Doctors Abusing Patients
January 29, 2010 · By Jonathan McLeod
This story is horrific. This is rape.
Imagine that you are undergoing a fairly routine surgery – say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.
Do you consider this okay, or an outrageous violation of your rights?
Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.
Medical students routinely practice doing internal pelvic examinations while surgery patients are unconscious, and without getting specific consent, at least in Canada.
Guidelines in the United States and Britain say specific consent is required but, by contrast, Canadian guidelines state that pelvic examination by trainees is “implicit.”
…
She [Dr. Sara Wainberg] polled her fellow students and found 72 per cent had also done exams on unconscious patients, without consent, confirming that it is routine.
Read the whole thing. There’s a lot to unpack regarding this practice. The mentality behind this is insulting, illiberal and dehumanizing. There is no justification for penetrating women (or men) without their consent. It does not matter what letters follow your name; it does not matter that the word, “Dr.”, precedes your name; it does not matter that she is unconscious; it does not matter what other things she has consented to; you are not allowed to violate her. The same rules that apply to the alley way apply to the operating room.
Further thoughts can be found here.
That’s why when you sign your consent forms you should read the fine print. There’s nothing preventing you from crossing out the clauses that give the teaching hospitals permission to do this.
I’m waiting for the fine print to start including implicit permission to donate your organs :-)
Good point, skuleman. Patients do need to take a more proactive role in their care. My question would be, do we know if there was a fine print? Are they operating under “implied consent”? Even if we answer ‘yes’ to those questions, it still strikes against informed consent.
And don’t worry, I’m sure they’ve already found a way to extract your permission for organ donation. Let’s just hope we don’t wind up in a Meaning of Life scenario.
I have never been raped — at least, not that I am aware — but from what I hear of such an experience, I would suspect that these involuntary pelvic exams are a bit more pleasant.
No matter what you do, you can never prove that informed consent exists in any particular instance. You can never know whether the person understands what they read let alone whether they even read it. The concept of informed consent is arbitrary and it is never absolutely verifiable. As far as the legalities are concerned, we are just stuck having to follow the rules and decisions of the judges, the lawyers and other professional arguers who decide our fate.
In the context of government monopolized health care here in Canada, I do not understand what the big deal is about this issue. Getting involuntarily probed down in the nether regions seems to be standard accepted practice.
Sorry Charles, I can’t buy into your postmodern dissection of this issue. We have a common understanding of the word ‘consent’, and we regularly apply it in our social affairs.
Even the med students involved readily admit that they did this without consent. So, even if we we’re going to get into debate about the plausibility of proving consent, the abusers didn’t think there was consent. That’s pretty damning.
And no matter what jokes we may want to make about what the government does to us, when one person sticks something into another’s vagina without her consent or participation, it’s rape.
I have a question for you, Jon. If anything, what should be done about this? Since you are so adamant to submit yourself to the orders, the rules and the definitions of the elite authorities, should these medical students be treated and labelled as common rapists??
or should exceptions be made?
That’s quite a reasonable question, Charles.
Yes, essentially, they should be labelled rapists.
In terms of how they should be treated, they should be brought up on charges. In Canada that means sexual assault (as I’m sure you know that the criminal code does not use the word ‘rape’), and those should be the charges (putting aside plea bargains and whatnot) they face.
As I have written, I can lend some understanding to the med students. They were instructed to assault the patients, and they’re probably conditioned not to question the instructions. That seems like a mitigating circumstance.
To borrow your phrase, they do not seem like common rapists. I would think we should treat them similarly to the way we would treat people involved in the strip search prank call cases. In fact, I would suggest they probably don’t need to be treated quite as harshly.
In terms of their profession, I would think the Royal College has some sort of regulation against unnecessarily probing random unconscious women. Whatever the punishment for that is would probably be a good start.
I think the doctors who instructed the med students to assault women should bear greater responsibility. They’re equally guilty, but, I would argue, had more control over the situation.
For both groups of perpetrators, I’m not sure if prison time is necessary. I don’t think I’d be crying if some of these people were sent to jail, but I’m guessing – especially for the med students involved – that jail time isn’t necessary to make sure these people don’t do this again.
However, I haven’t thought a lot about what criminal punishment would be warranted. I’m open to being persuaded. Part of the reason I haven’t thought too much about it is that, as I said, I’m pretty sure nothing will come of these crimes. I’ll be happy if there are just some administrative punishments handed down. I’ll be horrified if they keep assaulting patients when they’re out cold.
Although I do not agree with them entirely, I think your responses are pretty good but once you make exceptions — mitigating circumstances is just a fancy way of making exceptions — then you are being just as post-modern as I am.
You are mistaken when you say we “have a common understanding of the word ‘consent’, and we regularly apply it in our social affairs.” The practical reality is that when the people in black robes and white wigs argue amongst themselves, one thing they have to determine is whether consent was established to their satisfaction. All mitigating circumstances come into play.
To put it simply, there is no consent-o-meter that can be applied to anybody. Determining consent is always and everywhere arguable.
By the way, I do not think that is a bad thing nor a weakness in the practice of law. It is just the way God made us.
When a woman is conscious she is given the choice. My wife was explicitly asked during each child delivery if an intern or student could examine her. I believe this is standard practice given the nature of the exams (in the most secret and sacred of parts).
The same should apply to the unconscious; they should be consulted prior to being put under general anesthetic. That students can come in and practice techniques on the genitalia of unsuspecting people is troubling to say the least.
Mark, I think it would be more accurate to say that when a woman is conscious, she can be given the choice. To say that she is implies a universality of experience that, sadly, is just not the case. Lots of women – myself included – have had things done to their bodies, while conscious, without being given the opportunity to refuse or consent. It’s wrong, it’s illegal: it’s a fact.
I salute the courage of Sara Wainberg and her co-authors Heather Wrigley, Justine Fair, and Sue Ross. This topic has been cloaked in silence too long. The article was published in Journal of Obstetrics and Gynaecology Canada 2010; 32(1):49-53. The abstract is on the JOGC site at http://www.sogc.org/jogc/abstr.....tion_1.pdf
The abstract’s Conclusion says, in full: “The majority of patients wish to help medical students to learn but expect consent to be sought if medical students are to perform pelvic examinations on anaesthetized patients. Before introducing explicit consent in Canadian teaching centres, it will first be necessary to determine the feasibility of seeking consent specifically for this procedure.”
When doing the feasibility study, physicians might take a leaf out of the Nursing School manual. During my university days (decades ago), I heard student nurses describe the process by which they learned to give injections. First, they practiced on oranges. When they mastered that, the nurses could practice on human beings. But not just on anyone. They had to practice on each other. The Nursing School philosophy was, “You can’t do it to a patient until you’ve done it to your best friend.”
I am a realist. I expect female medical students would reply with a resounding “NO” if asked to practice pelvic exams on each other. My point is: Imagine the vehemence of the response of the medical students, taken collectively. That is a yardstick to the fundamental justice of open disclosure with patients. A surgery consent form can always be modified by patients — all one has to do is write down and initial any changes you want made to the “boilerplate” form the hospital provides. But first a patient must be aware of what can happen, and be told of any “implicit” medical exams under anesthesia, before the patient can amend the form. How can patients exclude something if they don’t know it exists? The meaning of “informed consent” does not include subterfuge.
Thanks for the thoughts, Medical Justice. It’s a good point, if med students would be horrified to do it to each other, why should they be allowed to do it to other people.