A bill now awaiting Governor Cuomo’s signature will prohibit the performance of a pelvic examination on an anesthetized or unconscious patient without the oral or written informed consent specific to the pelvic examination by the patient or a patient representative. Furthermore, the performance of a pelvic examination must be within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and the patient has already consented to such care. Performance of such exams without consent would be considered professional misconduct for both performance and supervision domains. Exceptions are made for medically necessary diagnostic or treatment purposes when the patient requires immediate medical attention and an attempt to secure consent would delay treatment, thus increasing risk to the patient’s life or health. Five states have enacted such laws and New York is poised to be the sixth one.
In 2005, the Association of American Medical Colleges had deemed “performing pelvic examinations on women under anesthesia, without their knowledge or approval …unethical and unacceptable.” In 2011 (reaffirmed in 2017), ACOG released a committee opinion that states explicitly
Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.
Despite the above guidance and years of concern, reports still surfaced that this practice was ongoing, triggering legislative action. While performing pelvic exams without consent has been deemed unacceptable by professional colleges and state houses, proficiency in the performance and interpretation of a pelvic exam is still a requisite medical skill. In certain clinical scenarios, a thorough gynecologic assessment may be lifesaving. Therefore, many medical schools have moved toward paid volunteers or pelvic trainers to ensure that students receive adequate training.
JAMA Forum: Teaching Pelvic Examination Under Anesthesia Without Patient Consent
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