Should the AMA's Ban on Sexual Misconduct Go Even Further?

Hi. I'm Art Caplan from the Division of Medical Ethics at NYU School of Medicine.

A persistent problem in our society, and in many other countries, is sexual abuse by professionals, by people in power, who are able to exploit their advantage—and their power relationship—to gain access to people, and then take advantage of them without their consent, or at least manipulate them into sexual activity or sexual contact. This is clearly a problem in medicine. Recently, the American Medical Association (AMA) issued a very clear statement that it would have a no-tolerance policy for people at the AMA Convention who might be involved in any form of sexual harassment, any form of unwanted sexual contact, with anyone else at the meeting. I think that their policy is a good thing. It may be sad that we have to remind people that sexual misconduct won't be tolerated. Nonetheless, the reminder was there, and ethically, I think it's fine.

The problem is that in medicine, as we have seen in the priesthood, with professors, teachers, and the military, people in authority are still prone to taking advantage of others when they can. The people in prominent positions in these fields are not doing the job they should be doing of policing this kind of conduct. Specifically, what I'm saying is, we know that a small number of people violate what should be an absolute sexual prohibition. You can't have sexual contact with a patient, just as a priest can't do that, or a professor shouldn't do that, or a commander in the military shouldn't do that. You have to not just say, "Well, if I know that somebody did that, I am going to pass them on to the next hospital or let them continue in practice."

I served on a licensing board for a state many years ago, and we did see instances in which physicians had sexually abused a patient or a family member, and these physicians were reported. We got into long discussions about whether it was right to even remove their license or to restore it if they had undergone a therapy program.

I am going to take a hard line here: I think that if you are convicted of a sexual violation, sexual abuse of a patient, you cannot practice. You lose your ability to have patient contact. There may be other positions or jobs that you can do, but you shouldn't have access to patients anymore. To me, it is a no-tolerance policy—not just at a convention, but in one's practice. I know that is a tough line, because people obviously can make a mistake or an error, but we simply cannot tolerate it, any more than we can tolerate a priest molesting a child or a commander in the Army molesting a lower-ranking member of the armed services. You just cannot do this and command or continue to get respect from the public and trust from your patients.

Sometimes patients do not even understand whether the touching is appropriate. Sometimes they are afraid to go to the doctor to talk about somebody who might have abused them. They may be thinking that the doctor can't be trusted and that physicians who have licenses may have violated that sexual misconduct prohibition. I think it is not a good position for medicine to be in, and I think that we should make it clear to all healthcare providers that sexual misconduct just cannot be tolerated. Just as the AMA said no tolerance at the meetings, I say no tolerance anywhere. I think we have to be tougher than we are on sexual misconduct in medicine.

I'm Art Caplan at the NYU School of Medicine. Thank you for watching.

Talking Points: Should the AMA's Ban on Sexual Misconduct Go Even Further?

Issues to consider:

Using data from the National Practitioner Data Bank (NPDB), Public Citizen's Health Research Group conducted a study on physicians who have been reported to a national database due to sexual misconduct. The study found that a total of 1039 physicians (most were over age 40) had at least one NPDB report related to sexual misconduct during the study period January 1, 2003, to September 30, 2013.^[1]
The Public Citizen study also found that of those 1039 physicians, 786 were disciplined solely by state medical boards. In nearly 90% of cases, the disciplinary actions taken by the boards in response to physician sexual misconduct were serious in nature, such as revocation, suspension, or restriction of the medical license. The boards took such serious actions in approximately two thirds of cases related to other types of physician offenses.^[1]
Approximately two thirds of the sanctions taken by hospitals and other healthcare organizations against physicians with sexual misconduct offenses involved revocation or suspension of physicians' clinical privileges in the healthcare organizations. In contrast, only 52% of such actions were taken against physicians with other types of offenses, according to the same study cited above.^[1]
A 2014 University of Michigan survey of 1719 recipients who received career development awards from the National Institutes of Health from 2006 to 2009, found that 30% of women reported having experienced sexual harassment compared with 4% of men.^[2]
The survey also found that among women reporting harassment, 40% described more severe forms of harassment, and 59% perceived that these experiences had a negative effect on their confidence in themselves as professionals. Another 47% reported that these experiences negatively affected their career advancement.^[2]
Some healthcare professionals are concerned that recognizing sexual harassment is important because perceptions that such experiences are rare may, ironically, increase stigmatization and discourage reporting.
Some healthcare professionals contend that efforts are needed to mitigate the effect of unconscious bias in the workplace and eliminate more overtly inappropriate behaviors.

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