Sexual harassment is defined as the abuse of power, by involving sex, which violates the individual’s autonomy or right to pursue his/her legitimate interests without harmful interference by others, especially when the person is vulnerable, e.g. a patient, employee, child or elderly person. It has elements of coercion and violation of trust. When this is made known in the media the organisation and even an entire profession maybe adversely affected.
Harassment within organisations
The US produced extensive legislations about this in 1980, and defines harassment in the workplace as: Unwelcome sexual advances, request for sexual favour, and other verbal or physical conduct of a sexual nature constitutes sexual harassment when submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment, submission to or rejection of such conduct by an individual is used as basis for employment decisions affecting such individual, or such conduct has the purpose or effect of unnecessary interfering with an individual’s work performance or creating an intimidation, hostile or offensive working environment.
Hostile work environment constitutes unwelcome sexual advances, requests or other sexual conduct that may be unreasonable interfere with work performance or create an intimidating or offensive work environment.
Harassment of patients
This is forbidden as it violates the autonomy of the patient/client, who is already vulnerable. It also violates the trust of colleagues in the organisation and profession. If the feelings are genuine and voluntarily returned the relationship should only be pursued once the patient-health professional relationship no longer exists. The question arises, whether this violates the right to freedom of association, but one also needs to remember that the patients’ vulnerability may extend beyond the period of the professional relationship.
Harassment by patients
This appears to be far more common problem in physiotherapy where therapists come into close physical contact with patients. Patient behaviour may also be altered by medication, due to their altered physical and/or psychological state, isolation and damaged self-esteem. Several studies have established that up to more than 90% of physiotherapists and physiotherapy students have experienced some form of sexual harassment, ranging from mildly inappropriate to moderate to severely inappropriate sexual behaviour. When it is mild, most will ignore it or not respond, whereas if it is severe, appropriate disclosure and a note in the patient’s folder should result, usually with a just outcome and reassignment of the patient to another therapist. Moderately inappropriate behaviour presents the most difficulty, as it cannot be ignored but it is also difficult to pinpoint and describe. Sometimes an institution may fail to respond appropriately as patient satisfaction may be more important in order to maintain the business and this leaves the therapist without protection or fairness. It may even be considered whistle blowing, which can be interpreted as revealing secrets and even question his/her integrity. Institutions should afford employees the same legal protection as it does patients/clients, as in the long run sexual harassment harms quality care and the institution’s image. The following steps are suggested by Gabard and Martin (quoting Scot, who is both an attorney and a physical therapist):
- Investigate the victim’s complaint
- Counsel the offender to stop
- Transfer the patient to another therapist
- Consult other professionals, as appropriately
- If the patient persists in sexual harassment, remove him/her from service
- Cooper, I. & Jenkins, S. (2008). Sexual boundaries between physiotherapists and patients are not perceived clearly: an observational study. Australian Journal of Physiotherapy, 54:275-279
- New Zealand Society of Physiotherapy policy on Professional Sexual Boundaries.