It’s time to end Pa’s outrageous practice of non-consensual, unnecessary pelvic exams | Opinion

January 14, 2020 6:30 am

By Elizabeth Fiedler and Liz Hanbidge

A successful doctor-patient relationship is one founded upon trust. During surgery, one is literally placing one’s life in their doctor’s hands. Unfortunately, right now in Pennsylvania, doctors and medical students can perform invasive, unnecessary, physical exams on unconscious patients without their consent.

A year ago, one of Representative Fiedler’s brave constituents reached out to share her story.

“I was introduced to two medical students. I was never asked or told if they were going to perform a pelvic exam on me ‘for practice’ or ‘experience,’ she said. “To this day I do not know if they examined me or not, because I couldn’t get a straight answer from my gynecologist when I asked her directly about it.”

Horrifying. Representative Hanbidge learned about the practice by reading news coverage of this deeply troubling practice and later spoke with a constituent who also had concerns. 

In our Commonwealth, medical students can and do perform pelvic exams on patients who are under anesthesia for a procedure without explicit consent. The patient often is entirely unaware of what is being done to her body while she is under anesthesia.

The exam is performed not for the health benefit of the patient, but as a training exercise for the medical student.

This practice is not just confined to invasive pelvic exams: patients could similarly be subjected to rectal and prostate exams while under anesthesia.

This seems outrageous and antiquated, but it is happening to our friends, our neighbors, ourselves, without us even knowing. As soon as we learned about it, we knew we needed to end this practice in Pennsylvania.

We believe this common practice is a violation of our bodies and our rights, one that disproportionately, though not exclusively, impacts women.

That is why, along with support from colleagues on both sides of the aisle, we are introducing legislation to ensure medical schools, teaching hospitals, and medical institutions receive informed patient consent for all procedures and exams performed under anesthesia by medical students or for training purposes. 

It is an undeniable violation for doctors to perform unauthorized exams of patients’ bodies while they are under sedation and unable to consent.

It defies understanding that this practice is still legal and occurring in our Commonwealth. As human beings and as patients we have rights, and our legislation is designed to protect those rights.

Our common sense legislation does not prevent physicians from performing exams and treatment necessary to protect a patient’s health, or to act in an emergency situation. It also doesn’t outlaw exams for training purposes.

It simply requires that patients provide explicit approval before their bodies are used for medical training. In fact, Rep. Fiedler’s constituent said, “If I had been explicitly asked and told of the benefits [that] conducting such an exam would have for their training, I probably would have consented.” 

Even more disturbing than the current practice perhaps, is that research on where and how frequently this practice occurs is not well-documented: the majority of people who have been given such an exam will never know.

Most women who have been used for practice pelvic exams have no way of being certain, unless they wake up with discomfort unrelated to their surgery or have other reasons to be suspicious such as finding gauze or instruments inside them while recovering from anesthesia after surgical procedures for an unrelated ailment.

However, 90 percent of medical students from Philadelphia’s five medical schools admitted to having performed a pelvic exam on an anesthetized woman.

Since 2003, the Association of American Medical Colleges has been on record opposing the practice, stating that “performing pelvic examinations on women under anesthesia, without their knowledge or approval…is unethical and unacceptable.”

We believe that pelvic and rectal exams performed without consent are part of a larger societal problem in which our bodies are not respected. We join more than a dozen other states proposing bills banning unauthorized pelvic, rectal, and prostate exams.

Performing such exams without consent is currently illegal in Hawaii, Virginia, Oregon, California, Iowa, Illinois, Utah, Maryland, and New York and similar legislation is pending in other states, including Minnesota and Massachusetts. It is well past time for our Commonwealth to join this fight. 

Trust is integral to the doctor-patient relationship. Performance of an unauthorized pelvic exam on an unconscious patient is an obvious violation of those tenants and destroys that doctor-patient bond. Extraneous procedures unrelated to medical treatment should require a separate consent. 

Our legislation will help protect patient’s rights and increase the trust that Pennsylvanians have in their medical care. We call on the General Assembly, in a bipartisan fashion, to stand with patients and end Pennsylvania’s outrageous practice of non-consensual, unnecessary pelvic, prostate, and rectal exams.

State Reps. Elizabeth Fiedler and Liz Hanbidge, both Democrats, respectively represent the Philadelphia-based 184th House District, and the Montgomery County-based 61st District. They write from Harrisburg. 

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