Informed Consent: Calling for Explicit Permission Forms for Certain Medical Exams

Imagine you go under anesthesia for a procedure and a pelvic or prostate exam is performed on you without your knowledge.

A Yale University bioethicist says it happens all over the country, including in Connecticut as medical students train at teaching hospitals.

A Stratford woman is pushing for a law that would require explicit consent.

Livia Fry’s petition to end this practice is gaining a lot of traction. More than 70,000 people have signed so far.

State lawmakers have tried, and failed, to get bills passed to stop this practice.

Fry, 30, stresses health care workers are heroes, but she says childhood dermatologist checkups with lots of training doctors looking on left her with PTSD.

“This is just what observation and photographs did to me, imagine a nonconsensual pelvic or prostate exam when you’re going for back surgery? It would devastate people,” said Fry.

While Fry says she in no way wants to take educational opportunities away from our future doctors, she just hopes the exams are done with explicit permission.

So, she’s pushing for a state law to require direct and informed patient consent, instead of perhaps a clause hidden in a pile of paperwork a patient signs before another procedure.

“And if you sign it, God bless you and thank you. More power to you. If not, that is your choice. We don’t owe our bodies in exchange for health care,” she said.

“We do know from national survey data, as well as local focus groups, that unconsented intimate exams within the clinical setting are indeed, occurring nationwide, as well as here in Connecticut,” said Lori Bruce.

Bruce, the associate director for Yale University's Interdisciplinary Center for Bioethics, has been studying this practice.

She says she’s hearing from medical students who want to have this specific consent too.

“There are concerns that that surface that say, if physicians start asking, can we have our medical students do extra training exams, there is perhaps a fear that everyone would say no, and that this would halt medical education. And of course, we don't want that. However, what we have learned from a number of national surveys and international surveys, is that when asked people are overwhelmingly likely to say yes, of course,” said Bruce, who is t

Connecticut lawmakers have presented related bills the last couple of years, the last requiring informed consent for a pelvic or prostate exam on a patient who is under deep sedation, anesthesia, or unconscious.

But they never made it out of the public health committee.

NBC Connecticut reached out to two teaching schools in Connecticut.

Dr. Molly Brewer, UConn Health’s OBGYN Chair tells us, “We go through the consent form line by line.”

Brewer says she agrees with the need for this consent, but her concern is that these discussions lead to the ban of any of these important teaching exams, ones future doctors need to learn.

“I’m an advocate for women and we want to produce physicians who are well trained for our women and that’s really the bottom line,” said Brewer.

Fry’s petition particularly points out Yale School of Medicine.

They responded with a statement:

“We recently have been made aware of a petition that erroneously alleges Yale School of Medicine (YSM) medical students conduct unindicated, non-consented pelvic exams while patients are under anesthesia. The petition also discusses proposed state legislation that the petition’s author believes would prevent such practices.

"The American College of Obstetricians and Gynecologists has stated that 'pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.' At YSM and Yale New Haven Hospital, we take this standard very seriously and have been and continue to be committed to adhering to it in our daily practice."

"At Yale School of Medicine and Yale New Haven Hospital, unindicated, non-consented pelvic exams are not being performed on anesthetized patients.

"For those patients having gynecologic surgery, it is an expected standard of care for gynecologic surgeons and their trainees to examine pre-operatively the pelvic anatomy before proceeding with the surgery, just as it is a standard to examine pre-operatively any other palpable organ before proceeding with surgery involving the given organ. This is critical to the selection of the optimal surgical approach and the instruments that will be used, as well as to preemptively identify any potential challenges that could lead to a higher risk of complications during surgery.”