Students and interns, are hidden; the patient is manipulated and deceived. The patient is blatantly lied to before and after about who actually performed the procedure. Vague language in the consent form may allow for such substitutions. Other times patients are given "conscious sedation" (date rape drugs) to obtain drug facilitated signatures on consent forms when the patient is in no condition to read the form they are being asked to sign, will not likely remember the incident, and are in a drug induced mind altered (including unnaturally conciliatory) state of mind. This is a method often used on patients who staff has reason to think will not consent to substitutions, video taping, or multiple pelvic exams", adolescent girls, rape victims, religious patients, or simply a patient who wants to know and approve the experience level of the performing physician.
Once under anesthesia for surgery or colonoscopes physicians often take the opportunity to do things to patients to which they did not consent, such as teams of interns, residents, and students lining up to perform pelvic, breast, and rectal exams on sedated patients, for the sake of education. Errors are covered up, injuries denied; even molestation (medical and sexual) of sedated patients is covered up and allowed to continue. This is not the medical culture which we are lead to believe exists, where patients health, rights, and dignity are health professionals primary concern.
We are convinced that in the western world the average medical patient has established rights to dignity, privacy, and self-determination, that physicians are trained to respect and protect these rights, and any physicians found in violation are punished and/or restricted from practice . This is a perspective the public holds because it is an image that is aggressively projected and protected by medical "professionals". It is an understanding come by via propaganda and is not reflective of reality. So, what is real?
My goal herein is to think about how we got to the point where in spite of what we are told about patient/physician relations, women are subjected to forced rape exams, non-consensual non-emergency, often even non-medically indicated pelvic exams, and more. This is a sort of "People's History" of Allopathic Medicine. With no intent to go into the detail Howard Zinn has in his books, I want to take a critical look at medical practices as they relate to violations of patient's autonomy, of the fiduciary relationship between patient and physician, how such violations are rationalized, and what needs to be done to ensure patient autonomy, dignity, and rights are respected.
I. The History:
We tend to be vaguely aware of a distant historical past of exploitive medical experiments performed upon the bodies of slaves, mental heath patients, criminals, prisoners of war, veterans, poor women and minorities. We seem to rarely know the details however, Newborns injected with radioactive substances, military personnel exposed to chemical weapons, mentally challenged children infected with hepatitis, seventy-three disabled children fed oatmeal laced with radioactive isotopes, pregnant women injected with radioactive iron,"; from it's inception allopathic or "western" medical "advancements" to a significant extent, originated from research and education methods that violate any sense of human or civil rights, autonomy or dignity. 1
At first patients wealthy and poor alike feared and avoided violent and invasive allopathic care. It was a well-grounded fear, and avoidance of the allopath was a wise decision. When medicine was diverse in theory and practice, patients had a choice of homeopathic, naturopathic, Chinese medicine, herbalists, Indian medicine, "allopathic medicine" (which became what we now know as "western medicine"), and midwives. Diet, dietary supplements, herbs, tonics, and topical, were the tools of the most scientific (empirical) medical care. Environmental exposures, bleeding, mercury poisoning, and other very unscientific methods were employed by the allopath. What became known as regular medicine was not based upon science but philosophy, theology, and myth, while traditional Chinese Medicine, homeopathic, and herbal based medical care were grounded in centuries of empirical data collection and analysis. The relative lack of success in treatment, in conjunction with the violence and death that plagued any patient who dared suffer the allopath, and given that patients had a choice, most chose NOT to seek the care of the allopath. The poor reputation of allopathic medicine in conjunction with much competition from other practitioners ensured the relative poverty of the allopathic physician. Left with few paying patients relative to other physicians, allopathic medicine was not thriving.