Some medical schools and teaching hospitals have historically trained students by having them perform pelvic, breast, prostate, or rectal examinations on patients under anesthesia for surgery, often without obtaining the patient’s consent.
This controversial practice has faced increasing scrutiny and is gradually being phased out. Currently, 25 states have enacted laws that mandate explicit consent for pelvic exams.
Furthermore, the U.S. Department of Health and Human Services recently issued new guidelines requiring patients to provide written consent for any intimate physical examinations that are not related to their personal medical needs.
“The Department is aware of media reports as well as medical and scientific literature highlighting instances where, as part of medical students’ courses of study and training, patients have been subjected to sensitive and intimate examinations — including pelvic, breast, prostate, or rectal examinations — while under anesthesia without proper informed consent being obtained prior to the examination,” stated a letter from Xavier Becerra, secretary of the U.S. Department of Health and Human Services.
The new guidance from the U.S. Department of Health and Human Services emphasizes the critical importance of hospitals establishing clear protocols to ensure that healthcare providers and trainees obtain and document informed consent from patients before performing sensitive examinations. The guidance underscores the necessity of giving patients the right to refuse such examinations, thereby safeguarding their autonomy and dignity.
Study Reveals 3.6 Million Americans Underwent Pelvic or Prostate Exams Without Consent
Research and advocacy by Lori Bruce, the associate director of the Yale Interdisciplinary Center for Bioethicsin New Haven, Connecticut, have been pivotal in bringing about these changes.
Bruce and her team conducted a comprehensive study revealing that approximately 3.6 million American women and men are likely to have undergone unconsented pelvic or prostate exams. This research has shed light on the widespread nature of the issue and highlighted the need for stringent consent protocols.
Bruce’s research also highlighted significant racial disparities in the administration of these unconsented exams. The findings indicated that Black patients are four times more likely that white patients to report having received such examinations without consent. The study also found no significant gender differences, with both men and women equally likely to experience unconsented exams.
Much of U.S. Medical Knowledge Stems from Experiments on Black Individuals
The ethical implications of these practices have been a topic of considerable debate within the medical community. Keisha Ray, PhD, an associate professor in humanities and ethics and the director of the medical humanities concentration at the McGovern Medical School in Houston, emphasized the challenge of balancing medical education with patient rights.
“Sometimes in the pursuit of education people can do things that they think are for the greater good, but it can harm individual patients,” she says.
Dr. Ray highlighted the necessity of addressing this issue within the context of historical abuses in the medical field.
“A lot of what we know about medicine and about the human body comes from researchers, scientists, and clinicians abusing marginalized people, whether that be Black people, Jewish people, poor people, people from low income backgrounds, people with not a lot of political or social power, or people who are in prison,” she says.
Black Enslaved Women Exploited for Medical Research
America has a history of performing research on people who were very vulnerable, like enslaved Black women, says Dr. Ray. “Much of the knowledge of gynecology and gynecological disorders and illnesses has come from clinicians who performed experiments on enslaved Black women that they would purchase specifically for this purpose,” she says.
She pointed to the example of J. Marion Sims, a 19th-century physician often referred to as the “father of gynecology,” who notoriously conducted experimental surgeries on enslaved women without anesthesia. This dark chapter in medical history serves as a reminder of the profound ethical violations that can occur when patient consent is disregarded.
Some of the principles of medical ethics came out of these abuses, says Dr. Ray. “People started to come out and say, ‘Wait a minute, we can’t just go around using people for their bodies, we have to make sure that certain ethical principles are followed,’” she adds.
Unconsented Exams on Black Individuals Likely Linked to Medical Racism and Limited Access to Insurance and Healthcare
Dr. Ray explains that there are a number of reasons why these sensitive exams without consent are more likely to be performed on Black patients.
“There’s basic medical racism and having a lack of compassion or lack of seeing the humanity in Black patients,” she says.
Due to a legacy of racism that has restricted many Black individuals’ access to healthcare and health insurance, they are more likely to seek care at teaching hospitals or state-funded hospitals, which are often teaching institutions, says Dr. Ray.
“And so if you have a higher Black clientele, then you’re going to have more Black people undergoing these kinds of exams,” she says.
Nonconsensual Exams Harm Both Patients and Providers
Bruce said in a press release, “This landmark achievement for patient consent was attained because countless advocates — including patients, community members, medical students, ethicists, and some physicians — spoke up despite pressure to remain silent.”
Bruce noted that although medical professionals do not intend harm when performing intimate examinations on unconscious patients, research indicates that it can also negatively affect medical students. This is because they often feel a sense of wrongdoing despite being compelled to comply with the procedure.
“Over time, some students develop moral erosion. They may devalue the importance of informed consent, and this shift in belief extends across all patient care, not just pelvic and prostate exams,” she said in the release.
Bruce also highlighted evidence suggesting ample learning opportunities would still be available. According to several research studies, approximately 90 percent of patients consent to additional training exams when asked, she noted.
Despite the implementation of these measures, instances of unconsented exams my persist. If you suspect or discover that a sensitive exam was conducted on you without your consent, it is advisable to contact the institution where it occurred. Additionally, you can file a complaint with your state’s medical licensing board, advises Dr. Ray.