“When a yes should mean no”: doctors and boundaries
We thank Dr Bhan for his letter in response to our paper ‘Elephant in the room’. He has correctly noted that even what might be described as consensual acts of sexual boundary violations (SBVs) between doctors and their patients are not truly so due to the power differential in their relationship. This is why our paper points out that “consensual” acts of SBVs with adults are considered unethical but not illegal — barring issues around the law on adultery in India at present. We refer to “consensual” within inverted commas, as the validity of consent for such acts is questionable because the patient might have said “yes” — or at the minimum did not say “no” — because of transference issues. Transference reactions are the attitudes and feelings patients bring into the relationship based on their relationship with significant others in their life.
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