Pelvic examinations under anesthesia by medical students without consent

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Line drawing showing bimanual palpation as part of a pelvic exam

Pelvic exams under anesthesia by medical students without explicit consent are often done to teach medical students how to conduct pelvic exams. They are typically done during gynecological surgeries, but not exclusively.[1]

First-year medical students find such examinations more morally problematic than those who have completed ob/gyn clerkships,[2] an example of a phenomenon known as ethical erosion.[3]

A study done in 2003 found that 90% of Pennsylvania medical students had done pelvic exams without consent.[4] One medical student described performing them "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."[5]

A 2022 study of six American medical schools found that off the 84% of medical students that had performed pelvic exam(s) under anesthesia, 67% stated that they never or rarely witnessed explicit consent being obtained for a student to perform the pelvic exam under anesthesia.[6] It is possible that such consent had been obtained when the clinician provided a discussion of the type of procedures to be performed, along with a discussion of the risks, benefits, and alternatives to the procedures; this discussion typically takes place at a preoperative visit.[7]

Students have described pressure to do the examinations from their superiors.[8][5][9] They have reported that they believed "they did not have the personal autonomy to object to performing pelvic EUAs that they believed were unconsented."[6]

Support

The New York Times found that "doctors often argued that patients implicitly consented to being enlisted in medical teaching when visiting a teaching hospital, or that consent for one gynecological procedure encompassed consent for any additional, related exams."[4]

People have described beliefs that if consent was asked, medical students would not be able to get experience performing pelvic exams; however, a majority of women polled stated that they would consent to such procedures.[3] A utilitarian perspective argues that the educational benefit and consequential benefit to future patients is invaluable.[1]

Others have opposed bans to maintain institutional autonomy and prevent government overreach.[1]

Opposition

A social media hashtag, #MeTooPelvic, was created.[4] People have described the exams as violating and traumatizing.[4][10] They have been described as sexual assault,[8] and a comparison to rape has been drawn due to the digital penetration without consent.[1]

The Association of Professors of Gynecology and Obstetrics recommends that pelvic examinations only be done with explicit consent.[7]

A Kantian perspective argues against such exams, claiming that they treat women as mere means.[1] Autonomy of the patients has been violated.[11]

A 2022 study of third and fourth year medical students at the University of Pittsburgh School of Medicine found that 75% of students believed that explicit consent should be obtained for educational pelvic exams under anesthesia.[12]

Legality

More than 20 states have banned such exams.[13]

References

  1. ^ a b c d e Seybold, Samantha L. (November 2022). "Not just "bodies with vaginas": A Kantian defense of pelvic exam consent laws". Bioethics. 36 (9): 940–947. doi:10.1111/bioe.13084. ISSN 0269-9702. PMC 9826341. PMID 36067372.
  2. ^ Ubel, Peter A.; Jepson, Christopher; Silver-Isenstadt, Ari (February 2003). "Don't ask, don't tell: a change in medical student attitudes after obstetrics/gynecology clerkships toward seeking consent for pelvic examinations on an anesthetized patient". American Journal of Obstetrics and Gynecology. 188 (2): 575–579. doi:10.1067/mob.2003.85. ISSN 0002-9378. PMID 12592274.
  3. ^ a b Friesen, Phoebe (2018-10-30). "Why Are Pelvic Exams on Unconscious, Unconsenting Women Still Part of Medical Training?". Slate. ISSN 1091-2339. Retrieved 2023-12-05.
  4. ^ a b c d Goldberg, Emma (2020-02-17). "She Didn't Want a Pelvic Exam. She Received One Anyway". The New York Times. ISSN 0362-4331. Retrieved 2023-12-05.
  5. ^ a b Barnes, Shawn S. (October 2012). "Practicing Pelvic Examinations by Medical Students on Women Under Anesthesia: Why Not Ask First?". Obstetrics & Gynecology. 120 (4): 941–943. doi:10.1097/AOG.0b013e3182677a28. ISSN 0029-7844. PMID 22996113.
  6. ^ a b Kaur, Karampreet; Salwi, Sanjana; McNew, Kelsey; Kumar, Nimisha; Millimet, Hannah; Ravichandran, Niharika; Tytus, Karla; Zhang, Angela Y.; Garrett Wood, Angelica; Grimm, Barry; Fairbrother, Erin L. (2022). "Medical Student Perspectives on the Ethics of Pelvic Exams Under Anesthesia: A Multi-Institutional Study✰". Journal of Surgical Education. 79 (6): 1413–1421. doi:10.1016/j.jsurg.2022.05.015. ISSN 1878-7452. PMID 35672245. S2CID 249382859.
  7. ^ a b "APGO Releases Statement on Teaching Pelvic Exams to Medical Students - Association of Professors of Gynecology & Obstetrics - APGO". apgo.org. Retrieved 2023-12-05.
  8. ^ a b "Why more states are requiring consent for pelvic exams on unconscious patients". PBS NewsHour. 2023-02-11. Retrieved 2023-12-05.
  9. ^ "More states are requiring patients to give consent for medical students performing pelvic exams". AP News. 2023-05-20. Retrieved 2023-12-05.
  10. ^ "Without consent: Pelvic exams under anesthesia still happen without patient knowledge". KSHB 41 Kansas City News. 2022-10-03. Retrieved 2023-12-05.
  11. ^ Friesen, Phoebe (June 2018). "Educational pelvic exams on anesthetized women: Why consent matters". Bioethics. 32 (5): 298–307. doi:10.1111/bioe.12441. ISSN 0269-9702. PMID 29687469.
  12. ^ Zuchelkowski, Benjamin E.; Eljamri, Soukaina; McDonnell, Jill E.; Varma, Bhavya; Stern, Natalie G.; Rothenberger, Scott D.; Arora, Kavita Shah; Chang, Judy C. (2022). "Medical Student Attitudes on Explicit Informed Consent for Pelvic Exams Under Anesthesia". Journal of Surgical Education. 79 (3): 676–685. doi:10.1016/j.jsurg.2021.12.013. ISSN 1878-7452. PMC 9064935. PMID 35058165.
  13. ^ "More states require patient consent for students to perform pelvic exams". ny1.com. Retrieved 2023-12-05.
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