Sex, honesty and the supervisory relationship: a response to Ryan

An argument has been presented in this journal for a generally permissive attitude to consensual sexual relations between psychiatrists and trainee psychiatrists except in circumstances where there is a direct supervisory relationship. This paper challenges that view.

The arguments are reviewed. A developmental perspective of training is used to show that the autonomy of trainees is restricted in a manner similar to a student in relation to a teacher. This confers on psychiatrists a duty of care.

On the basis of respect for autonomy, the strength of argument for a prohibition on consensual sexual relationships is strong for a young trainee, and weakens as a person proceeds through training and approaches the status of a colleague. A policy of restraint would facilitate the development of a general atmosphere of trust, which is an important requirement for good supervision and the basis of professional relationships. An ethical judgement cannot be made, however, without the consideration of other relationships and commitments existing outside the supervisory relationship for each person involved.

In order to create a secure and unambiguous training environment that maximises trust, a general principle of prohibition on sexual relationships between psychiatrists and trainees is preferred, although circumstances exist where such relationships are not unethical.