Saturday, January 30


Some simply lovely news from Canada:

Imagine that you are undergoing a fairly routine surgery — say, removal of uterine fibroids or hysterectomy. During or right after the procedure, while you are still under anesthesia, a group of medical students parades into the operating room and they perform gynecological exams (unrelated to the surgery) without your knowledge.

Do you consider this okay, or an outrageous violation of your rights?

Regardless of your feelings, you should be aware that this is standard procedure in many Canadian teaching hospitals.

Ah, it's those bloody paternalistic doctors again.

The interesting thing about this is that it's not against any laws or even guidelines. In fact, it's not even that there are no rules covering such an event: there are guidelines, which say that this is OK because permission is "implicit". The fact that it's come to light might eventually lead to a change in the law, but not to any prosecution. Under Canadian law, no-one's done anything wrong. Apparently, it never occurred to anyone that there was anything wrong with putting their fingers into the genitals of a woman they don't know without her permission.

The article doesn't mention when the practice first became routine, but it looks to be well established: 72% of medical students polled said they had done it. What is particularly striking is the total lack of basic ethical thinking present in the brains of Canadian doctors. I mean, this is simply not something that needs to be banned. Legalise it in Britain tomorrow and I still wouldn't do it. But doctors are so much more sophisticated than me.

The story goes back to 2007 when Sara Wainberg was a medical student at McMaster University. Her younger brother Daniel, also studying to be a doctor, phoned for advice: As part of his rotation in obstetrics and gynecology, he had been asked to perform a pelvic exam on a woman who was under anesthetic. He refused, saying doing so without consent would be unethical.

"It got me thinking," Sara Wainberg said. "I had done this numerous times in my training and it had never occurred to me that it might be unethical."

Yes, this woman is the whistle-blower on this barbaric practice, but she still did it perfectly happily herself for years without ever questioning it and would probably still be at it to this day if her brother — who must have missed one or two of his indoctrination sessions — hadn't pointed out the bleeding obvious to her. And did she have a revelation and realise just how awful it was? No, it made her think about it. She even did a survey of patients to find out what they thought of it. And, would you believe it, turns out they're broadly against being raped — which is what the law in the UK and various other jurisdictions would call this. In fact, I'm pretty sure that this would constitute rape or at least sexual assault in Canada if it were done by anyone other than a doctor. But, you know, doctors are special.

That was 2007. It is now coming to light. During the last two years, while Dr Wainberg faffed around before eventually deciding that, hey, turns out it is wrong, and then publicising the matter, lots more women have had this done to them. What strikes me is that she seems to have approached the whole scandal as an interesting question in moral philosophy that needs plenty of cogitation, rather than as an appalling thing that is being done to actual people and that needs to be stopped immediately.

Remember, these are the guys who reckon they should have the legal power to decide to turn off your life-support machine. Because of their excellent judgement. This has been going on for years, and, out of all the medical students to pass through Canada's teaching hospitals in that time, one has noticed that it's immoral.


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