Imagine needing surgery. You would worry about a lot of things. Finding the best doctor. Finding the best hospital. Having a complication. Not waking up from the anesthesia. The pain you will experience afterwards. The list goes on. Now imagine having one more worry. But this one isn't to do with your health. Rather, it is to do with protecting yourself. Protecting yourself from forced vaginal or rectal penetration while you are unconscious and unable to give - or withhold - consent. Protecting yourself from forced vaginal or rectal penetration by your own healthcare providers - the very people into whose hands you are entrusting your life. Would you have the surgery? Would you take that risk? Now you have a choice to make. Do you protect your health, and indeed, your own life by undergoing the surgery? Or do you protect your body from an unwanted and unwarranted invasion by not having the surgery, but in doing so risk your health, and maybe even your life?
The situation above probably sounds ridiculous to you. It probably sounds like something out of a dystopian novel. Maybe like something out of The Handmaid's Tale. But the reality is, this is the situation facing the people of Connecticut right now.
Because of a loophole in laws surrounding consent, teaching hospitals have a lot of leeway in the way they use their patients in their teaching practices. Language in consent forms is written to be intentionally broad, particularly surrounding the role of students and trainees in the provision of healthcare. In many cases it consists of only one or two lines, and follows the following formula: "I understand that students and trainees may be involved in my care and consent to treatment by providers in the event of unforeseen events or complications." Those one or two lines are typically buried in the middle or at the end of a form, which patients often report being rushed to sign them by providers or administrators as they are "standard." And because no details on what key terms, such as "student involvement" are given, nothing is ruled out and everything is fair game.
Most patients assume "student involvement" - unless otherwise specified - is limited to observation. Unfortunately, this is not the case. In Connecticut, it is both a legal and common practice for students - sometimes multiple students, one after the other - to practice pelvic and prostate examinations on anesthetized patients without their direct and informed consent. These examinations are not necessarily related to the treatment the patient is receiving. For example, someone may sign on the dotted line consenting to back surgery, and end up subjected to one or more unnecessary and non-consensual pelvic or prostate examinations. These examinations play no substantive role in the patient's treatment, and are not necessary to their care. They are done solely for the benefit of the students - so that they can practice.
There is a bill before the Connecticut state legislature right now - HB-5067 - that would ban the use of non-consenual pelvic and prostate examinations as a part of the medical education process. It will still allow students to practice their clinical skills - it poses no threat to their education or to their ability and opportunity to one day become competent, confident, and experienced clinicians. It simply prohibits students from practicing these invasive examinations on patients who have not given their consent.
HB-5067 is the latest iteration of this legislation, which was first introduced in the Connecticut state legislature in 2019. Unfortunately, while other states have acted quickly to enact similar laws, Connecticut's bill cannot even get a public hearing. Public testimony supporting the bill - usually made available to the public on the Clerk of the House's website - is being kept quiet and is now only available by special request. Inquiries by activists and concerned citizens to the Public Health Committee are going unanswered.
This is not the fault of the dedicated legislators who initially introduced the bill or who have since signed on to it with their full public support. Sadly, the bill is being blocked by the state's medical community. The Yale University School of Medicine has opposed this legislation since its initial introduction in 2019, and maintains that these practice exams are necessary, and that the vague language in existing consent forms is sufficient. They insist that "all consent forms contain specific language explaining the involvement of trainees in the decision making and procedural process." Please take a moment to judge that for yourself. Yale's consent forms read as follows:
"I understand that some of the system hospitals are teaching hospitals. Doctors or other health practitioners who are members of the care team and are in training may help my practitioner with the procedure. I understand the purpose and potential benefits of the procedure in relation to my goals. I give permission to my responsible practitioner to do whatever may be necessary if there is a complication or unforeseen condition during my procedure."
Tell me - would you define a student or trainee who is legally incapable of diagnosing a problem as a "responsible practitioner" in the event of a complication or unforeseen condition? Would any reasonable person? And how does a student's need for practice - which is in no way unforeseen and can be established ahead of time - fall under that category? And when you sign a form stating you understand the benefits of a procedure to your goals, would you even begin to imagine that an entirely extra and unnecessary procedure - an intimate examination by a student who is unlicensed and therefore incapable of providing you with care conducted solely for the purpose of them practicing their clinical skills - could possibly be covered under that language? The truth is, this language is intentionally broad. And these "procedures" are not being conducted for the benefit of the patients. They are being conducted for the benefit of the institution.
Interestingly enough, many medical students express discomfort conducting intimate examinations on patients for the purpose of practice without having that patient's direct and informed consent. However, they fear standing up to attending physicians and insisting on consent, as doing so could result in retribution and threaten their careers. This bill stands to protect medical students too. It will protect them from the trauma of being forced to violate other human beings in the name of their education, and will create an environment in which their attending physicians are required to teach them the process of working with a patient to obtain direct and informed consent, which in the long run will make them better doctors. It should be noted that states that have passed similar consent laws in recent years have had no reports of medical students' performance or learning outcomes suffering as a result.
We aren't asking for much. We aren't asking teaching institutions to sacrifice the educational opportunities they offer their students, or to take opportunities away from students. We are simply insisting that those opportunities only be offered with the consent of the patients whose bodies they are using. We are insisting that exploitation and abuse no longer play a role in the medical education of our state's future doctors, and that they are taught the importance of consent early on. And we are insisting that our laws protect us from the dehumanization and indignity of being turned into living teaching tools without our consent. Hospitals exist to serve their patients - patients do not exist to serve hospitals, and we do not owe hospitals the use of our bodies in exchange for necessary healthcare.
If you are a Connecticut resident just becoming aware of this practice, please join us in standing up and saying enough. Please join us in telling the Yale University School of Medicine to stop standing in the way of this bill's passage, in telling the Public Health Committee to schedule a public hearing and make available public testimony, and in telling your legislators to vote in favor of this legislation if and when a vote is called. If you live outside of Connecticut, please stand in solidarity with our state's residents and in demanding justice and protection for us when we are at our most vulnerable.
In addition to signing below, please consider reaching out to the Public Health Committee at (phtestimony@cga.ct.gov or by phone at (860) 240‑0560 and to the Yale University School of Medicine at 203-785-4672. If you are a Connecticut resident, please consider reaching out to your state representative (if you unsure of who yours is, you can find out https://www.cga.ct.gov/asp/menu/cgafindleg.asp
If you would like to learn more about this issue, please have a look at the following articles:
Explicit Consent for Pelvic and Prostate Exams: A Case for CT House Bill 5067
https://ctexaminer.com/2021/03/20/explicit-consent-for-pelvic-and-prostate-exams-a-case-for-ct-house-bill-5067/
Providers Are Sexually Assaulting Patients — and It's Legal
https://www.healthline.com/health/nonconsensual-internal-exams-sexual-assault#1
Medical Students Regularly Practice Pelvic Exams On Unconscious Patients.
https://www.elle.com/life-love/a28125604/nonconsensual-pelvic-exams-teaching-hospitals/
