Warning: This blog contains descriptions of sexual assault.
“Recent reports that medical students are performing pelvic exams for training purposes without their consent or knowledge have sparked intense debate and calls for stronger regulation.” But that “explosion of public backlash” began in the mid-1990s. California was the first state to outlaw the practice, but “early gains quickly evaporated.”
As I discuss in my video, “Ending the Covert Practice of Pelvic Exams on Non-Consenting and Unconscious Women,” “This practice, common since the late 1800s, went largely unchallenged until a 2003 study reported that 90 percent of medical students completing obstetrics and gynecology rotations at four Philadelphia-area medical schools performed pelvic exams on anesthetized women for educational purposes.” (A subsequent study found that this rate was lower than in other parts of the country.) So what does it all boil down to? “Pelvic exams performed on anesthetized women without their consent: Still going on.” How can this situation persist until 2025? Medical ethicists call such practices “immoral and indefensible.” “Ultimately, this is a practice that should be stopped suddenly and immediately.” Some schools vowed to end the practice, but unfortunately, these early victories quickly fizzled. At the same time, a small number of schools reviewed their policies, and a similar number of hospitals and medical schools publicly defended the practice.
The Association of Professors of Obstetrics and Gynecology writes, “As medical educators, we must balance our obligation to train the next generation of physicians with women’s freedom to decide who they receive care from and which aspects of their care their learners are responsible for.” “Some particularly outspoken faculty members argue that ‘public’ patients, or those without health insurance, have a duty to institutions and society to participate because they receive free or subsidized care.” Regulations that curb this practice are said to “place inappropriate and unnecessary barriers for medical students who need to learn basic medical skills” and therefore “should be opposed.” Not surprisingly, medical students still perform pelvic exams on women under anesthesia.
Professional medical societies pay lip service to the concept of asking for explicit consent, but despite recommendations, “evidence…suggests that this practice persists.” And, “misappropriation of women is not a local phenomenon confined to a few misguided medical schools,” but an international problem.
Even after the rise of the #MeToo movement and the sentencing of notorious American gymnastics doctor Larry Nassar to 40 to 175 years in prison for touching women’s genitals without their consent, “there are still women who are being used for coaching in these exams without their permission or consent.”
The 2020 update from the Yale Center for Bioethics is titled “The Ignored Pot Boils: The Continued Request for Explicit Consent for Intimate Health Examinations.” “Over the past 30 years, several stakeholders, both inside and outside of the medical community, have been vocal in their opposition to these tests. The arguments of medical associations, legal scholars, ethicists, nurses, and even some physicians have not forced meaningful systemic change.” To be sure, there is lip service from medical associations recommending a ban on nonconsensual pelvic exams, but those statements are “advisory and incomplete. As evidenced by the inaction of medical institutions, medical associations simply lack the ability to force systemic change.” In response to situations where medical professionals are unable to police themselves, many states have passed laws to protect patients from this practice.
But of course, if you’re under anesthesia, how do you know if a medical student is in line? “Teaching hospitals take patients in the worst conditions – patients who are unconscious – to find out what is going on, and exploit them in ways that leave no physical signs and are not recorded in the patient’s medical record.” So when the media loses interest, as has been the case for decades, “what will motivate faculty and hospitals to change voluntarily?” Perhaps, “as doctors start being threatened with lawsuits, they will start obtaining informed consent.” One commentator wrote, “Hospital administrators who allow their medical students to perform pelvic exams on nonconsensual anesthetized women should consult with their attorneys regarding the definition of rape in their jurisdiction.”
“The solution is simple: just ask.” Ask the woman for permission. It’s their body and their choice. “However, recent experience shows that meaningful and complete change on a hospital-by-hospital basis is unlikely unless the hospital or physician pays significant compensation (in some form of litigation) for this lapse in ethical judgment. We believe that day is coming soon, lest the neglected pot finally boil over.”
“Some defend it as harmless, while others argue that asking for consent makes patients more likely to say no, denying students an important part of their training.” When I first wrote about the practice in my book Heart Failure more than 20 years ago, when I was in medical school, I talked about receiving similar comments from classmates. Talk to patients, even people you trust. We may need to treat them as humans. ”
It is unconscionable that medical students are legally allowed to perform pelvic exams on anesthetized women without their consent. Even if you live in one of the states where this practice is technically illegal, how do you know the law will be respected after you lose consciousness? Maybe medical students should wear body cams.
If you missed the related video, watch Medical Student Practices Pelvic Examination on Woman Anesthetized Without Consent.
