Autonomy Suspended: Using Female Patients to Teach Intimate Exams without their Consent

Recent reports of medical students performing pelvic exams for training purposes on anesthetized women without their consent have produced a firestorm of controversy. Peter Ubel and colleagues found that 90% of medical students performed such exams during their obstetrics/gynecology rotations. A series of 2003 reports focused a white-hot spotlight on this teaching practice and resulted in Federal Trade Commission and Department of Justice hearings and action by the American Association of Medical Colleges and the American College of Obstetrics and Gynecology. In this article, Professor Wilson examines the merits of the defenses and justifications for using female patients for pelvic exams without obtaining their explicit consent. Part I explores the scope and extent of the use of patients as “live cadavers” to train the next generation of healthcare providers. Not only are anesthetized patients used to teach exams; recently-deceased patients are often used to teach medical procedures. Part II documents how these practices have a disproportionate impact on the poor and uninsured, despite the fact that the benefits – proficient physicians – are distributed across society. Finally, Part III tests the justifications based on implied consent, actual consent, and necessity for dispensing with the simple step of asking patients for permission before conducting educational exams. Where these justifications rest on factual assumptions, this Part evaluates how well those assumptions stack with what is known about patient behavior and knowledge. The use of patients, both anesthetized and recently-deceased are important in providing medical students with the opportunity to learn necessary skills, but medical educators are misinformed about patient awareness regarding the usefulness of practice procedures. Wilson concludes that greater respect for patients in medical teaching is achievable but will result only when teaching faculty acknowledge the weaknesses of justifications routinely offered for using female patients as teaching tools without their knowledge or permission