It’s not every day that you find Andre Jacque, Lena Taylor, Janel Brandtjen and Chris Taylor on the same side of a reproductive health issue.
Jacque and Brandtjen, Republicans from De Pere and Menomonee Falls, respectively, are two of the Legislature’s staunchest opponents of abortion, while Lena and Chris Taylor, Democrats from Milwaukee and Madison, are just as committed on the opposite side of that issue.
But in a divided state government where compromise has been hard to come by, these lawmakers have found an issue to unite them.
The four legislators are the lead cosponsors on a bill that would require hospitals to obtain explicit informed consent before medical students can perform a pelvic exam on a patient under anesthesia — something currently done sometimes as part of training, authorized under a general informed consent form.
“I really believe if we can agree on this, every single person in the Legislature should be able to agree on this,” Chris Taylor (no relation to Lena) told me. “And you’ve got to try. Even with people you vehemently disagree with, you have to try to find some area. And usually you can.”
The group of lawmakers recognizes that they would appear to be unlikely collaborators on legislation in this arena, given their passionate, public disagreements about other reproductive issues. But in interviews, they stressed their friendly professional relationships with each other, and their desire to find areas of agreement whenever possible.
“The reality is there can be deeply held, passionate political principles, and yet there are any number of issues that can and should transcend that,” Jacque told me.
That’s a refreshing and encouraging attitude to encounter as many of the state’s elected officials have struggled to reach consensus on far less divisive efforts, like funding homelessness initiatives and reforming the state’s juvenile justice system.
Under the bill, introduced late last month, Wisconsin hospitals have to have a policy “requiring written and verbal informed consent before a medical student may perform a pelvic exam on a patient who is under general anesthesia or otherwise unconscious.” Ten other states have already done the same.
During a pelvic exam, a medical professional inserts gloved fingers into a patient’s vagina to examine her vulva and her internal reproductive organs. A speculum is also used to spread the patient’s vaginal walls, allowing examination of the vagina and cervix.
It’s an important exam that can help identify infections or tumors, and it’s important, of course, for medical students to learn how to perform it properly. And while medical students can practice the procedure with mannequins or on paid, conscious volunteers, an anesthetized patient’s relaxed muscles can make it easier to locate and assess internal organs.
There is nothing sexual about a pelvic exam, but it’s one of the most vulnerable experiences a generally healthy woman will have in her doctor’s office. For survivors of sexual assault, it can be retraumatizing.
There are ways doctors can work with patients who have experienced sexual assault to provide trauma-informed care in these situations, but that’s not possible if the patient doesn’t know the exam is going to occur. Reports by Vice and The Associated Press have referenced patients who woke up during pelvic exams they didn’t know were going to take place, leaving them feeling violated.
The Association of American Medical Colleges has decried performing pelvic exams without specific consent as “unethical and unacceptable.” The American College of Obstetricians and Gynecologists has said that while patients should be encouraged to participate in these training exercises, “if any pelvic examination planned for an anesthetized woman offers her no personal benefit and is performed solely for teaching purposes, it should be performed only with her specific informed consent.”
In the first reporting on this bill, the Wisconsin State Journal noted that UW Health adopted a policy last year requiring informed consent for “educational sensitive exams.” Previously, UW Health — like most teaching hospitals — received general consent from patients to allow medical students to train during their procedures, but did not specifically mention pelvic exams.
That’s a good start — now it’s time for others to follow suit.
“This is just common sense, right? Giving women dignity and transparency,” Brandtjen told me. “I think making sure that women are given the dignity of information, and that transparency is part of the system is incredibly important … I think anytime that we let people take control of their health, it gives more comfort in what’s going on in the process.”
Both Chris Taylor and Brandtjen credited Jacque with moving the bill forward from a conversation Taylor started with him, to a bill with more than 20 bipartisan cosponsors. Jacque told me he tries to introduce bills that address issues that fail “the common sense test.”
“Talking about what is both an invasive procedure but also one that is not medically necessary when it’s being performed (under anesthesia), I think consent is a very important part of that process,” Jacque said.
Despite the bill’s bipartisan support, it’s not without opposition. The Wisconsin Hospital Association does not support it, but has not commented on its reasoning. However, in other states that have considered or passed similar bills, medical professionals have argued the legislation is unnecessary. The Yale School of Medicine argued, when a similar bill was introduced in Connecticut last year, that medical societies — not lawmakers — should set these standards.
As someone leery of efforts by legislators to disrupt the doctor-patient relationship, that’s an argument I understand and respect. I oppose laws that require medical professionals to give patients information they believe is medically inaccurate, as well as laws that remove patients’ ability to seek the care they and their doctor agree is best for them.
Because of that, I’ve grappled with my support for this legislation. But in my — admittedly, layman's — view, this legislation is limited and focused enough to serve the purpose of giving patients confidence in their care without banning an important teaching tool. A 2011 Canadian study of 102 women ages 21-94 found that 62% of those surveyed would consent to a pelvic exam under anesthesia, if asked.
The doctor-patient relationship is nothing without trust. Requiring specific consent for a sensitive exam should only bolster that trust. Because if someone’s going to be examining my vagina, I’d like to know about it.
Share your opinion on this topic by sending a letter to the editor to email@example.com. Include your full name, hometown and phone number. Your name and town will be published. The phone number is for verification purposes only. Please keep your letter to 250 words or less.