Can a physician do a pelvic exam when you are under anesthesia without your consent?

Описание: “Teaching Pelvic Examination Under Anesthesia Without Patient Consent”, @jamanetwork, 2019.

A lingering stain on the history of medical education, the age-old practice of unsanctioned pelvic examinations was hardly without consequences. Although rationalized as necessary for medical training, the practice all but suspended the ethical precept of respect for persons, upending expectations of patient privacy and autonomy and undermining presumptions of professionalism, leaving notions of trust in tatters.

Unapproved pelvic examinations constituted but one expression of the medical paternalism of the day, along with nonconsented rectal examinations by medical students in male patients undergoing prostate surgery. Neither practice is compatible with the ethical and policy guidelines of the American Medical Association (AMA), which state that “patients’ … refusal of care by a trainee should be respected in keeping with ethics guidance.”

State laws have been enacted (in California, Hawaii, Illinois, Iowa, Oregon, and Virginia) that define unauthorized pelvic examinations as a misdemeanor that could be grounds for loss of medical licensure.

The US Preventive Services Task Force concluded in 2017 that “current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women.” ACOG published a similar position statement in 2018. Taken together, these developments strip away any residual educational rationale for the continued deployment of pelvic examinations under anesthesia.

** Laws against the practice have been passed by 15 states, including California, New York, Florida, and Illinois.

#obgyn #gynecology #gynecologist #obstetrics #pelvicexam #anesthesia #informedconsent #pelvicexams #obgynresident #medicalstudent

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