Drugged Pelvic Exams, Ghost Surgeries & More: Exceptions to Informed Consent in Medicine

If graphic discussion of sexual assault or medical abuse is distressing to you, turn back now.  

Can you think of a setting in which the vaginal penetration of an unconscious woman under the influence of total sedation would not be considered criminal sexual assault?  What about anal penetration on an unconscious person by a large group of strangers while others watch--gang rape, right?  Sexual assault is bad enough when it occurs at a drunken frat kegger or high school house party where teens with undeveloped brains & no supervision get caught up in an alcohol-soaked atmosphere, but it's somehow worse when it involves adults in powerful positions like doctors or nurses.  They should be held to an even higher standard than the rest of society. 

So why are non-consensual pelvic exams being performed on anesthetized women (and occasionally men) all over this country while they're undergoing totally unrelated procedures?  And why are so few people aware of it?  

No Knowledge?  No Consent?  No Problem.

Slide titled "Two Sides of the Argument" by Terry Tsang to Connecticut General Assembly

What do these exams entail?  A group of med students will gather 'round the unconscious patient, who may be in the process of receiving surgery for something like a spinal or uterine condition, and "take turns" penetrating her vagina digitally after the instructor demonstrates the proper method as if he or she was giving a mini-TED Talk.  Surgical patients fill out a general consent form first, but the language is extremely vague & you'll have no idea you're signing away your right to not be used as a living cadaver.  If you wish to avoid this barbaric violation of your private parts, you have to specifically state "DO NOT GIVE A VAGINAL EXAM" or whatever, which means you'd have to know such a thing was even a possibility first.  Many, many women do not.  

There's no reason to suspect you'll wake up bleeding with a sanitary napkin shoved between your thighs like this poor woman in the UK, who just went in for a laparoscopic procedure of her abdomen & got a whole lot more.  If you've already suffered sexual abuse or molestation in your life as roughly 1 in 4 women has, the trauma of this violation can be enough to send you into a tailspin.  Many would say this counts as a sexual violation in itself.  By all legal definitions it does.  (And wtf:  There's NO reason a vaginal exam should cause bleeding and pain!)  When asked for consent in one study, 100% of women said NO to vaginal exams under anesthesia in medical settings.  This is what prompted the medical institution to go ahead with non-consensual exams.  (I guess "no" means "yes" in teaching hospitals).  Med students have to learn how to conduct these exams on real live patients, which I can empathize with.  But this is not the way.  

Women do not exist for you to "practice your craft" on.  We're not dummies or fuckdolls--we're human beings like you.  Just because you view the human body in a detached, analytical manner does not mean the rest of us do.  Consenting to surgery is not consenting to being flayed open & used as a live Annie doll by an entire graduating class of eager MD's.  The fact that doctors view women with such contempt makes me question just how much (rather, how little) they value our lives on the operating table in general.  Should they even be performing surgery on us if they feel this entitled to abuse our bodies?  How big of a God complex must you have to think this is okay?  If a woman were to deny consent to a pelvic exam before surgery, would she be more likely to get poor quality care or even face retaliation from a vengeful surgeon while in his/her care?  Has anyone ever bothered to do a study on such things?  

And yes, occasionally men are given prostate exams without consent as well.  It's far less common but every bit as vile.  Unfortunately the "lack of consent" issue goes beyond the sexually abusive into more life-threatening territory, including horrors like trainee-performed spinal taps & "ghost surgeries" in which a medical student performs your surgery instead of the doctor you consulted with who you were led to believe would be conducting it.  These things are standard practice at teaching hospitals.  Emergency care also has different standards for consent* when it comes to medical trials.  In 2004, a bunch of ER patients who were unable to verbally consent due to critical injury were given synthetic blood ("Polyheme") transfusions that later killed them.  46 patients died in all compared to only 35 in the control group.  "No matter how you slice it, it's a disaster" is how Pharma Bro Martin Shkreli referred to it back in 2006.  

*According to 21 CFR 50.24, there are exceptions to informed consent in emergency research, including when 1.) The subjects will not be able to give their informed consent as a result of their medical condition; 2.) The intervention under investigation must be administered before consent from the subjects' legally authorized representatives is feasible & 3.) There is no reasonable way to identify prospectively the individuals likely to become eligible for participation in the clinical investigation.

... yeah, those sound like YOU problems.  

Restoring Medical Ethics

"4 Pillars of Medical Ethics": Is your doctor meeting this low bar?

Informed consent is the cornerstone of ethical medical treatment & is codified into both national & international law.  It's made appearances in every document from the Hippocratic Oath of 500 B.C.E. to the UN's International Covenant on Civil & Political Rights drafted in 1966.  And for good reason: Lack of informed consent resulted in some of the most grotesque war crimes in human history, including Japan's Unit 731 & the CIA's MK-ULTRA covert mind control experiments to name a few.  The fact that doctors & surgeons in Western nations are still conducting intimate exams & carrying out experimental medical treatments on unconscious patients without our consent is a violation of not only medical ethics but our basic human rights.  It's criminal assault & should be treated as such.  

Everyone has a right to not be sexually violated while seeking medical care.  If you think these exams & medical trials are so damned important for the advancement of medicine, you sign up for them or do a better job of convincing patients to volunteer for them willingly.  Figure out another way for your med students to get their hours & experience in.  But what you're NOT gonna do is use me or my loved ones as cannon fodder for your rapey exams.  

I would urge anyone who's concerned about this issue to write your representative and, actually, scratch that, go write up an advance directive that includes CLEAR language about what you do and do not consent to in a worst-case hospital scenario.  Research & include which sedatives you want to be given if you're on a ventilator, what life-saving measures you want to be administered if you require resuscitation & how long to keep you on life support if it becomes necessary.  Don't consent to a pelvic exam or experimental ER treatment?  Include that too along with your organ donor status.  (Google "organ donor horror stories" before checking that box on your driver's license, seriously).  This should be separate from your last will & testament, which includes who will inherit your belongings after you die.  Nobody likes to think about this stuff but it beats ending up trapped in a non-functioning body unable to scream while doctors of death harvest your organs or talk graphically to your loved ones about "pulling the plug". 

I should add that not all medical professionals who are forced to engage in these consent-free procedures feel good about doing it--some are loudly opposed & traumatized by the practice.  But it's part of their required training.  This short video gives an example of just that:  

Med student expected to give 100 pelvic exams on anesthetized patients

Also, this is not a reason to become paranoid or distrusting of the medical system in general.  There are many dedicated doctors & nurses who sacrifice their personal lives, physical well-being & sanity in the name of caring for their patients.  We should all be grateful for their devotion to seeing through the grueling hours of medical school & the mental trauma of their jobs.  This is a legislative issue reflecting lawmakers' disregard for the sanctity of human life & bodily autonomy, not of a clump of non-sentient fetal tissue but of feeling, breathing, thinking human beings with loved ones & lives of their own.  It's on all of us to put a stop to it by demanding better.