Madison news - No consent: patients probed by medical students

AUSTRALIAN medical students are performing intimate examinations on unconscious and anaesthetised patients without their consent.

The shocking discovery, revealed in new research to be published in an international medical journal, raises serious questions about the ethical standards of our next generation of doctors.

It is expected to provoke a furious reaction from patient groups.

Unauthorised intimate procedures carried out by students included genital, rectal and breast exams. Almost half of patients were under the influence of medication or unconscious, while the remainder were conscious.

Among cases described in the research was that of a man who had been anaesthetised in preparation for surgery but was then unknowingly subjected to rectal examinations from a “queue” of students.

He hadn’t given consent beforehand.

“I was in theatre, the patient was under a spinal [anaesthetic] as well and there was a screen up and they just had a queue of medical students doing a rectal examination,” a student confessed. “[H]e wasn’t consented but because.. you’re in that situation, you don’t have the confidence to say ‘‘no’’ you just do it.”

Astonishingly, another student admitted to having “no qualms” about giving a female patient an anal examination without her consent because they didn’t consider her permission relevant.

Study author Professor Charlotte Rees - former associate professor in medical education at the University of Sydney and current director of the centre for medical education at the University of Dundee in Scotland – raised serious concerns about a culture of senior clinicians ordering students to perform intimate examinations without valid consent.

Of the students who faced the dilemma in the research, 82 per cent obeyed orders and carried out unauthorised intimate examinations.

“We think that it is weakness in the ethical climate of the clinical workplace that ultimately serves to legitimise and reinforce unethical practices in the context of students learning intimate examinations,” writes Prof Rees.

Many students were torn between strong ethics about getting patient consent in society and the weak ethics among medical staff, the study found.

Not all students who participated in the study of 200 students at three undisclosed medical schools in Australia and the UK agreed to carry out intimate examinations without patient approval.

One told how they refused to participate when a doctor failed to gain valid consent from a woman who was “part spread-eagled on the bed and the nurse is [sic] pulling down her jeans at the same time and it was all very complicated and you could see her, she was about seventeen.”

In contrast, the student who gave a woman an unsanctioned anal exam justified it by saying: “If you’re having your anus cut out then having someone’s finger put in it anyway, I just thought was an irrelevance basically so I have no qualms what[so]ever about not having specifically consented her to allow me to do a rectal examination [sic].”

The research will appear in the journal Medical Education. 


By CLAIR WEAVER, senior feature writer, madison magazine