Recent reports of women under anesthesia unknowingly used as teaching tools for medical students to practice pelvic examination have spurred legislation to bar the practice in several states, including Arizona, Maine, Pennsylvania, and Wisconsin. Most of the bills would also impose penalties on practitioners who continue to do these exams without the permission of patients. Several states have already banned the practice, most recently New York. While it is unclear how often the procedure is performed, a June 2018 report in Bioethics suggests the practice has continued for decades, despite repeated calls for, at a minimum, explicit patient consent. The reports have also reignited discussion of the ethics of the practice in the context of women's rights.

The American College of Obstetricians and Gynecologists' Committee on Ethics has stated that pelvic exams for teaching purposes on anesthetized women should be performed only with permission from patients and under the supervision of an educator.

With the value that health care professionals place on informed consent-legally and ethically-and the availability of other means to learn female anatomy, such as simulation and advanced imaging technology, why has the practice continued? Some say medical paternalism is the root cause, noting that this attitude affects male patients, too, who may receive unconsented rectal exams for teaching purposes while anesthetized for prostate surgery. Others cite a societal culture that lacks respect for women's dignity, autonomy, and right to decide what happens to her body.-Gail M. Pfeifer, MA, RN