SALON

Friday, Jan 29, 2010 7:30 PM UTC

Hands off my pelvis, doc!

Canadian medical students practice gyno exams on unconscious patients without their consent

By

Topics: Medicine, Broadsheet, Health,

Hands off my pelvis, doc!

Broadsheet readers know that U.S. hospitals and courts have fallen down repeatedly when it comes to respecting the privacy and bodily integrity of women — at least the pregnant ones. Among women who’ve refused to undergo c-sections, for instance, one was confined to a hospital against her will, one was accused of abuse and neglect in part because she insisted on delivering vaginally, one was arrested during a home birth, one was brought up on murder charges for having a stillborn baby, and one was forced to undergo the procedure at 25 weeks even though it risked her life. (Neither she nor the fetus survived.) That’s just a sampling. But in at least one area, we seem to be doing something right, while Canada — that magical, progressive dreamland of universal healthcare and legal gay marriage (never mind the current government) — allows a horrifying violation of women’s medical rights. In “many Canadian teaching hospitals,” writes public health reporter Andre Picard in the Globe and Mail, “Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent.”

The U.S. and U.K. have guidelines requiring consent before a bunch of strangers are permitted to explore a patient’s orifices, but “Canadian guidelines state that pelvic examination by trainees is ‘implicit.’” You agree to one procedure while under anesthesia, and you’ve agreed to all of them, I guess? Or maybe just the ones that might be awkward and uncomfortable if you were conscious. Writes Picard (who deplores the practice), “The long-standing argument in favour of allowing these exams to be done on surgery patients is that it provides a unique opportunity for students to practice the delicate, invasive examination without causing the woman pain or embarrassment.” There’s probably a joke about the fabled Canadian politeness in there somewhere, but I’m really too disgusted and dispirited by that sentence to try. What makes a pelvic exam bearable, as a patient, is communication with the person performing it. You know what the great thing about being awake is? If it hurts, you can say something. And the practitioner can then do something to make it stop hurting. Practicing on an unconscious woman may mean she doesn’t feel any pain, but it doesn’t mean you’ve learned how to do the job without causing any. Nor how to deal with a patient who just can’t relax, no matter how many times you explain that the process would go much more smoothly if she did; an unconscious woman isn’t instinctively clenching her muscles while trying to act cool. An unconscious woman also isn’t going to be able to tell you that the speculum is freezing or you need more lube or that, say, she’s a sexual assault survivor who finds pelvic exams traumatic. And above all, an unconscious woman cannot give you permission to put things in her vagina.

The idea that letting unskilled people perform a “delicate, invasive examination” on women who have not consented, don’t know it’s happening, and cannot tell the student to stop is a good thing for women — no pain! no embarrassment! – is so patently offensive and ass-backward, I don’t really know where to begin. I can appreciate the concern that too few conscious women would volunteer to be guinea pigs for inexperienced speculum operators, but A) that’s still no excuse and B) it’s not necessarily a problem anyway; a survey of patients in a pelvic disorders clinic found that “Sixty-two per cent of respondents said they would consent to medical students doing pelvic exams, and an additional 5 per cent said ‘yes’ but only if a female student was doing the exam.” It turns out all you have to do is ask. But even if that weren’t the case, says Picard, “There are other ways to do this training, using simulation models, paid volunteers and consenting patients in other settings such as clinics.” There is simply no justification for treating unconscious patients like plastic models or cadavers. And I can’t help  wondering: Is this how Canadian medical students learn to do rectal exams as well? How about dental training — do they figure it’s best to practice wielding all those pointy instruments on people who are knocked out before graduating to conscious patients? Or is it only women’s bodies that are considered property of the medical facility once the anesthesia kicks in?

“This is the result of a failure to communicate,” writes Picard. “It is also a striking example of a lingering bit of paternalism that is still all-too-present in medical culture.” Even if the U.S. already has appropriate guidelines on this particular issue, those examples of forced cesareans, not to mention forced sterilizations, forced ultrasounds, and oh yes, forced births — illustrate that we’re still suffering from the same paternalistic medical culture and deliberate lack of communication with people who reasonably expect to have the final word on what’s done to their own bodies. At least, we are when those patients are women, and the decision in question is regarding their reproductive organs. Really, the thing that surprised me most about Picard’s article is that it isn’t happening here. 

Kate Harding is the co-author of "Lessons From the Fatosphere: Quit Dieting and Declare a Truce With Your Body" and has been a regular contributor to Salon's Broadsheet. More Kate Harding.

Next Article

Related Stories

More Related Stories

Featured Slide Shows

The week in 10 pics

close X
  • Share on Twitter
  • Share on Facebook
  • Thumbnails
  • Fullscreen
  • 1 of 11
  • Lisa Montgomery embraces her nephew Thursday after a tornado tore apart her home in Cleburne, Texas. The twister killed six people and destroyed entire swaths of the North Texas town.
    Credit: AP/LM Otero

  • Jack McMahon, the defense attorney for abortion doctor Kermit Gosnell, speaks outside the Criminal Justice Center in Philadelphia Tuesday. His client was convicted of killing three babies in his clinic, and will serve multiple life sentences.
    Credit: AP/Matt Rourke

  • A photo taken Monday captures Vice President Joe Biden's response to a Milwaukee second-grader's innovative proposal to end America's epidemic of gun violence. This guy!
    Credit: AP/Jenny Aicher

  • Sen. Rand Paul, R-Ky., flanked by a grouper-eyed Michele Bachmann, addresses the IRS' admission that it targeted Tea Party groups in advance of the 2012 election. In an op-ed for CNN Thursday, the Kentucky senator slammed the president for his faux outrage.
    Credit: AP/Molly Riley

  • Ousted IRS chief Steven Miller is sworn in on Capitol Hill Friday. Miller testified before the House Ways and Means Committee on the extra scrutiny the agency gave conservative groups applying for tax-exempt status.
    Credit: AP/J. Scott Applewhite

  • Attorney General Eric Holder pauses as he testifies on Capitol Hill before the House Judiciary Committee Wednesday. Holder is under fire, among other things, for the Justice Department's gathering of phone records at the Associated Press.
    Credit: AP/Carolyn Kaster

  • O.J. Simpson sits during an evidentiary hearing at Clark County District Court in Las Vegas, Nev., Thursday. Simpson, who is currently serving a nine-to-33-year sentence in state prison for armed robbery and kidnapping, is using a writ of habeas corpus to seek a new trial.
    Credit: AP/Las Vegas Review-Journal/Jeff Scheid

  • Major Tom to ground control: On Sunday astronaut Chris Hadfield recorded the first music video from space, a cover of David Bowie's "Space Oddity."
    Credit: AP/NASA/Chris Hadfield

  • When it rains it pours. President Barack Obama speaks during a news conference Thursday with Turkish Prime Minister Recep Tayyip Erdogan, inexplicably inspiring an #umbrellagate Twitter meme.
    Credit: AP/Jacquelyn Martin

  • A smoke plume rises high above a road block at the intersection of County A and Ross Road east of Solon Springs, Wis., Tuesday. No injuries were reported, but the the wildfire caused evacuations across northwestern Wisconsin.
    Credit: AP/The Duluth News-Tribune/Clint Austin

  • Recent Slide Shows

  • Share on Twitter
  • Share on Facebook
  • Thumbnails
  • Fullscreen
  • 1 of 11

Related Videos

Comments

 41 Comments

Comment Preview

Your name will appear as username

You may use these HTML tags and attributes: <a href=""> <b> <em> <strong> <i> <blockquote>

follow salon

Most Read

Popular on Reddit

links from salon.com

From Around the Web

Presented by Scribol
listener_new_rect The Listener: So long, Sookie Stackhouse

Recommendations