American Teaching Hospitals: Where Pelvic Exams Under Anesthesia Happen

Before undergoing a liver biopsy at Memorial Sloan Kettering Cancer Center in New York City, I asked my surgeon’s nurse whether I was to be catheterized for the procedure. In response to this perfectly legitimate question the knave sardonically replied: “I’m really not supposed to say this, but what difference does it make? You’re going to be under general anesthesia.”

It was at that moment that I started to wonder: With an attitude like that, what do they really do to us when we are under anesthesia? And thus a little Internet surfing was most certainly in order.

In my journey into the subterranean depths of cyberspace, I was startled to come across a most terrifying sea monster indeed: a disturbing discussion where medical students debate, often favorably, the ethics of doing practice pelvic exams on anesthetized women undergoing surgery. The thread is here.

Apparently, there is no shortage of medical students, interns, residents, and attending physicians who feel they are entitled to penetrate the vaginas and anuses of anesthetized patients that lie paralyzed and helpless on the operating table, and who feel that they have the right to do this without first obtaining the patient’s consent. This naked display of barbarism and sociopathic behavior speaks volumes about the moral unraveling that is so glaringly on display in the West today.

This scandalous practice is evidently not uncommon in Australia, as this article attests.

The forum is fascinating in that it allows the reader to be a fly on the wall, giving one a glimpse into how many American medical students think – if that is, in fact, the appropriate word. (Some spelling corrections have been made in the following quotations. Hopefully, these Ivy League superstars will take more care in looking after their patients than they do with the written word. Considering the attitudes on display here, I am not optimistic).

The discussion opens with a medical student named Unregistered Abuser, who, like a kind of postmodern Socrates struggling with an existential conundrum, puts forth the following question:

Let me pose a question. I am on gynecological surgery and several different residents and attendings have told me that prior to surgery it is a great idea to perform a pelvic exam on the anesthetized woman in order to get practice. Many have said it is not traumatic to the patient and you get a more technically adequate exam since the patient is not guarding. Sure enough, before every procedure the attending and resident…perform a quick pelvic exam. Is this wrong? The attending does it for one last chance to feel for any previously undiagnosed masses or other abnormalities, but the resident and student do it primarily for educational purposes. The patient has consented to the surgery, but not for the pelvic exam. Does consent to surgery of the uterus, vagina, vulva, ovaries, etc. also imply consent to manual palpation of these structures during the surgery?

A medical student named Starayamoskva comments: “It is standard procedure. How else do you think the residents and students are going to learn?” A student named Gauss replies: “Pelvics on anesthesized women prior to surgery is routine – informed consent was obtained as part of the surgical consent.”

Doc Ivy chimes in, “As a woman I have to say that I really don’t have a problem with this. If I am at a teaching hospital it’s what I would expect.” A medical student named tupac_don flippantly remarks, “Been there done that, it’s A okay.” And not to be outdone, one student who could be the very devil himself says, “Patients…have rights? This phrase is thrown around by every damn idiot…but where does it come from? Hey Mr. lawyer, does the Bill of Rights say ‘Medical students shall not examine a patient’s vagina prior to vaginal surgery?’ This patient’s have rights bull**** came from lawyers…. Healthcare isn’t even a right.”

So how did we arrive at this cesspit of degeneracy and the most abject moral bankruptcy? And where did these despicable monsters come from?

They came from our schools, our press, and our mass media. They came from our consumerism, our materialism, our barbarism abroad, and the totalitarianism of our prison system. They were born out of the ashes of post-New Deal America, where our nation’s once proud middle class now lies in ruins, and we are increasingly trapped in a world of the affluent living in their gated communities on one side, and the miserable wretched masses – the oppressed, the destitute, and the debt-ridden on the other.

The dismantling of the humanities has also played a significant role in fomenting this dehumanization. This is because most colleges and universities presently exist for only two reasons: to maximize the greatest possible profit, while also serving as vocational institutes that mold young people into becoming automatons trained to perform increasingly specialized jobs. (Jobs which, particularly outside of health care, do not even exist).

This absence of a proper humanities education has undoubtedly contributed to the inculcation of many medical students with the pernicious idea that patients are mere objects and teaching tools. And the danger of significant numbers of young people receiving an advanced scientific and technical education that is utterly devoid of any foundation in the humanities, lies in the fact that the soullessness and amorality that follow will inevitably usher in an age of authoritarianism and absolute unchecked barbarism.

Many medical students are also made acutely aware of which patients have money and good health care plans, and which don’t. This two-tier system is well on display in many medical institutions across the country, as patients are separated into the haves and the have nots. (And lest we forget, there are also the “have mores,” as George W Bush was once kind enough to point out). One student writes on this thread: “At my school, the rule is that it’s ok to do [pelvic exams on anesthetized women] on welfare patients but not on private patients.”

The oligarchy’s mass media brainwashing apparatus has been relentless in spreading the virus of neoliberal free market dogma. And this has also exacerbated commodification, dehumanization, desensitization, as well as contributing to a profound loss of compassion, empathy, and a sense of self.

The attitude of the attending physician will unequivocally have a profound impact on the behavior and thinking of the medical students, interns, and residents that they mentor. And their philosophy and approach to patient care will shape and mold the moral character (or lack thereof) of their charges in profound ways, and for many years to come.

The physician Peter Ubel writes on the website kevinmd.com:

Moral attitudes are often a function more of our experience than of our training. When some colleagues and I surveyed medical students and asked them how important it was to ask permission before conducting a pelvic exam on an anesthetized woman, brand new medical students almost universally stated that permission was vital but by the time the students finished their OB/GYN rotations three years later, they didn’t see permission as being important anymore. Despite the lectures they’d received about ‘informed consent’ during the first two years of medical school, six weeks of an OB/GYN rotation was enough to change their moral attitudes.

Men under anesthesia are not immune to this barbarous practice, as the attending physician can order medical students to line up and perform practice prostate exams on anesthetized male patients.

How ironic, that if a student passes out while intoxicated at a party and their body is vaginally or anally penetrated while they are unconscious, the law states unequivocally that this is illegal. However, if a student gets a 4.0 GPA, aces the MCAT, and goes to medical school they can actually do this all day long and to their heart’s content.

Many medical students will feel in their heart that this practice is unethical, yet proceed with the unauthorized exam as they wish to get a good grade and don’t want to anger their attending physician. And like soldiers in the military, the pressure to conform will be overwhelming. It will take great courage to say no.

There is also an inextricable connection between nonconsensual physician shadowing and nonconsensual rectal and pelvic exams performed on anesthetized patients. With the former, once this Rubicon has been crossed it becomes ingrained in the minds of everyone on the medical “team” that the patient is more of a primate than a human being, and is consequently undeserving of any right to privacy whatsoever. Moreover, once these civilized norms of morality and ethics have been breached, it will be easy for a medical student to take things just one step further, and violate a patient’s body on the operating table “for practice.”

It is vitally important that medical students, residents, and fellows be inculcated with an understanding that both observing a patient’s session with their doctor as well as examining a patient’s body, constitute a privilege and not a right. And they must be made to understand that this privilege can only be granted when both the attending physician  and the patient sign off on it.

There may be some medical students who are angrily reading this, and who have concluded that I am somehow attempting to sabotage their efforts at becoming doctors. As one who has taken a lot of photographic portraits on the streets of New York City, never have I taken someone’s portrait without first obtaining their consent. If a photographer makes the case that there is an ethical and an unethical way of taking portraits, does it then somehow follow that they are of the opinion that photographic portraiture should be banned altogether?

Every teaching hospital in this country has a website where they speak ad nauseam of their profound respect for patient privacy. The problem is that their conception of the term applies only to protecting the digitalization of your medical records.

It is noteworthy that not all the medical students who participated in this discussion were in favor of this practice. Souljah1 says: “Lining up 4-6 medical students to do pelvics on anesthetized women is totally ****ed up in my opinion. Not giving clear information regarding students lining up to examine their genitalia and reproductive organs is incredibly unethical in my opinion.”

And one brave medical student going by the name Mumpu argues, “Think about the absolute trust the patient places in your skills and professionalism when they go under anesthesia. They are paralyzed and unconscious and it is grossly unprofessional of you to violate that trust by violating their body. There’s no ‘greater good’ clause here. To do an unconsented exam is assault (any firefighter/EMT who ever worked on the streets knows this), to do an unconsented pelvic is sexual assault.”

And so perhaps we can take heart in knowing that even in this dark age of book burning and the most appalling ignorance, there are still those who live their lives with a powerful sense of morality and ethics, who have retained their humanity in the face of stifling reactionary dogmas, and who have resisted the call of dark forces that lie in wait behind every shadow and every unlocked door.

David Penner has taught English and ESL within the City University of New York and at Fordham. His articles have appeared in Counterpunch, Dissident Voice, The Arizona Free Press, and Global Research. He can be reached at: penadam@hotmail.com. Read other articles by David.