In recent years, the practice of obtaining consent from medical patients, particularly when conducting examinations under anesthesia (EUAs) of the sensitive pelvic, rectal, or prostate regions, has gained increased attention. While the United States has seen significant media coverage and regulatory changes on this issue, Canada continues to lag behind. Although there are professional guidelines in place requiring specific consent for EUAs, non-consensual exams persist in Canadian medical practice.
In a recent publication in Journal of Surgical Education, Phoebe Friesen, an assistant professor in McGill’s Faculty of Medicine, investigated the perspectives of Canadian medical students on the importance of consent for sensitive EUAs. Her interest grew from discussions with her students, where several expressed discomfort about performing non-consensual pelvic exams on anesthetized patients.
“I felt disturbed when I heard about it,” Friesen said in an interview with The Tribune. “I think there is this ambiguity around consent [….] It’s often something practitioners never [properly] learned, sort of like this paternalistic practice that was just passed on, never questioned, and then passed on again.”
When medical students enter their clinical rotation years, they work with a variety of clinicians, each of whom models a different approach to patient care and consensual practices. This means that the attitudes around consent that a medical student ultimately acquires may reflect the practices of the particular clinicians they work with.
“You might have one [attending physician] that in the stereotypical way, sees it as primarily a legal act,” Friesen explained. “On the other side of the spectrum, students are going to see incredibly slow, attentive consent, where patients are given an opportunity to ask a lot of questions.”
During her research, Friesen distributed an anonymous questionnaire to 134 medical students across six medical schools in Canada. Of these, 119 completed the survey entirely. The respondents included 79 women, 33 men, and 9 students identifying as trans, genderqueer, two-spirited, nonbinary, or preferred not to answer.
The results indicated that 72 per cent of students believed that specific consent for EUAs was a moral requirement, 20 per cent were unsure, and eight per cent did not consider specific consent for EUAs to be a moral obligation at all. Those who felt specific consent was necessary cited a variety of reasons, including patient rights, autonomy, respect, and integrity. Some students also expressed concerns that non-consensual exams could be exploitative or even constitute assault.
However, some respondents questioned the need for explicit consent, arguing that it could impede educational opportunities.
Some men in medical school also shared that they feel they do not receive enough exposure to certain medical training compared to women in medical school. One respondent wrote, “I have now graduated medical school and still do not feel that my ability to perform pelvic exams is adequate.”
“[The findings on how] eliciting specific consent might be a challenge, particularly for male and racialized students, are really interesting,” Friesen noted.
Friesen pointed out a key distinction between how medical students and the general public view patient care. In the world of medicine, students may see patients as opportunities for education. However, outside of the medical field, the necessity of consent is understood as an obvious, ethical, and humane boundary.
“People outside of this world [of medicine] just see it as completely obvious that you would ask someone for consent,” Friesen said. “There just really seems to be a difference in logic.”
The findings of this study highlight the need for greater emphasis on ethics and consent in medical training. Friesen advocates for a more structured and mandatory curriculum that includes comprehensive education on these issues.
“My hope is that McGill will be the first Canadian institution to put forward an explicit policy on this,” Friesen said.
Given that patients have expressed a clear desire for the requirement of consent for EUAs and that the study shows the majority of medical students support this practice, it’s clear that action must be taken to make this the standard moving forward.
