Florida Legislature has no business regulating women’s pelvic exams | Opinion
Legislating women’s bodies is an international problem. It comprises countries known for human-rights violations, such as Burkina Faso, and the United States. The U.S. legal system, especially, continues to intrude upon the healthcare decisions women make. Florida has one of the latest example. It recently passed legislation requiring that a physician have a woman’s written consent for a pelvic examination, rather than the normal verbal-consent process that doctors have always used for this procedure .
This law initially came out of efforts to prevent pelvic examination in women under anesthesia without consent. That is a good thing. However, state lawmakers altered the legislation to impose criminal charges on physicians and practitioners who do not have written consent from patients to perform all routine pelvic examinations. Though the legislation does not specify gender, it is implicated in the language as the law says nothing about the examination of male pelvic organ counterparts. Therefore, the new law directly targets the care that women receive.
How does the legislation affect women and how does it affect the care practitioners are providing women? In the midst of the #MeToo era when abuse against women has come to the forefront, we must acknowledge that consent is a key component of any relationship, including the physician-patient relationship. However, consent is more than agreeing to sign a form. It is a mutual agreement between the physician and the patient. A patient has to trust that the physician will give her all the information she needs to come up with the best plan of care, incorporating her lifestyle, ideals and overall picture of health. This is a complex task forged by the physician-patient relationship, not by overzealous legislators.
Physicians must carefully guide the patient through this sensitive aspect of the visit. Navigating this lies within the art of practicing medicine; it cannot be legislated. The examination is not a perversion or a sexual act, but rather an important diagnostic procedure used to guide appropriate medical treatment.
Consent for the pelvic exam, and any other examination, is obtained during the visit with the practitioner. But the American College of Obstetrics and Gynecology has warned that requirement for written consent for a routine pelvic exam is “burdensome” for women’s healthcare. Furthermore, a written consent form trivializes the pelvic examination as a procedure that is purely optional for diagnosis and unimportant to identify the correct treatment. Laws should not interfere with the necessary procedures needed to provide patients with quality medical advice; nor should they criminalize those who provide sound care to women.
Informed consent is a critical component of all good medical practice. The American Medical Association (AMA) describes informed consent as occurring “when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention.” This communication is variable based on the patient’s needs and cannot be confined to a specific script, especially for patients with limited medical literacy.
The AMA does note that informed consent should be documented. In terms of pelvic exams, a better solution than the new Florida requirement would be to check a box or have a sentence indicating that the patient gave consent to the pelvic exam in the medical record. Still, this should be considered a good medical practice as opposed to a legislative requirement.
Most women’s healthcare providers work tirelessly to help their patients medically, emotionally, psychologically and socially to navigate all the components of their healthcare. Each of these aspects contribute not only to women’s health, but to societal health. For instance, maternal mortality is an indicator of a society’s overall well-being. However, Florida’s new law has made taking care of women a legal landmine for practitioners and further shifts the consciousness of those providing women’s healthcare from a great privilege to a possible liability.
Florida’s law has unintended consequences for both the patient and the practitioner. While no healthcare provider would disagree that patients always have the right to opt out of pelvic examinations, legislating women and their medical care provides no benefit for healthcare delivery and is a false safety net. Though the United States is a far cry from the women’s-rights violations in other countries, like Burkina Faso, it is important that we seriously consider what it means that our society continues to legislate women’s bodies and to criminalize the providers delivering their care.
Laura Martin D.O. is an assistant professor of urology in the division of Female Pelvic Medicine and Reconstructive Surgery at the University of Miami and a Public Voices Fellow of the OpEd Project.