Article Text

other Versions

Download PDFPDF
Engagement without entanglement: a framework for non-sexual patient–physician boundaries
  1. Jacob M Appel
  1. Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Jacob M Appel, Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; jacobmappel{at}


The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to assess non-sexual interactions with patients that transcend norms of practice. This paper attempts to offer an operational model for such assessment that considers not only the traditional emphasis on beneficence, but also incorporates concerns over entanglement and concordance.

  • professional-professional relationship
  • professional misconduct
  • ethics

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors JMA is the sole contributor and responsible for all content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.