The authors respond: Consent requirements for pelvic examinations

The authors respond

CMAJ September 4, 2012 vol. 184 no. 12 doi: 10.1503/cmaj.112-2052

• © 2012 Canadian Medical Association or its licensors
• All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.

• Letters

The authors respond

1. Elaine Gibson, LLM,
2. Jocelyn Downie, SJD

+ Author Affiliations

1. The Health Law Institute, Dalhousie University, Halifax, NS

Margaret Morris has missed the point of our article.1^,2 We agree that some residents conduct pelvic examinations solely for therapeutic purposes (i.e., they are fully trained in conducting such examinations and the only purpose for the examination is the care of the patient) and the policy statement does not fail in relation to such residents. However, Morris ignores the fact (explained in our article) that some residents are conducting pelvic examinations solely for training purposes, or for a combination of therapeutic and training purposes. Our considered view, grounded in a careful review of the relevant law, is that patients must be asked for explicit consent to a resident’s performing a pelvic examination in whole or in part for training purposes. On this narrow point we took issue with the revisions to the policy statement3 because of its shift from covering residents and medical students in this context to only covering medical students. We argued, and continue to hold, that residents should either be added back into the policy statement in relation to the conduct of pelvic examinations for training purposes, or a separate policy for residents (requiring disclosure of purpose and explicit consent for such examinations) should be developed.

We share Morris’ goals of achieving “the best possible care for women in the academic environment” and ensuring that “all health professionals providing care for women are adequately trained.” However, we do not agree that calling for disclosure of training purposes and explicit consent in residents performing pelvic examinations for training purposes can be characterized as “needlessly raising anxiety in the public and putting the clinical academic process in jeopardy.” In a study conducted at the Calgary Pelvic Floor Disorders Clinic, a majority of women surveyed indicated that they would consent to a pelvic examination for training purposes if asked.4 Further, even if the result would be fewer patients agreeing to have such examinations conducted, this is no justification for overriding legal rights and ignoring ethical responsibilities.

References

1. ↵
   1. Morris ML

   . Consent requirements for pelvic examinations [letter]. CMAJ 2012;184:1393.

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2. ↵
   1. Gibson E,
   2. Downie J

   . Consent requirements for pelvic examinations performed for training purposes. CMAJ 2012;184:1159–61.

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3. ↵
   1. Liu KE,
   2. Shapiro J,
   3. Robertson D,
   4. et al

   . Pelvic examinations by medical students. J Obstet Gynaecol Can 2010;32:873–5. Available: www.sogc.org/guidelines/documents/gui246PS1009E000.pdf (accessed 2011 Apr. 27).
4. ↵
   1. Wainberg S,
   2. Wrigley H,
   3. Fair J,
   4. et al

   . Teaching pelvic examinations under anaesthesia: What do women think? J Obstet Gynaecol Can 2010;32:49–53.

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