In 2010, a Canadian medical paper made waves when it alleged that pelvic examinations performed under anesthesia by medical students may be unethical. Such examinations occur after patients are asleep and are often considered excellent teaching moments for medical students, especially when learning such exams on conscious patients can be awkward. Pelvic exams involve doctors or medical students “[inserting] their fingers into a patient’s vagina to examine the cervix and uterus” and check for abnormalities. Similarly uncomfortable rectal exams often occur for men while they’re under anesthesia prior to prostate surgery.
The issue of consent was first raised by Dr. Dan Wainberg, who as a medical student felt that pelvic examinations were not sufficiently supervised. He described an experience as a medical student in the operating room prior to a surgery:
“The gynecologist sent me over to the bed to do a pelvic exam on this woman…and he
went off to do something else. And so I was left there by myself doing a pelvic exam on
an unconscious woman as someone who really didn’t have a lot of knowledge of what
I’m supposed to be feeling for. And I thought to myself, who would consent to something
like this? …if the woman knew what was going on…. she’d probably be pretty upset, and
justifiably so….I just thought, what am I doing? And what would this woman think if she
were to wake up right now?….I don’t think anyone paid any attention to me whatsoever,
including the surgeon who was supposed to be basically my supervisor, or teacher.”
While all patients at teaching hospitals sign forms acknowledging that medical students may take part in their treatment, the authors of the 2010 paper hoped to understand whether women admitted for gynecological surgery were aware that a practice pelvic exam might happen while under anesthesia, and if they were not aware, how they would feel about it. Just over half of the women surveyed expected a medical student would be present during surgery, yet only 19% were aware that a medical student might do a pelvic examination. As it turns out, 72% of the women expected to be asked for consent before medical students undertook pelvic examinations. A majority, 62%, said they would consent to medical students doing pelvic examinations if given the opportunity, but some would only allow female students, others were not sure, and 14% said they would refuse a medical student conducting the examination.
Clearly, most women (62%) support the idea of medical students conducting pelvic examinations. But most women also hoped to be asked for consent. Medical teaching is undoubtedly a wholesome and beneficial activity, not a nefarious or evil one. But perhaps the way we think about the female body in this context could be improved by remembering the feelings and wishes of the woman. Even if the outcome is the same, it feels very different to a patient to undergo an exam after consent; one scenario can feel violating, while the other does not.
I believe this is analogous to many other issues which face society today. The crux of this issue is empowering people who are vulnerable, even when those “in power” are well intentioned. Certainly, doctors and medical students are not oppressive or looking to take advantage of patients. But this does not mean that patients are not entitled to clearer communication or an opportunity to express their feelings and wishes. Even if the outcome is the same, it is important that doctor and patient arrive there together, simply by virtue of the deeply personal nature of the human body. It is a matter of human dignity that if respected, can improve the experience of health care workers and patients alike.
Baker, Elna. “661: But That’s What Happened.” This American Life. Last modified November 11,
- Accessed November 26, 2018. https://www.thisamericanlife.org/661/transcript.
Chamberlain, Susan, Alan Bocking, Michael McGrath, Wylam Faught, Robert Liston, R. Douglas
Wilson, Margaret Morris et al. “Teaching pelvic examinations under anaesthesia: what do
women think?.” Journal of Obstetrics and Gynaecology Canada 32, no. 6 (2010):
Wainberg, Sara, Heather Wrigley, Justine Fair, and Sue Ross. “Teaching pelvic examinations
under anaesthesia: what do women think?.” Journal of Obstetrics and Gynaecology
Canada 32, no. 1 (2010): 49-53.