Ethical decision making

Throughout the year, the CCOA will present an ethical or conduct scenario. The guidance provided on how to respond to these scenarios are meant to help build knowledge, competence and confidence in handling these types of ethical or conduct situations in your practice. The scenarios described do not represent specific conduct or ethical challenges of regulated members; however, they are situations that could occur. 

Upon reviewing each scenario, consider this question: what would you do to handle the situation?

Scenarios

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Scenario: Disclosure of inappropriate touching by a colleague


You are busy in practice and treating back-to-back patients. You just finished treating a patient that both you and your associate treat. This is a patient that you see occasionally and during that treatment you had noticed that something was off with the interaction relative to previous interactions. Being busy you did not take the time to ask the patient if they are okay, knowing that some days are better than others, and that if they wanted to talk, they would say something. Being double booked, you continue to your next appointment.

You are treating the next patient and there is a knock on the door to the room. Your assistant indicates that they need to speak to you immediately. In your office they quietly explain that when your last patient was at the front desk checking out, they were visibly emotional. Your assistant empathetically asked the patient if they were okay. The patient broke down crying. They were not okay. While reassuring the patient, your assistant brought them to your consultation room to provide some privacy and speak with them.

Your assistant relates that during that conversation with the patient, while sobbing, the patient let your assistant know that on their last visit with your associate they had been touched inappropriately. The visit had started out like any other visit; however, it took a turn partway through. The doctor had suddenly slid their hand under the patient’s waistband in the front. The doctor proceeded to touch the patient in a sensitive area under their clothing. The doctor murmured, “wow, you are tight here.” The patient froze not knowing how to respond. That treatment had been on their mind since their last visit. 

During their treatment with you, you recommended to treat close to the area where they had previously been treated by your associate. You stopped to let them know what you thought should happen and why, then asked if they could reposition the clothing and asked permission to touch in the area. After you left the room, they relived what had happened with your associate. They felt saddened and overwhelmed by the feelings they were experiencing as they remembered the previous treatment. They would like to speak to you about the treatment they had with your associate.

  • How do you respond to the disclosure from your assistant?
  • How do you respond to the disclosure from the patient?
  • How do you help the patient?
  • What are you required to do after the disclosure?
  • How do you handle the situation with your associate?
  • How to prepare now for the possibility of this situation?

The Conduct in question

The patient reports experiencing inappropriate touch during the last appointment they had with your associate. This conduct has been reported to your assistant, who reported it to you.

How do you respond to the disclosure from your assistant?

Thank your assistant for their keen observation and empathetic care for the patient.  They observed and helped the patient in the most important way possible. They listened and believed the patient.

How do you respond to the disclosure from the patient?

It is important to take a moment to acknowledge the sensitive and difficult position that you find yourself in. You must be prepared to speak to the patient.

When you are speaking to the patient you must be prepared to listen to the patient actively and empathetically. The most important thing you can do in this situation is believe the patient. Acknowledge the impact that the patient has experienced and see how you can help them.

How do you help the patient?

The first step in helping the patient is to believe them when they disclose their experience.

The patient should be encouraged to make a formal complaint to the CCOA Complaints Director who can offer the patient the Patient Relations Program. This program provides counselling to support the recovery of the patient from their trauma.

What are you required to do after the disclosure?

In addition to encouraging the patient to report this situation to the College, you have a duty under the Health Professions Act to report the conduct of your associate.

127.2(1) If in the course of a regulated member acting in the regulated member’s professional capacity the regulated member has reasonable grounds to believe that the conduct of another regulated member of any college constitutes sexual abuse or sexual misconduct, the regulated member must report that conduct to the complaints director.

You must report this conduct to the CCOA Complaints Director. Failure to disclose sexual misconduct or sexual abuse that you were aware of and did not disclose could result in a finding of unprofessional conduct against you.

How do you handle the situation with your associate?

In this situation, or any situation involving a patient, the primary consideration is to the health and safety of the patient. What can you do to protect the patient?  What considerations is the patient seeking?

This must be addressed with your associate. As part of addressing this situation remind your associate that you must report the patients’ disclosure to the CCOA. 

This will raise the other issue of whether you want to continue in the relationship with your associate. 

How to prepare now for the possibility of this situation?

Each practitioner should consider training for themselves and their staff on responding to disclosures of sexual assault. Your local Sexual Assault Support Centre may provide instruction regarding this important topic. It would be a beneficial step to providing training/communication to all employees (other regulated members, clinic staff, etc.) in advance of how these situations should be handled.

Prepare all employees for how these situations should be handled, discuss in advance, ask for suggestions about improving the clinical experience.

Don’t wait for something to happen – discuss things now. Your staff are excellent resources and should be included in helping improve the safety for all patients when receiving care.
Published: January 2022

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