Although doctors have an ethical and professional obligation to refrain from breaching the sexual boundaries with their patients, research has demonstrated that the patients can also sometimes be the initiators of unwanted sexual behaviour or consensual sexual boundary breaches. Informed by Brazier’s concerns about the potential imbalance between patients’ rights and health care professionals’ responsibilities, this chapter argues that, whilst the need to maintain sexual boundaries in heath care professional-patient relationships is a matter of professional accountability, if such breaches are deliberately initiated by the patient, they too should bear some moral responsibility. We explore such breaches by patients and consider the appropriate legal and ethical response.