Today’s question comes from a University academic who has:
… been involved in teaching paramedic students at different universities and in different ambulance services and have noted with some surprise that some full time paramedic academics (Lecturers and Senior Lecturers) have become romantically or sexually involved with students enrolled in the degree they teach. Upon inquiry I’ve learned that the universities in question did not forbid this practice (though, staff were obligated to declare it). I am also aware that some clinically active paramedics have “invited” students that have been placed under their supervision (in an ambulance service, working on the road for one or several days) to have a romantic and/or sexual relationship with them. I know of several cases where this has caused great distress to the student.
With that context established, I note that in The Paramedic Code of Conduct (June 2018) Section 8.2 (Professional behaviour), states (in part, page 18):
Professional boundaries are integral to a good practitioner–patient/client relationship. They promote good care for patients or clients and protect both parties. Good practice involves:
a) maintaining professional boundaries
b) never using a professional position to establish or pursue a sexual, exploitative or otherwise inappropriate relationship with anybody under a practitioner’s care; this includes those close to the patient or client, such as their carer, guardian, spouse or the parent of a child patient or client
[c) recognising that sexual and other personal relationships with people who have previously been a practitioner’s patients or clients are usually inappropriate, depending on the extent of the professional relationship and the vulnerability of a previous patient or client;… ]
Furthermore, section 10.2 (Teaching, supervising and assessing) states (again, in part) that good practice in teaching and supervising involves:
d) avoiding any potential for conflict of interest in the supervisory relationship; for example, by supervising someone who is a close relative or friend or where there is another potential conflict of interest that could impede objectivity and/or interfere with the supervised person’s achievement of learning outcomes or relevant experience.
Finally, under the National Health Act [the Health Practitioner Regulation National Law], s 140 defines [the situations in which a health care professional (e.g. a registered paramedic) is obligated to notify their board of specific actions that another registered professional has undertaken. The Act specifically identifies the following as ‘notifiable conduct’ (140(b):
(b) engaging in sexual misconduct in connection with the practice of the practitioner’s profession;
Section 141A of the same Act notes that if, “in the course of providing a health service to another registered health practitioner” the first healthcare practitioner “forms a reasonable belief that the second health practitioner has engaged, is engaging, or is at risk of engaging, in sexual misconduct in connection with the practice of the practitioner’s profession” then this also a situation where the first healthcare professional is mandated to notify the National Agency.
In both cases (a student at a university, or a student in a clinical placement being sexually/romantically propositioned by a professional paramedic responsible for grading their performance as a student) it seems clear to me that there is a such an inherent power differential in those professional relationships that it makes truly voluntary consent impossible. Furthermore, such a proposition would seem to contravene the requirement to avoid any potential conflict of interest in the supervisory relationship. As paramedics are legally held to uphold the Code of Conduct, I interpret this to be a legal issue and not just one of professional culture (or personal morals).
Therefore, my question is this: Under the terms of the paramedic Code of Conduct is it ever appropriate for a professional paramedic to sexually or romantically proposition a student they are teaching and/or supervising? Furthermore, if a paramedic has reason to believe that another paramedic has romantically or sexually propositioned a student under their supervision, would this be considered a mandatory notifiable situation?
The clear answer is ‘no, it’s never ‘appropriate for a professional paramedic to sexually or romantically proposition a student they are teaching and/or supervising’. The conflict of interest and abuse of power, suggested by my correspondent is obvious. If the parties want to move to that sort of relationship alternative supervision/mentoring arrangements would need to be in place, ideally one of them would move to another university or they wait until the student has graduated (still making sure not to supervise the student when those feelings are present even if they are not being acted upon).
The sections quoted above, in particular cl 8.2 of the Code of Conduct seem primarily directed to patients, but there is no need to restrict it. First a student is also under a mentor’s care (see 8.2(b)). Second what is ‘sexual misconduct in connection with the practice of the practitioner’s profession’ is not defined to be limited only to misconduct with respect to patients. A practitioner who is supervising or teaching a student is still practising their profession and sexual misconduct in the course of their teaching duties is still ‘sexual misconduct in connection with the practice of the practitioner’s profession’.
A nurse had his registration suspended who had, inter alia, ‘while teaching had touched a student nurse in an inappropriate manner and made sexually suggestive comments’ (Nursing and Midwifery Board, Tribunal suspends nurse for professional misconduct, 30 October 2018). The consequences of sexual misconduct in the education setting can be very significant (for an Australian study, see Louise Stone, Christine Phillips, Kirsty A. Douglas ‘Sexual assault and harassment of doctors, by doctors: a qualitative study, Medical Education 2019 doi: 10.1111/medu.13912).
Anyone who thinks suggesting a sexual relationship with a person in such a position of dependence as a student has slept through the #metoo movement.
A university academic or an ‘on road’ mentor who becomes sexually involved with a student/mentee would I suggest be prima facie guilty of unprofessional conduct. Whether that is established in any given case would be a matter for a Panel or Tribunal. Regardless, a practitioner who becomes aware that this is happening and is being maintained, even if it has been disclosed, would be obligated to report it under s 141 so that the matter could be investigated and determined by the relevant Board, Panel or Tribunal (see Medical Board of Australia, ‘Tribunal reprimands doctor for failure to report sexual misconduct, imposes conditions’ 4 March 2016).