Pelvic Exams Done on Anesthetized Women Without Consent: Medical Sexual Assault
A doctor has no business performing medically unnecessary procedures on a patient without the patient's consent.
It is absolutely obscene to perform these procedures on an unconscious patient, out under anesthesia, who has not given consent.
Yet it has happened and continues to happen.
And yes, it is sexual assault, which is, in part, defined as:
Forcible object penetration--penetrating someone's vagina or anus, or causing that person to penetrate her or himself, against that person's will.
Phoebe Friesen published a paper in 2017, "Educational pelvic exams on anesthetized women: Why consent matters." An excerpt:
Recounting a difficult experience he had during medical school, Shawn Barnes writes:In obstetrics and gynecology, I encountered the first act of medical training that left me ashamed.For 3 weeks, four to five times a day, I was asked to, and did, perform pelvic examinations on anesthetized women, without specific consent, solely for the purpose of my education.
Typically, this would unfold as follows: I would be assigned a gynecologic surgery case on which to scrub in. I would be required to go meet the patient beforehand and introduce myself as 'the medical student on the team' or some such vague statement of my role in the procedure, without mentioning a pelvic examination.
I then would follow the patient into surgery. Once anesthesia was administered and the patient was asleep, the attending or resident would ask me to perform a pelvic examination on the patient for educational purposes.
To my shame, I obeyed.
As a medical student, I am all too aware of the hierarchy that exists during training. My medical education experience has reinforced the notion that the medical student should not question the practices of those above him or her.
I was very conflicted about performing an act that I felt was unethical, but owing to both the culture of medicine and my own lack of courage, I did not immediately speak out against what I was asked to do by residents and attendings.
Arthur L. Caplan, PhD writes at MedScape more recently that pelvic exams are still being given to women under anesthesia without their consent:
I had thought this sort of teaching practice had ended. But apparently it has not.In many teaching hospitals around the world, students doing their gynecology rotation "practice" a pelvic exam on a surgical patient after they're put under anesthesia. Sometimes, more than one student will practice the exam, with many sets of gloved fingers in the patient's vagina without their knowledge.
Phoebe Friesen argues in Bioethics "why consent matters" (I want to scream "OBVIOUSLY!") when "educational" pelvic exams are done on anesthetized women -- and correctly explains that such exams are "indefensible."
She quotes a post from studentdoctor.net, a "popular forum" for med students, that does a good job of explaining why:
A response from PregnantAt51 reads: I am cringing a little at this thread. As a female student not yet in the medical field, I am disturbed to hear that by consenting to surgery, I risk having someone literally in my vagina without consent for purposes that benefit only the providers, and not me. Are patients really viewed as a teaching tool rather than a human being? That I will be splayed and sliced during the procedure doesn't mean that additional indignities are acceptable. It's still my vagina, even if I am naked and unconscious. I didn't lend it to anyone to practice techniques.
Friesen's conclusion -- and I agree:
I have argued that the practice of performing pelvic examinations on women who are under anesthetic and have not consented is unjust, in that it violates both the autonomy and the bodily rights of patients and also serves to jeopardize trust within the patient-physician relationship.I considered the possibility that this practice constitutes an excep- tion to the requirement of informed consent, either because it has utilitarian consequences or because it is trivial, and concluded that this is not the case.
In order to respect the bodily rights and autonomy of women, each ought to be asked specifically to consent to medical students performing pelvic examinations on them while under anesthetic, preferably before they are in the preoperative holding area, and by someone other than the medical students themselves.
Evidence suggests that the majority of women who are asked will consent and that they will be a lot less likely to feel they've been assaulted while unconscious at the hospital.
Tell women they are helping student doctors learn and give them the choice to opt out. It is their choice.
Personally, however, learning about these violations, if I were to go into surgery tomorrow, I would, number one, be creeped out and feel threatened about what might be done to me; and number two, be insistent that doctors do nothing beyond the necessary and scheduled procedure.
And I say that as somebody whose driver's license reads "donor" -- meaning, upon death, I'll be cut up for parts. However, that's a status I chose -- and therein lies a vast difference.
Medscape via @PaulHsieh
Humm. Not sure I am particularly worried about this. If you elect as a free person to have surgery done at a teaching hospital it is certainly implied that students will be working on you.
Is it just the pelvic exam you are worried about or do you think, blood draw, blood pressure, ears, eyes, nose and anything else that invoves either looking at an unclothed patient or touching them should be covered by specific consent as well?
If I were a teaching hopsital, I would probably make any patients sign a general consent form for nurses, PA’s lab techs and nursing aids to touch me intimately. Nothing particularly special about my vaginia.
Also, legally, not really assault. Might be a battery.
Isab at May 4, 2018 12:21 AM
Is this sort of practice done in Hospital surgical bays around the World? Or is this some creepy unethical practice dreamed up by AMERICAN doctor's and or the AMA? "American Medical Assholes," for short. Figures, AMERICAN doctor's have always felt their god's, and their shit doesn't stink. It seems there is no shortage of creepy behavior, I wonder what else doctor's or surgeons do to defenseless people under anesthesia? Women should sue just for spite. A lawsuit or the threat of loss of income is the best deterrent for rogue doctor's. I find this sort of piggish behavior "disgusting." I guess training medical students on a cadaver is just too expensive these days. After all, what women could or would complain? After all, waking up sore after ten sets of fingers were probing your "box" from student experience should be considered "par for the course." Check please!
Scott at May 4, 2018 12:38 AM
It is obscene to do procedures on an anesthetized patient that have no benefit for them without their consent.
And I am not a lawyer, obviously, but yes, it seems to fit the definition of sexual assault.
Amy Alkon at May 4, 2018 6:09 AM
I delivered a baby at a teaching hospital. I was asked (and consented) to examinations by a student while I was there. (Actually, the on call doctor didn't want to catch babies, and another hadn't arrived yet, so a student nurse wound up catching my baby.)
I have, many times, been happy to be a guinea pig for new techs doing blood draws, as my veins are tricky and needle pricks don't bother me.
If I'm getting surgery to have my appendix out, or for a kidney problem, or for my liver or lungs, or really anything other than surgery on my actual vagina, there is zero reason for anyone, let alone multiple people, to be touching any part of my vagina. If multiple students were putting their hands inside my vagina without my consent, I would consider that sexual assault. (Or whatever the proper legal team is.)
The issue isn't that it's a student, or even multiple students. The issue is anyone (even a doctor who's been in practice for many years) performing a procedure, especially one on an explicitly sexual organ, without consent.
Jazzhands at May 4, 2018 9:24 AM
It's not like the hospital is leaving the patient nude on the table with a sign welcoming all perverts to come on by and cop a feel. Doctors, in training or otherwise, are examining her for medical purposes.
It's the same thing as when a student doctor is asked to stick his/her finger into a patient's open thoracic cavity and get a feel for a valve resection. It's training, not perversion.
Assault is a threat to cause harm, physical or otherwise, while battery is defined as use of force against another with intent of causing physical harm without his consent. "In other words, assault is the attempt to commit battery."
Conan the Grammarian at May 4, 2018 9:58 AM
Pretty sure the surgical consent you sign at a teaching hospital covers that...as well as pictures of whatever surgical procedure you're having done to be used in the teaching environment. Don't want to give consent for all that? Go get your surgery somewhere else. If I were a betting woman, I'd bet that you're consenting to the pelvic exam...maybe not spelled out that way, but I'm sure the consent is all encompassing.
Now if we're talking about a doctor sexually abusing a patient under anesthesia, then I'll get my panties in a twist.
sara at May 4, 2018 10:20 AM
"...give them the choice to opt out. It is their choice."
No, I would say assume that they are opted out until they explicitly opt in.
This is a situation where a competent, professional nurse should step up and have something to say. I consider it my most important responsibility to advocate for my patients; and their dignity is certainly of great importance to them, even if they're not in a state of mind to know it.
I work in mental health. I'm often appalled by how little regard some doctors and nurses have for the dignity and humanity of their patients. I've found it to be a waste of breath to try to persuade, debate or argue with them to change their thinking. Some people just don't give a shit about stuff like that, especially if they think it won't be in the patient's medical record and no one who does give a shit will ever know about it.
What they do give a shit about is exposure and liability. So if some care provider, with some superficial pretense of care and treatment, treats any of my patients in a way that I think violates their dignity, I document a description of that treatment in the patient's medical record.
Whereas persuasion, debate and argument have been a waste of breath, writing a simple, accurate progress note has had a very chilling effect on unethical practices.
If there's nothing wrong with having a half dozen medical students take turns examining an unconscious patient's vagina without her prior knowledge or consent, then there shouldn't be any objection to documenting what was done and by whom in the patient's medical record. In fact, everything that was done to any patient should be documented in the chart. Doctors, nurses and medical students shouldn't do anything to a patient that they don't want the patient or her lawyer to know about.
Ken R at May 4, 2018 11:41 AM
This crap seems to be just like TUBEs (Totally Unnecessary Breast Exams).
mpetrie98 at May 4, 2018 6:30 PM
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