Maintaining Appropriate Boundaries and Preventing Sexual Abuse and Harassment
The following guideline document has been updated from the previously posted “Sexual Abuse Prevention Plan and Dating Guidelines” which was approved by the council of the Ontario College of Pharmacists (OCP) in 1995 in response to the requirement of the Regulated Health Professions Act (RHPA).
As per section 1.1 of Health Professions Procedural Code, the purpose of the provisions in the Code with respect to sexual abuse of patients by members is to encourage the reporting of such abuse, to provide funding for therapy and counseling for patients who have been sexually abused by members and, ultimately, to eradicate the sexual abuse of patients by members. (RHPA 1993, c. 37, s.5.)
(Health Professions Procedural Code, 1991, being Schedule 2 to the Regulated Health Professions Act, 1991. S.O. 1991, Chapter 18. Retrieved at: http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_91r18_e.htm )
According to the OCP Code of Ethics, members have moral obligations in return for the trust given them by society. They must act in the best interest of and advocate for the patient, observe the law, uphold the dignity and honour of the profession, and practice in accordance with ethical principles and their respective standards of practice.
(Ontario College of Pharmacists. Code of Ethics. Retrieved at; http://www.ocpinfo.com/client/ocp/OCPHome.nsf/web/Code+of+Ethics
Members are expected to take responsibility for their behaviour.)
OCP regards any act of abuse or harassment of a patient, customer, staff person and / or colleague, as unacceptable and such actions constitute professional misconduct and / or criminal offence. Ignoring harassment or abuse is equal to condoning the abuser’s actions and further harming the victim.
There is no single all-encompassing definition of what constitutes a professional boundary. Boundaries are based on trust, respect and the appropriate use of power. In the context of this guideline, a boundary is the point at which the relationship changes from professional and therapeutic to unprofessional and personal.
|Title:||Maintaining Appropriate Boundaries and Preventing Sexual Abuse and Harassment|
|Revised Date:||2011||Review Date:||2018|
|Key Words:||sexual abuse, harassment, professional misconduct, boundaries|
|Related Topics:||child abuse, spousal abuse, professional misconduct|
|Legislative references:||Regulated Health Professions Act (RHPA)|
|College Contact: ||Patient Relations|
|Purpose:||To assist members in interpreting legislation regarding behaviour in a professional environment with regard to maintaining appropriate boundaries and preventing sexual abuse / harassment.|
Harassment means engaging in a course of vexatious comment or conduct that is known or ought reasonably to be known to be unwelcome.
(Human Rights Code, R.S.O. 1990, CHAPTER H. 19. Retrieved at; http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h19_e.htm#BK85 )
Harassment may include bullying, intimidating or offensive jokes or innuendos, displaying or circulating offensive pictures or materials, or offensive or intimidating phone calls.
- Sexual intercourse or other forms of sexual relations between the member and the patient,
- Touching of a sexual nature, of the patient by the member, or
- Behaviour or remarks of a sexual nature by the member towards the patient (1993, c. 37, s.4.)
(Health Professions Procedural Code, 1991 s.1(3).)
(Ontario, Ministry of Labour. Preventing Workplace Violence and Workplace Harassment. Retrieved at: http://www.labour.gov.on.ca/english/hs/sawo/pubs/fs_workplaceviolence.php )
THE MEMBER-PATIENT RELATIONSHIP
The core components of usual and customary pharmacy practice include gathering and analyzing information, presenting options to the patient based on the information gathered, dispensing medication, and offering follow up as required.
Members have an obligation to establish relationships with patients which are based on trust, support and mutual respect and further, are responsible for maintaining the professional integrity of the relationships.
WHAT IS AN APPROPRIATE BOUNDARY?
An appropriate boundary of a member-patient relationship would be one that complies with the OCP’s philosophy.
MAINTAINING APPROPRIATE PROFESSIONAL BOUNDARIES
(Adapted from the Guidelines for Maintaining Professional Boundaries published by the College of Physicians and Surgeons of Ontario. Retrieved at: http://www.cpso.on.ca/uploadedFiles/downloads/cpsodocuments/policies/policies/sexual_abuse_boundaries.pdf )
PREVENTING SEXUAL ABUSE AND HARASSMENT
A member must not become sexually involved with his or her patient.
- Show sensitivity and respect for the patient’s privacy and comfort at all times
- Avoid physical contact with a patient outside of clinical necessity
- Avoid any behaviour or remarks that may be interpreted as sexual by a patient
- Endeavour to be aware or mindful of a patient’s particular cultural or religious background
- Do not make sexualized comments about a patient’s body or clothing
- Do not criticize or comment unnecessarily on a patient’s sexual preference
- Do not ask details of sexual history or behaviour unless related to the purpose of the consultation
- Be cognizant of social interactions with patients that may lead to romantic involvement
- Do not talk with your patients about your own sexual preferences, fantasies, problems, activities or performance
- Learn to control the consultation setting and to detect possible erosions in boundaries
A member must not harass or otherwise intimidate his or her patient.
A member is required to file a report in writing with the Registrar if they have reasonable grounds, obtained in the course of practicing their profession, to believe that a member, of the same or different college has sexually abused a patient. The report must be made within 30 days and may only include the patient’s name where written consent has been given by the patient or, if the patient is incapable, the patient’s representative. The report must include the name of the member filing the report, the name of the member who is the subject of the report and an explanation of the alleged sexual abuse.
There is a $25,000 fine for failure to report. (Health Professions Procedural Code, 1991, s.93(1)a. )
Members are indemnified for making reports in good faith. (Health Professions Procedural Code, 1991 s.92.1. )
The RHPA requires that Ontario’s regulated health professions develop sexual abuse prevention programs. The College has undertaken to educate members and students about these issues and has provided training to key College staff on how to handle complaints involving topics of a sexual nature.
FUNDING FOR THERAPY & COUNSELING
Pursuant to the RHPA, the College has established a fund for therapy and counseling for persons who, as patients, were sexually abused by a member of the College. The maximum amount of funding and the period of time in which funding is available to a person in relation to sexual abuse has been set by Regulation. (Funding for Therapy or Counseling for Patients Sexually Abused by Members. OReg. 59/94. Retrieved at: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_940059_e.htm )
The Patient Relations Committee administers the fund.
SEXUAL RELATIONSHIPS WITH FORMER PATIENTS:
The member should terminate the therapeutic relationship with a patient prior to initiating a sexual or romantic relationship. The member should consider whether the therapeutic relationship has created a vulnerability or dependency on the part of the patient that may make it inappropriate to engage in a sexual or romantic relationship.
- Under the RHPA, any form of sexual relations between a member and a patient (including a spouse) is considered to be sexual abuse.
- In the event that a member is required to provide care to a spouse in an emergency or incidental situation, the member must transfer care as soon as is practical. Incidental care has been defined by the Ontario Court of Appeal as “minor in nature, casual or arising in fortuitous conjunction with a spousal relationship.
- When in doubt as to whether a therapeutic relationship exists/ has terminated, members should refrain from any personal relationship with the individual until they seek advice from the College.
- Sexual contact with a former patient may be considered professional misconduct even though it is not sexual abuse as defined under the RHPA. A sexual or romantic relationship is inappropriate in cases where the therapeutic relationship has created a vulnerability or dependency on the part of the patient that affects the patient’s ability to act freely.
- Sexual relationships between members and caregivers raise concerns about breach of trust and power imbalance. It is advisable that members refrain from sexual or romantic relationships with these individuals.