Unauthorized Pelvic Exams are Sexual Assault

Abstract

The pelvic exam is used to assess the health of female reproductive organs and so involves digital penetration by a physician. However, it is common practice for medical students to acquire experience in administering pelvic exams by performing them on unconscious patients without prior authorization. In this article, we argue that such unauthorized pelvic exams (UPEs) are sexual assault. Our argument is simple: in any other circumstance, unauthorized digital penetration amounts to sexual assault. Since there are no morally significant differences between UPEs and other instances of digital penetration, UPEs are sexual assault. So, insofar as one is against sexual assault, one should be against UPEs.

Keywords:

• Sexual assault
• consent
• pelvic exams
• health care rights

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 In this article, we will be using ‘authorization’ and ‘consent’ synonymously.

2 While we emphasize that UPEs aren’t unique to the United States, much of our data comes from there.

3 Hereafter, we will drop the qualification ‘informed.’ All references to consent should be understood as references to informed consent.

4 Notably, UPEs are currently legal in thirty-one states (The Epstein Health Law and Policy Program n.d.).

5 To be clear, we aren’t making a legal argument in this article—different countries have different laws and different legal standards, making it very difficult to make a general legal argument. However, we think that it’s worth noting that UPEs and Hurt Back fit the United States’ legal definition of rape, which holds that ‘the penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim’ is rape (An Updated Definition of Rape n.d.). Again, we aren’t concerned with matters of legality in this article.

6 Two reviewers suggested that we address the issue raised in this section.

7 It’s worth noting that there’s reason to think that pelvic exams on unconscious patients don’t provide an optimal educational experience. Though the unconscious patient is more relaxed, she cannot inform the student of any discomfort or pain during the exam (Ubel, Jepson, and Silver-Isenstadt 2003). This deprives the student of crucial feedback on their administration of the exam, as well as exposing the patient to potential injury. Furthermore, even if it is better to teach pelvic exams (or yoni massages) on unconscious patients, it doesn’t follow that it’s permissible to do so without explicit authorization. Authorization (or lack thereof) is precisely what is needed to turn a pelvic exam from an act of sexual assault to a medical procedure: consent may be morally magic (Heidi Hurd 1996), but it must be there for its magic to work.

8 This justification draws on a legal ambiguity in American medicine about what general consent to student involvement includes. However, this ambiguity does not exist in countries like the U.K. (General Medical Council 2016). Consequently, this kind of objection won’t work for anyone wanting to defend UPEs as a general practice. Thanks to an anonymous reviewer for bringing this to our attention.

9 Much of the debate over the moral permissibility centers over this issue of whether a woman’s general consent to treatment is sufficient to entail her specific consent to her body being used for pelvic exam practice. Those who argue that UPEs do not violate informed consent hold that it is sufficient. Our example below shows that general consent isn’t sufficient.

10 No doubt for one to give informed consent to undergo procedure p, she must know more than just that she will undergo p, e.g. she must know the risks involved with p, and so on. But informed consent requires at least this.

11 It’s also worth noting that, unlike other procedures performed by medical students such as drawing blood or suturing a wound, UPEs are purely educational and are completely unrelated to the patient’s treatment (Friesen 2018a and 2018b). UPEs would thus not be covered under a general consent to treatment and so would constitute a violation of consent.

12 To be clear, consenting to student involvement is (i) not to consent to having a pelvic exam if one is not already scheduled and (ii) not to consent to having a student perform a pelvic exam if one has been scheduled.

13 For further discussion of issues pertaining to unconscious victims, see Heyes (2016).

14 A reviewer has suggested that a better example would be this:

Drunk: David and Sarah are kissing at a party. Sarah is drunk and passes out. David proceeds to digitally penetrate her.

Everyone agrees that Drunk is a case of sexual assault and that it bares some similarity to UPEs. While we agree that Drunk is a case of sexual assault, we think it’s less illuminating than Hurt Back: it’s too dissimilar to UPEs to do much ethical work. This is because the defenses that can be used for UPEs clearly aren’t applicable in the case of Drunk: one can’t claim that David digitally penetrating Sarah is beneficial for Sarah, that it serves educational purposes for David, etc. And so we think Hurt Back is far more useful than Drunk.

15 For comments on this article, thanks to Reviewer 3. Special thanks to Lynn Parrish for helpful and encouraging comments. And thanks especially to G.L.G.—Colin Patrick Mitchell—for particularly insightful comments.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Perry Hendricks

Perry Hendricks is a PhD student in philosophy at Purdue University. His primary areas of interest are ethics, philosophy of religion, and epistemology.

Samantha Seybold

Samantha Seybold is a PhD student in philosophy at Purdue University. Her primary areas of interest are social epistemology, ethics, and feminist philosophy.