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
- Elaine Gibson, LLM,
- Jocelyn Downie, SJD
+ Author Affiliations
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.
