Very serious charges are being made that some Australian and UK medical students conduct intimate body exams on unconscious patients without consent. From the story:
AUSTRALIAN medical students are carrying out intrusive procedures on unconscious and anaesthetised patients without gaining the patient’s consent. The unauthorised examinations include genital, rectal and breast exams, and raise serious questions about the ethics of up-and-coming doctors, Madison reports. The research, soon to be published in international medical journal, Medical Education, describes – among others – a student with “no qualms” about performing an anal examination on a female patient because she didn’t think the woman’s consent was relevant. Another case outlined in the research describes a man who was subjected to rectal examinations from a “queue” of medical students after he was anaesthetised for surgery.
This is a violation of human dignity and the right to bodily integrity, that is to say, a human rights violation and a criminal assault. It is, of course, a medical ethics holy grail that a patient’s consent must be obtained before conducting any medical procedure–even one that doesn’t harm. And it reflects a certain dehumanizing of the perpetrators. It would be interesting to learn why the students thought such actions were acceptable.
But what if the patients were permanently unconscious instead of anesthetized? Many in bioethics claim that such people are not “persons,” or do not have the capacities to be considered fully equal with others. Some say their value is less than that of animals with higher capacities. They are advocated as splendid natural resources, say for use in medical experimentation or as sources of organs. Heck, we intentionally dehydrate them to death based on quality of life judgmentalism.
So, what would the objection be to using these patients as props teaching medical students how to do body cavity exams? If they don’t have intrinsic dignity, if they are not injured, if they can’t know that they are being examined, what is the problem? After all, once you deny human exceptionalism, those deemed less than us become open for instrumental use.
January 31st, 2011 | 12:57 pm
Wesley,
I predict that those who are heavily invested in denying the humanity of the unconscious and cognitively disabled will become heavily invested in denying that this is an issue of consent.
But first will come the bush league deniers: “It’s different when the possibility of waking up any *knowing* you were violated is an issue!”
But that is a load of crap.
Actually, I really can’t wait to hear the other responses.
January 31st, 2011 | 1:56 pm
Doctors and medical students are not even supposed to use dead patients as teaching props without prior consent. It’s not about the “intrinsic worth” of the cadaver (the dead are obviously of less value than the living). It’s simply about obtaining consent.
Wesley J. Smith Reply:
January 31st, 2011 at 2:01 pm
No, Raven, it isn’t just about consent. How shallow and sterile that would be: It is about human dignity. That is why we treat corpses with respect. It validates human moral worth and importance.
January 31st, 2011 | 2:40 pm
Wesley, we treat corpse with respect because the living have an interest in how their bodies are treated after death. Consent is about respecting humans. There’s nothing shallow or sterile about that.
Wesley J. Smith Reply:
January 31st, 2011 at 2:42 pm
Well, now you added something that changes your first point, which said it is only about “consent.”
January 31st, 2011 | 2:49 pm
Wesley, it is “only” about consent. You just failed to understand why consent is important.
January 31st, 2011 | 3:28 pm
Yes, it is wrong for students to perform procedures, even cursory examinations, without consent.
January 31st, 2011 | 4:32 pm
Why should consent matter, though? Why is it so important to us? If a case can be made for doing something for the betterment of science/society/more than one person, can’t consent be dispensed with?
January 31st, 2011 | 4:36 pm
Let’s be careful with investing too much trust in consent.
When grandma hears that her medical bills are being payed for from Timmy’s college fund, she might “consent” to be euthanized, but that doesn’t make killing her right.
January 31st, 2011 | 6:10 pm
Greetings from the land of the gainfully employed (I start whenever my drug test is processed; tomorrow, hopefully).
Take this scenario:
What if Ma and Dad have a son who is cognitively disabled – say severe autism. The son is conscious, but unable to give any sort of consent to *anything.* However, his parents are assigned as his caretakers and speak for him in his inability to speak for himself.
Now, a bit from the article quoted above:
‘he unauthorised examinations include genital, rectal and breast exams, and raise serious questions about the ethics of up-and-coming doctors, Madison reports. The research, soon to be published in international medical journal, Medical Education, describes – among others – a student with “no qualms” about performing an anal examination on a female patient because she didn’t think the woman’s consent was relevant.’
Imagine now that Ma and Dad, who speak for their son, give consent to have their son examined under anesthesia while he’s in for, say, a tonsillectomy or appendectomy. Someone has legal consent to perform these procedures, but is that ethical?
I don’t think so – the person being examined has no knowledge of what’s going on and may not even be able to process the information if someone tried to explain it to him. This would violate his dignity as a human being, even though he’s cognitively dysfunctional. He has the same right to be protected from being a lab mouse without consent.
I point this out because some have said this is strictly about a person not being able to give consent. I say, only a person who both *can* and *does* give consent should be allowed to be examined, because otherwise we open up the possibility of abuse under the guise of “medicine.”
January 31st, 2011 | 8:43 pm
I think that parents and guardians are a different area, Tabs, because the ability to give consent *for* the person is given temporarily or on a contigency.
January 31st, 2011 | 9:31 pm
The cited article states, “The unauthorised examinations…raise serious questions about the ethics of up-and-coming doctors.” It seems to me that this calls into question the ethics of CURRENT doctors, the teachers of theses trainees, who ordered/encouraged/allowed/tolerated this behavior.
Ah, but now to the inevitable other hand. I remember from the early days of my training, now more than 30 years ago, the following was common: If a patient arrived in the emergency room in extremis, we would make every effort, of course, to save his life. Such efforts almost always involve insertion of an endotracheal (ET) tube (a tube into the airway). It takes a fair bit of skill to insert an ET tube properly. When our efforts had failed, and the patient was declared dead, the students would typically practice the skill by removing the endotracheal tube and reinserting it several times. While I acknowledge some intellectual misgivings about this practice now, I must say that I feel no emotional wrongdoing associated with it. In fact, it feels like the right thing to do. That honed skill later allowed us to save other lives later. I leave to others the theoretical analysis of this.
February 1st, 2011 | 8:35 am
So, Raven, I am could you explain *why* obtaining consent is important, in your view?
On what basis do we have an obligation to obtain the consent?
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