Professional Boundaries and Prevention of Sexual Misconduct and Abuse Standard
The public can expect that licensed healthcare professionals will treat them with dignity and respect and never engage in sexual abuse, sexual misconduct, or exploitation. Licensed healthcare professionals must establish and maintain clear, respectful, and culturally sensitive boundaries in all professional interactions; recognize and manage power imbalances and avoid conduct that may impair judgment or cause harm; and uphold boundaries across all contexts of practice, including virtual care, research, and social media.
This Practice Standard applies to all professional interactions between licensed healthcare professionals and the individuals with whom they engage in a professional capacity.
A licensee must:
- Maintain appropriate professional boundaries in all professional contexts—including boundaries that are physical, emotional, psychological, sexual, financial, relational, and digital in nature—which means to:
- Observe professional boundaries and demonstrate them consistently.
- Maintain appropriate professional boundaries with patients, substitute decision-makers, caregivers, family members and others close to a patient, supervisees, students, and colleagues.
- Clearly communicate professional boundaries to patients.
- Maintain professional boundaries in a manner consistent with each patient’s cultural norms and individual needs.
- Accept responsibility for maintaining professional boundaries, regardless of another person’s actions, consent, or participation.
- Monitor and manage their own personal and professional risk factors, which may increase their risk for boundary violations.
- Refrain from excessive self-disclosure, preferential treatment, and social or business interactions that may compromise professional judgment or objectivity.
- Recognize the power imbalance with patients, which means to:
- Properly manage the inherent power imbalance in the healthcare provider–patient relationship, as well as other relationships in which a licensed healthcare professional has—or may be perceived to have—undue influence or authority over another person.
- Never take advantage of their professional role to encourage or engage in sexual abuse or sexual misconduct.
- Refrain from sexual misconduct, which means to:
- Refrain from using words, gestures, body language, or physical contact that is—or could be perceived to be—sexualized or intended to manipulate or use the professional relationship to initiate or pursue sexual activity or to leverage emotional closeness for personal gain.
- Never engage in sexual intercourse or any other form of physical sexual contact with a patient.1
- Never provide psychotherapy to a person with whom they have had an intimate or sexual relationship.
- Manage high-risk and special situations, which means to:
- Never provide health services to any individual with whom they have an existing intimate or sexual relationship, unless the need for care is urgent and no other healthcare provider is readily available.
- Recognize that in Indigenous, close-knit, or resource-limited communities, personal relationships may be unavoidable, making it necessary for a licensee to assess the impact of any personal relationship on their own impartiality and on patient trust, and to provide or continue care only when the benefits to the patient clearly outweigh the risks and appropriate steps have been taken to ensure respectful, unbiased care.
- Be aware of restrictions on relationships with former patients, which means to:
- Never have an intimate or sexual relationship with a patient to whom they have provided psychotherapeutic care.
- Exercise caution and professional judgment before forming a relationship with a former patient, ensuring that:
- Sufficient time has passed since the termination of the professional relationship, such that there is no longer a power imbalance or reliance on the licensee.
- The professional relationship could no longer reasonably be expected to influence the former patient’s decision making.
- Report where required, which means to:
- Report safety risks arising from failure to observe professional boundaries to CHCPBC, as required by the HPOA.
- Under the HPOA, sexual engagement with a spouse does not constitute sexual misconduct, so long as the spouse has consented. ↩︎
Glossary
Consent: a voluntary, informed, and capable person’s agreement to receive a specific health service. Consent is valid only when:
- The person is capable of making the decision;
- The person receives the information that a reasonable person would require about the nature, purpose, benefits, risks, and alternatives to the proposed service;
- The person is given an opportunity to ask questions and receive answers;
- The decision is voluntary, not obtained through coercion, fraud, ormisrepresentation; and
- The consent relates to the specific health service proposed.
Consent may be expressed orally or in writing, or inferred from the person’s conduct, and may be withdrawn at any time.
Health service: any service or activity provided by a licensee in relation to healthcare, including collecting information; assessing, diagnosing, preventing, monitoring, treating, or managing a person’s health or health-related condition; or providing health-related information to an individual or the public, whether or not treatment is provided.
Patient: a person to whom health services are provided. Throughout the Ethics and Practice Standards, “patient” includes substitute decision-makers, parents, and guardians where applicable.
Power imbalance: the dynamic that exists by virtue of the authority and influence that a healthcare professional holds in relation to a patient or individual being assessed due to their role and subject matter knowledge, which places the patient or individual being assessed in a vulnerable position.
Professional boundaries: the legal and ethical limits that define and protect the professional relationship between a healthcare professional and a patient or individual being assessed. These boundaries ensure the professional relationship remains safe, therapeutic, and focused on the needs or the patient or the interests of the individual being assessed, with the necessary level of psychological and social distance to preserve the healthcare provider’s objectivity and prevent exploitation of the power imbalance, rather than devolving into a personal relationship.
Professional relationship: the relationship that arises when a licensee, acting in their professional or practice-related capacity, provides or undertakes to provide services, advice, assessment, care, treatment, education, supervision, consultation, or other professional activities to or for an individual, a client, a patient, a family, a group, an organization, or the public.
Psychotherapeutic care: structured care intended to support mental, emotional, or behavioural health, including counselling, psychotherapy, and other talk-based interventions that involve a sustained, trust-based relationship focused on exploring and addressing psychological concerns.
Social media: online platforms and digital tools that enable individuals and/or organizations to create, share, and engage with content and to interact with others in public or semi-public virtual environments.
Substitute decision-maker: a person who is legally authorized to make healthcare decisions on behalf of an adult who is incapable of giving or refusing consent, in accordance with British Columbia law. A substitute decision-maker may include, as applicable:
- A temporary substitute decision-maker selected in accordance with the Health Care (Consent) and Care Facility (Admission) Act.
- A representative appointed under a representation agreement pursuant to the Representation Agreement Act.
- A committee of the person appointed by the court under the Patients Property Act.
Supervisee: an individual working under the supervision of a licensed and authorized healthcare professional. This may include support personnel, students, interns, or individuals required to engage in supervised practice.