Having obstetric/gynecological surgery anytime soon at one of the hundreds of teaching hospitals around the country?
Then be forewarned that, while you are under general anesthesia, medical students may be performing “practice” pelvic exams on you without bothering to first notify you or obtain your consent. Instead, the hospital assumes that you “consented” to the exam when you signed the general pre-operative surgery consent form, even though these forms typically do not mention the procedure. A few years ago, a short-lived media firestorm led to federal hearings on the issue; the American Association of Medical Colleges (which represents most of the nation’s medical schools and over 400 teaching hospitals) issued a statement condemning the practice as “unethical and unacceptable.”
But according to my colleague Robin Fretwell Wilson, who has done extensive research on the issue, the practice lives on at many teaching hospitals around the country. Incredibly, many doctors justify the practice by simply asserting that women will not consent if asked. Since medical students need to practice pelvic exams, they argue, the needs of the medical establishment should trump a woman’s right to be asked for permission before unnecessary medical procedures are performed on her. (In fact, their assumption that women won’t consent if asked is dubious; one study indicates that at least 50% of women do give permission when asked in advance.) According to Professor Wilson, some teaching faculty bluntly assert that poor patients who receive free or subsidized care at a teaching hospital “owe it to the facility and society” to participate. For more information on the controversy, see Professor Wilson’s article, Autonomy Suspended: Using Female Patients to Teach Intimate Exams Without Their Knowledge or Consent (available for download here at SSRN).
If you live in the great state of Virginia, you’re in luck. Thanks to Professor Wilson’s hard work and advocacy efforts, the Virginia legislature just enacted legislation requiring specific informed consent for the practice. (California has also enacted similar legislation.)
By the way, if you’re a man thinking that this issue doesn’t affect you, you might think again. If you ever go in for prostate surgery, think twice before you sign that general consent form: You may be signing up for a free rectal exam or two (or three), courtesy of whatever medical students happen to be on rotation that day.