Colorado medical providers must obtain prior consent from patients before medical students can perform pelvic exams on them while they are unconscious for a procedure under a bill signed into law Thursday.
By signing the bill in her capacity as acting governor, Lt. Governor Dianne Primavera placed Colorado with at least 20 other states that have consent laws on the books. But Colorado goes much further than other states in requiring medical students to be named in advance and know the patient, a step one bioethicist worries could impede students' chances of learning.
Supporters of the law, which had bipartisan support, say all aspects of it protect patients from feeling violated and, in some cases, re-traumatized after surviving a sexual assault. They hope it will set the standard for states that have weaker consent laws or none at all.
“Learning from a non-consensual intimate examination is traumatic, forcing patients to relive some of the worst moments of their lives. We are ending this unethical practice,” Democratic state representative Lorena Garcia, who co-sponsored the bill, said in a statement.
The goal is to ensure that a patient is fully aware of and agrees to students performing breast, pelvic, prostate, or rectal exams that may involve inserting fingers or devices into someone's vagina or anus.
It is difficult to quantify the frequency with which students perform such tests without informed consent, in part because patients may never know they were given and students may be afraid to raise their concerns with their superiors.
Typically, patients complete a series of forms providing broad consent for procedures that may be medically necessary while sedated, including for students to participate in their care.
In order for such procedures to take place under the new Colorado law, patients will need to sign a consent form that explains what will happen and includes the names of students who may participate.
Kayte Spector-Bagdady, a clinical ethicist and co-author of a 2019 recommendation from the Association of Teachers of Obstetrics and Gynecology, was concerned that determining which students can and cannot participate before the procedure could limit learning opportunities.
Schedules, especially in a hospital setting, can change quickly, Spector-Baghdady argued. If the named students are not available, Colorado law would not allow others to step in and learn. Those educational opportunities are essential for future doctors to become competent in treating women, she said.
Elizabeth Newman, director of public policy for the Colorado Coalition Against Sexual Assault, which supports the law, said naming students and getting them to know the patient are integral components of full informed consent and ensure students learn the rules that govern the consent process.
There are certain caveats, including that exams may be performed by licensed professionals in emergency situations where advance consent is not possible. The law includes whistleblower protections for medical students, and doctors and hospitals could face liability if they violate consent rules.
Those who have opposed the bills and laws in the US say they are examples of how the government needlessly intrudes on the trust of patients and providers, and that guidance should come from medical associations .
