Boundaries and Sexual Abuse Standard

Authority and Responsibility

Physiotherapists must maintain professional boundaries with their patients at all times. Physiotherapists must not sexually abuse their patients.

Managing Professional Boundaries

Boundaries in patient care are physical and emotional limits of the therapeutic relationship between the patient and the physiotherapist. The physiotherapist’s responsibility is always to act in the patient’s best interest and to manage the boundaries within the therapeutic relationship.

When managing the boundaries of the therapeutic relationship, the physiotherapist must:

• recognize that each patient’s boundaries will be unique to their own experiences, including their culture, age, values or experiences of trauma.
• be sensitive to the practice setting, especially when providing care in an informal environment, such as a patient’s home.
• respond appropriately when a professional boundary is breached. This involves identifying the breach, correcting the inappropriate behaviour, and documenting the actions taken to address the breach in the patient’s record.

Some examples of situations that pose a risk for a boundary violation include personal disclosure by the physiotherapist, giving or receiving gifts, engaging in business or leisure activities with a patient, and most frequently, comments, words or gestures that are not directly related to clinical care.

Restrictions for Maintaining Professional Boundaries

When a close or intimate relationship exists between the physiotherapist and the patient because of an emotional or other strong bond, it can impair the physiotherapist’s professional judgement.

• Physiotherapists must not enter into intimate or romantic relationships with their patients or their patients’ relatives or support persons.
• Physiotherapists must not treat their relatives or those with whom they have a close or intimate relationship, except in the case of an emergency, in which case, fees cannot be charged.
• Physiotherapists must not enter into intimate or romantic relationships with former patients unless:
  • at least one year has elapsed since the patient was discharged from physiotherapy care,
  • the imbalance of power inherent in the therapeutic relationship between the physiotherapist and the patient no longer exists, and
  • the patient is no longer dependent on the physiotherapist.

Sexual Abuse

Sexual abuse of a patient means,

1. sexual intercourse or other forms of physical sexual relations between the member and the patient,
2. touching, of a sexual nature, of the patient by the member, or
3. behaviour or remarks of a sexual nature by the member towards the patient.

For these purposes “sexual nature” does not include touching or conduct of a clinical nature appropriate to the service provided.

Mandatory Reporting of Sexual Abuse

If a physiotherapist becomes aware that a regulated health professional may have sexually abused a patient, they must report it to the professional college to which the other health professional belongs. Failure to do so may result in disciplinary action by the College.