21 October 2008

And just when I thought I'd heard it all...

I learned something very scary in Health Law today. Apparently it was common practice, up until about 10 years ago, for medical students to do unauthorized pelvic examinations on anesthetized female patients for learning purposes. The women who were victims of this wouldn't even know that it had been done. Some teaching hospitals still follow this practice, but many have changed their policy- not because the doctors found it to be unethical, but because the students have a problem with it. Good for the students for standing up against this, but what are the professors and practitioners doing the teaching thinking?

The medical rationale is that med students need to learn how to do proper pelvic exams, and that takes practice. Pelvic exams are one of the most private exams women undergo, and few will consent to one by anyone other than their doctor. A pelvic exam conducted by someone who hasn't had a lot of practice can be very painful for the woman involved. Unconscious, anesthetized women are the perfect practice subjects because they are relaxed.

For an in depth discussion of this, see: http://www.cnn.com/2003/HEALTH/03/11/pelvic.exams.ap/

My problem with this practice is the fact that the women (and some men in the case of prostate exams) involved have not had the opportunity to consent to this procedure. We are all autonomous beings with the right (assuming we have capacity) to determine what we want done to our bodies, and to consent to it. As Justice Cardozo famously stated in Schloendoff v. Society of New York Hospital, 211 N.Y. 125(1914), "Every human being of adult years and sound mind has the right to determine what shall be done with his own body."

An unauthorized pelvic exam violates the right of women, and, in my opinion, should constitute a battery, actionable in a civil suit. Some hospitals have included this in their general consent form, but it's not explicitly stated, and is generally just covered by a general clause stating that teaching may occur in the surgical process. I have no problem with these exams if the women explicitly consent to it, but without informing them, they are being violated. I won't go as far as some commentators and call it rape, because I think that is a very different situation, but it is battery.

I guess the bottom line is that before you undergo any surgery where you will be anesthetized, discuss this with your doctor, and make it very clear that you do or do not consent to such an exam. All in all, the best thing you can do is ask as many questions as you can so you know exactly what the doctor intends to do to you.

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