. Although majority of high profile cases of sexual misconduct cases are committed by male practitioners, female practitioners do also commit such acts (Benjamin & Sohnen-Moe, 2005, p.127).

Specific settings and classifications to consider

The definition of sexual misconduct may be too complex especially in considering if the act is ethical or unethical. There are three areas in a clinical field for example that leads to sexual misconduct. These are the relationships that are established during the therapy session. These areas include sexual intimacy between a therapist and a current client, former client and between a supervisor and a current supervisee (Avery, 2000, p. 67). Due to consecutive sessions and meetings, a therapist as well as a client may tend to go beyond the therapist- client relationship, which may further develop into an intimate relationship. The frequency of a therapy session and the relationship established between the therapist and the client may affect the outcome of a clinical or therapy process and chances of sexually inflicted acts are at most present.

A sexual misconduct, such as harassment may be considered if the victim was forced to engage in a sexual act without consent. Misconduct is considered when a sexual act is committed by a person that is beyond the limits or boundaries of a therapist-client relationship. Such an act does not only involve physical and intimate relationship; it also involves verbal sexual abuse.

Sexual misconduct is also considered when a practitioner abuses the client's trust to gain sexual advantages. An example of this would be if male physical therapist or a massage therapist may take some time to massage sensitive body parts of a female patient and claim that it is part of the therapy session. Since such therapies involve physical contact, the patient may perceive it as part of a routine procedure when in fact it is not.

Sexual Misconduct Reality

The existence of sexual misconduct in therapy relationships had been prevalent and classified into three types. These are sexual assault, abuse and harassment (Gabriel, 2005, p. 23). Sexual misconduct is often guised in the form of manipulative verbal and physical pressure to patients. Therapists tend to take advantage of a patient's weakness in order to gain sexual favors, up to forcing a patient to have intercourse with them.

The issue on sexual misconduct existed since the time of the Greek Physician Hippocrates in 400 BCE. Hippocrates was the first one to address the sexual misconduct issue and thus, most medical professionals and practitioners use the Hippocratic Oath (Benjamin & Sohnen- Moe, 2005, p.127). The new medical practitioner takes this oath at the beginning of his/her medical apprenticeship. The oath guides medical practitioners such as physicians on their main role especially in giving care of the sick as well as gaining the trust and faith of the patient because a particular medical practitioner's duty is to save lives and promote health and wellness.  With the trust and faith gained from patients and clients, physicians or any medical practitioners are expected to set and maintain professional boundaries between the physician and patient relationships (Benjamin, 2008, p.1). Therefore, the physician who is the stronger party between these relationships is always blamed for incidents related to sexual misconduct.

Sexual assaults especially on patients happen in most places, such as day care centers, nursing facilities and even private clinics and offices. About 70% of sexual assaults that are reported take place in the home of the victims or the perpetrators (Shahidullah, 2008, p. 160). Although the increasing number of cases had been brought to the attention of the legislature, still a large number of undocumented incidents of sexual misconduct pose a great threat not only on the safety of the patients but also to the credibility of medical practitioners. Although there are undefined statistics on complaints about sexual misconduct, there are no signs that the numbers of reports are not dropping nor are preventive measures reinforced by medical practitioners (Walton, 1998, p. 59.). Sexual misconduct is a direct violation of the code and ethics of medical practice. Hence, the practitioner who violated the code (the patient of course do not follow a certain code) is liable and guilty of a criminal conduct (Bloom, Nadelson & Notman, 1999, p. 4).

The significant role of medical practitioners in the rehabilitation of patients had led to the creation of ethical standards and statutes that protect patients from sexual misconduct. In North America, the American Psychological Association (APA) established a Committee on Ethical Standards for Psychologists to develop a code of ethics (Evans, 2004, p. 58). In 1993, the RHPA (Regulated Health Professions Act of 1991) was amended to include the health professions’ procedure code to deal with sexual misconduct and abuse committed by health care professionals (Evans, 2004, p. 60).The main purpose of the state in including such provision is to encourage the public to report sexual misconduct related incidents, provide assistance such as funding and therapies, and ultimately to eradicate sexual abuse of patients by medical professionals (Evans, 2004, p. 60).

Statistically, in a research done by Kenneth Pope and his associates, 87% of mental health professionals admitted to have been attracted to their client, whereas more than 9% of males admitted to have engaged in sexual activity with their clients and 2.5% of female therapists had sexual contact with their clients (Gross, 2003, p. 51). Majority of the victims of such offenses are females (about 32 years of age). As expected, most offenders had other ethical infractions prior to the sexual contact with a client (Gross, 2003, p. 51) that lead to sexual misconduct.

Unethical Violations for Sexual Misconduct

There are three general types of behaviors that are classified as sexual misconduct. These are sexual harassment, sexual abuse and sexualized behaviors. Sexual harassment takes form when sexual advances and favors are done under a non-consensual condition within and outside a specific setting, such as schools and workplaces where the submission to such conduct directly affects an individual’s employment or academic standing. Harassment is considered when submission and non-submission to such acts is used as a basis for the employment or academic evaluation and when it has purposely interfered with an individual’s performance at work or school (Yale Website, 2008).

Sexual abuse, on the other hand, may be identified when a medical practitioner uses a fiduciary relationship to gain sexual advantage of a client. A medical practitioner gains the trust and respect of the client because s/he has a particular knowledge and belief that is believed and trusted by the patient (Penfold, 1998, p.19). In this type of relationship, a professional abuses his authority over the client in committing sexual acts beyond the control or knowledge of the client.

Sexualized behavior, on the other hand, pertains to the intimate relationship of a professional to the client and further engagement in sexual activities. This behavior may also be considered as sexual misconduct because a practitioner uses the authority over the relationship to manipulate the client to engage in sexual activities. Sexualized behaviors are not only expressed through intercourse. These may also be identified through verbal means, such as jokes and comments, as well as glances and touches.

Identifying these sexual violations, clients therefore, need thorough education on their rights as patients as well as on how a specific clinical therapy for example, should take place. A checklist on what procedures are required for a treatment together with specifications and explanations should be obtained prior to attending the therapy session. The client should be able to distinguish possible sexual inappropriateness, such as questions not related to the treatment, hand gestures, body language and even facial expressions. An atmosphere of professionalism should always be present during the therapy and patients and therapists should maintain a specific distance from each other to avoid a possible spark of sexual behavior that may lead to sexual misconduct.

The Victims

A patient has the basic right for safe treatment and be free from sexual, physical and emotional abuse. The patient may at any time question a particular act which he or she finds invasive and sexual in essence and nature. The patient has also the right to discontinue the treatment should he or she feels that rights are being violated and that s/he may file a criminal suit based on the gravity of the offense. The patient may resort to different legal actions to protect him/her from sexual abuse and misconduct.

In the Roy VS Hartogs case, the court made a clear distinction between malpractice and seduction. The claim of Hartog about the lack of law in terms of seduction is not justified through deviation from medical practice and exercising sex as a treatment on the basis that the patient is mentally injured (Bloom, Nadelson & Notman, 1999, p. 19).  A practitioner who engages in sexual activity with a patient is deviating from contemporary standards of medical practice.

A fiduciary relationship is a relationship between an individual who is trusted that he or she can give cure to illness and provide medical care to another person. The ethical standards n this relationship is focused on providing the needed care and not taking advantage on the weaker person.  Involvement in unethical acts such as sexual misconducts is a direct deviation of this fiduciary as it violates the trust given to the person and was used for personal advantage. The existence of standard ethics for medical practitioners defines the guidelines in performing their duty as care providers. Having intimate sexual intimacy with a patient is one example of unethical acts since this breaks the line between the professional and personal relationship between the practitioner and the patient and, therefore damages the purpose of providing medical treatment at a professional level. Oftentimes, sexual relationships among supervisors and supervisees as well as that of patent and therapists lead to intimate relationships, which may be in conjunction with sexual activities and connection. 

Several organizations, even schools and companies advocate resistance against sexual misconduct through orientation programs and seminars, to equip students and employees on the nature and settings of sexual misconducts. Policies and guidelines are also outlined and implemented internally to provide protection to every member of an organization, such as students, employees and even patients in hospitals and nursing facilities.


Sexual misconduct is a range of unacceptable sexual acts that poses threats or damages the relationship between two persons. In the medical field, the medical practitioner and patient are expected to have a professional relationship and that the fiduciary role of the medical practitioner should not be used or abused to take advantage of the patient’s medical condition to gain sexual favors. The ethical concerns surrounding sexual misconducts revolve around the professional function and duty of health care providers. Trust and confidence, which is gained through the promise of being provided with treatment for specific ailments, are earned due to the fiduciary status of physicians. This trust and confidence of the people is the main objective of the Hippocratic Oath.

Sexual misconduct may bring tremendous effects on the everyday life of a victim. The damaging effects of sexual misconduct to the victims may be irreversible. Several organizations who run advocacies against sexual misconduct and women welfare offers counseling to victims of sexual abuse and misconduct. These organizations also provide legal assistance in filing criminal cases to perpetrators. Therapists at the onset of therapy sessions should be mindful, cautious and sensitive to the behavioral characteristics of the victim of sexual misconduct. This may help the therapist to further understand the victim and encourage expressiveness in order to identify the help that is required for quick recovery.





Avery, L. and Gressard, C. (2000). Counseling regulations regarding sexual misconduct: a comparison across states.  Counseling and Values  45(1), 67.

Benjamin, B. (n.d.). Sexual misconduct. Retrieved February 13, 2010 from

Benjamin B. & Sohnen-Moe C. (2005). The ethics of touch: the hands-on practitioner's guide to creating a professional, safe and enduring practice. Arizona: Sohnen-Moe Assocates.

Bloom, J., Nadelson, C and Notman, M. (1999). Physician sexual misconduct. Washington DC: American Psychiatric Press.

Evans, D. (2004). The law, standards, and ethics in the practice of psychology .Canada: Edmond Montgomery Publications Limited.

Gabriel, L. (2005). Speaking the unspeakable: the ethics of dual relationships in counseling and psychotherapy. New York: Routledge.

Gross, B. (2003). A touchy subject: Sexual intimacies between therapists and clients. American Psychotherapy Association, 6(2) 51

Miles, S. (2004). The Hippocratic Oath and the ethics of medicine. New York: Oxford University Press.

Penfold, S. (1998). Sexual abuse by health professionals: a personal search for meaning and healing. Toronto Canada: University of Toronto Press Inc.

Shahidullah, S. (2008). Crime policy in America: laws, institutions, and programs. Maryland: University Press of America.


Walton, M.  (1998). The trouble with medicine: preserving the trust between patients and doctors. New South Whales: Allen and Unwin

Yale University (2010, February 13). Definition of sexual misconduct including sexual assault and sexual harassment.  Retrieved from

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