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

Objective: An argument has been presented in this journal for a generally p ermissive attitude to consensual sexual relations between psychiatrists and trainee psychiatrists except in circumstances where there is a direct supe rvisory relationship. This paper challenges that view. Method: The arguments are reviewed. A developmental perspective of training is used to show that the autonomy of trainees is restricted in a manner si milar to a student in relation to a teacher. This confers on psychiatrists a duty of care. Results: On the basis of respect for autonomy, the strength of argument for a prohibition on consensual sexual relationships is strong for a young tra inee, and weakens as a person proceeds through training and approaches the status of a colleague. A policy of restraint would facilitate the developme nt of a general atmosphere of trust, which is an important requirement for good supervision and the basis of professional relationships. An ethical ju dgement cannot be made, however, without the consideration of other relatio nships and commitments existing outside the supervisory relationship for ea ch person involved. Conclusions: In order to create a secure and unambiguous training environme nt that maximises trust, a general principle of prohibition on sexual relat ionships between psychiatrists and trainees is preferred, although circumst ances exist where such relationships are not unethical.