Bill Seeks Specific Consent for Pelvic Exams Under Anesthesia by Students

Marcia Frellick

January 10, 2020

Bipartisan legislation, moving through Wisconsin's state legislature would require specific written and verbal informed consent before a medical student may perform a pelvic exam on a patient who is under general anesthesia or is otherwise sedated.

In many states it is legal for medical students, working alongside physicians, to perform a pelvic exam as part of their training to feel the positioning of the organs and check for masses. The patient may not know about the student's involvement before or after surgery.

A blog that tracks national movement on the legislation says 10 states have made the practice illegal, including four that acted in 2019: Delaware, Maryland, New York, and Utah. The others are California, Hawaii, Illinois, Iowa, Oregon, and Virginia.

The blog said that since January 1, 2019, 22 bills have been introduced in 17 states.

Some hospitals have relied on general consent forms that don't cover training procedures specifically.

State Representative Chris Taylor (D-Madison) one of the primary sponsors of the bill, told Medscape Medical News, "I think this is really a remnant of a time when women in the clinical setting were not afforded complete patient rights.

"Here we are in 2020 and the practice is still going on," she said. "A patient needs to be told and give specific consent. And I'm sure many patients would give consent. In the face of the #MeToo movement, in the face of women feeling much more empowered to speak out about sexual assault and sexual harassment, women find this to be a violation of their bodily autonomy."

Taylor said a constituent brought the issue to her attention. The woman had had a pelvic surgery that did not go well and after learning of the teaching procedure wondered if others could have been involved in her care when she was unconscious.

Last year, Elle magazine conducted a survey of 101 medical students from seven major medical schools in the United States. The magazine found that 92% said they performed a pelvic exam on an anesthetized female patient. Of those, 61% did so without explicit patient consent.

WHA Opposes the Bill

The Wisconsin Hospital Association (WHA) opposes the bill, but spokesperson Mark Grapentine told Medscape Medical News that the WHA would not comment further.

Taylor calls opposition to the bill "mind-boggling."

"It should be that women are told, they give consent or they don't give consent," she said.

The University of Wisconsin-Madison School of Medicine and Public Health adopted a policy on the issue last July.

It reads, "An Educational Sensitive Exam by a health professions student while a patient is under anesthesia or otherwise sedated is deemed appropriate only if such an exam is a routine part of the patient's procedure."

If such an exam by a student is deemed appropriate, "the attending physician is responsible for obtaining and documenting the informed consent of the patient for the Educational Sensitive Exam in the patient's medical record. The attending physician must include in the informed consent discussion an explanation of the educational nature of the Educational Sensitive Exam."

The American College of Obstetricians and Gynecologists also has a policy regarding the issue. It currently reads, "Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery."

Art Caplan, PhD, director of the Division of Medical Ethics, New York University Langone Medical Center and School of Medicine, in New York City, wrote in a commentary for Medscape that if the fear of getting specific consent is that too many women will say no, there are other options.

"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."

There's another reason it's important for medical students to get the consent, he writes.

"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," Caplan writes.

The bills in Wisconsin, introduced in December, have been referred to committees.

Taylor said the cosponsors are pushing for a hearing in the next couple of weeks.

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