COMMENTARY

Med Students Still Do Pelvic Exams on Women Under Anesthesia

Arthur L. Caplan, PhD

Disclosures

May 25, 2018

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU School of Medicine. How many of you watching learned to do a pelvic exam in medical school or residency on an anesthetized woman, who was getting ready to undergo a surgical procedure for some sort of obstetrical/gynecologic condition? Many people did. I thought the practice was over. After all, many groups, including the American College of Obstetricians and Gynecologists, have issued statements that that should not happen; no one should be using a woman to learn how to do a pelvic exam without consent before that teaching practice is undertaken.

However, when Phoebe Friesen, a former student of mine, was at NYU, she found out that in other parts of the country, and in other nations, there are still women who are being used as teaching subjects for these exams without their permission, without any consent. The practice is just unethical. It's wrong. It should not be happening. Pointedly, it is because the women themselves have the right to and deserve the respect of giving their permission. Obviously, it is an intimate bodily contact, and more than one person might be involved in these exams.

Think about people like Larry Nassar, who was convicted of molesting young women by touching them without their permission in the name of a therapeutic intervention. Nassar is an extreme case—I understand that. He was a deviant who was getting sexual pleasure from molesting women in the name of medical practice. Nonetheless, part of the outrage about what he was doing is nonconsensual touching in intimate areas on women. We don't want to see that practice even extended for the noble reason of trying to learn and teach about pelvic exams. I think we should be asking the women, because they have every right to say yes or no, to say whether it's okay to do that. Some may say yes, some may say no.

If too many people say no, I think the other option is to pay women or find women who would allow people to examine them. Interestingly enough, you may learn better on a conscious woman than on an unconscious woman. Many schools have moved to the practice of hiring women to take on this particular role to help students learn. The other reason it is very important not to do any type of nonconsensual touching is that it teaches students the wrong message. What we want to be saying is, get consent when you touch somebody. Don't treat somebody as an object or a thing; get their permission. It's very important to have informed consent.

Sometimes informed consent is a difficult thing to obtain, but it isn't in this area. People can understand very well what they are being asked. You want to teach the students to respect their patients when they are going to do something like this. It's very important to send the right message if you're going to use a patient in a teaching or research role, and to get their permission.

At the end of the day, this is a practice that should come to an abrupt and immediate halt. There should be no teaching on unconscious women without their permission. It's a violation of their privacy, their dignity, their right not to be touched without their consent. Continuing the practice sends the absolutely wrong message to medical students about how they should be relating to their patients.

I am Art Caplan at the NYU School of Medicine. Thanks for watching.

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