A model for boundary dilemmas: ethical decision-making in the patient-professional relationship.

The current "slippery slope" concept in boundary dilemmas is linked to a rule-based approach to ethical decision making. The author reviews the current "slippery slope" concept and professional ethics pertinent to boundary dilemmas. A graded-risk model for boundary dilemmas is introduced to offer a "process" approach to ethical decision making in boundary dilemmas. This model divides boundary crossings into four categories. Each category considers six variables: (a) the potential harm to the patient, (b) the potential benefit to the patient, (c) the presence or absence of coercive and exploitative elements in the boundary crossing, (d) the professional's motives and intentions, (e) the professional's aspiration to professional ideals, and (f) the context of the boundary crossing. This model of boundary crossings introduces complexity and specificity necessary for clinical decisions, teaching, retrospective judgements, and research in boundary dilemmas.