The Danger of Being Anesthetized: The Common Use of Unauthorized Pelvic Exams as Teaching Practice Constitutes Unethical Assault on and Objectification of Patients
Open Access
- Author:
- Devanarayan, Priya
- Area of Honors:
- Bioethics and Medical Humanities
- Degree:
- Bachelor of Science
- Document Type:
- Thesis
- Thesis Supervisors:
- Michele L Mekel, Thesis Supervisor
Michele L Mekel, Thesis Honors Advisor
Barbara Ann Birriel, Faculty Reader - Keywords:
- Unauthorized pelvic exam
pelvic exams
UPEs
ethics
Medical education
Informed consent - Abstract:
- Unauthorized pelvic exams (UPEs), defined as pelvic exams conducted on anesthetized patients without medical necessity, patient knowledge, or explicit patient agreement, occur in teaching hospitals as an “accepted” training practice. Utilizing the necessity of trainee skill development, specific consent is intentionally not obtained based on the belief that these exams pose no risk of physical harm and the assumption that, by accepting treatment at a teaching hospital, the patient implicitly consents to a host of examinations by medical trainees. Nevertheless, many patients who become aware that they were subjected to a UPE suffer from emotional trauma. Moreover, the performance of UPEs undermines the fundamental ethical principle of respect for persons, which includes patient autonomy. UPEs subvert patients’ fundamental right to self-determination, which is ensconced in both law and clinical ethics. Additionally, research demonstrates that medical students come to devalue the importance of patient autonomy and the duty of obtaining prior informed consent following medical clerkships in which pelvic exams on anesthetized patients were conducted without the students being present during the consent process in which the exam and the students’ role were made explicit. However, despite growing attention to and concerns about this teaching tool’s ethically and legally questionable nature, only 19 states have adopted legal protocols requiring express consent for such intimate examinations. State legal mandates necessitating explicit informed consent—as well as providing mechanisms for review and enforcement of such explicit consent mandates—must be adopted across the nation to ensure medical practitioners and healthcare institutions adhere to foundational ethical precepts.