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Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not.
In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor–patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.
Transference is “the unconscious assignment to others of feelings and attitudes that were originally associated with important figures” by the patient onto the doctor.
Counter-transference is the doctor's reaction to this process and this can include erotic feelings.
In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner. As attempts were made to rapidly infuse intravenous fluids and rescue his remaining renal function, the specialist cried ‘I realized that they were the wrong pills but !
The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. the power that a physician possesses by virtue of her training in the discipline and the art or craft of medicine”. ' Despite having the Aesculapian power of a doctor, and the Social power of a hospital specialist, in addition to considerable Charismatic power (he was a well-liked and respected colleague), none of these were sufficient to counteract his lack of Hierarchical power by being a patient.
To explain why this is always the case, even with former patients, it is useful to consider the sources of medical power in light of a framework suggested by family practitioner and ethicist, Howard Brody. Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is an unequal power differential between the doctor and patient.