Consent is critical for the respect of women undergoing treatments

Consent is critical for the respect of women undergoing treatments
Dr Gabriel Scally holds a copy of the Report of the Scoping Inquiry into the CervicalCheck Screening Programme at Buswells Hotel in Dublin. Credit: Brian Lawless/PA Wire

A woman of my acquaintance remembers lying in the hospital labour ward in the aftermath of a particularly difficult birth — elated and exhausted. She was waiting for the tray which held the pot of tea and two slices of toast that recently delivered mothers the world over will tell you is the best meal they’ve ever had.

The baby had eventually arrived safely but, down at the “business end”, work continued as her obstetrician quietly begun the job of stitching her up. At one point she looked down at him and found herself saying: “Try and make it so that I’ll recognise it afterwards.”

Not the chattiest of men, her joking request didn’t raise much of a response. But most women will know exactly why she passed the remark. Regardless of the fact that you’ve just given birth, that there is hardly a nook or a cranny of your nether regions that have not been on view in the previous few hours, it’s still awkward.

I remember my own last birthing experience, where I sat on a birthing ball naked from the waist down. For some reason I was on my own in the room. My husband must have been chasing up the epidural; why else would he have had the courage to abandon me as I howled in pain?

A member of the cleaning staff walked in to replenish the hand towels over the sink. I remember us looking at each other — she no doubt having seen it all a million times before and me, despite my absolute discomfort — recognising the utter incongruity of sitting there almost undressed as I perched on an inflated piece of plastic.

However, had that woman at that moment told me she had immediate access to an epidural, I’d have acquiesced to her bringing a marching band in to observe. Or the occasion when I was having IVF and the embryos were being put in. As I lay there legs wide open, there were around three people in the room.

Directly in front of me, through an open hatch, in the laboratory, there was one, maybe two more people. Not that any of this matters to you at the time — you’d invite in the audience of The Late Late Show to observe if you thought it would increase the chances of conception.

In truth, between fertility treatments, interventions to deal with subsequent high-risk pregnancies, births, subsequent smear tests, and other gynaecological bits and bobs, I’ve had my nether regions on display more often than I could count. But that does not signal subsequent open season on my or any other woman’s vagina. #

It’s important to state here that, while in these various situations, I personally was never treated with anything other than respect by the various medical personnel I encountered. Plus, even if I couldn’t see directly, I was always given a briefing on what was happening. It often felt undignified but it was necessary.

But does this mean that myself, and countless other women like me, would be happy to take a “while you’re down there approach” and have someone do something other than what was agreed in advance? Absolutely not. No. Never. Hands off.

I’ve heard of an interesting proposal for the men who have difficulty with the concept of consent in sexual scenarios — and this could possibly be applied in obstetrics/gynaecology as well. It is for someone to take them by surprise digitally and penetrate them without consent, say like what happens in a prostate exam. A cough softener, for sure.

File image.
File image.

This seems harsh and violent doesn’t it? It is clearly not something any right thinking person would advocate. However even the raising of such issues are simply borne out of utter frustration at what women can still be subject to without consent.

Despite the episodes and scandals we’ve had previously, it’s still a shock to read this week that in St Luke’s Hospital in Kilkenny tests were carried out on women, without consent, that involved flushing their vaginas with water, inserting a miniature scope for monitoring and measuring the pressure within the vagina. Ray O’Sullivan, the obstetrician at the hospital who carried out the tests told The Irish Times he did not feel he needed to obtain consent beforehand.

However, the hospital maintains he should have done so, has sought his suspension, and has reported the matter to the Medical Couincil. It was the nursing staff who raised the concerns over whether these women, five in all, had been asked for their consent, or if it had been passed by a hospital ethics committee.

As an apparent mitigating factor, Prof O’Sullivan said “they didn’t even know it’s been done” and that no patient had been harmed.

Sure enough we might say these women have much to be thankful for; after all, they need only look to the relatively recent experiences of their fellow countrywomen, all without consent who had wombs whipped out, fallopian tubes removed, and symphysiotomies undergone — where the joint is cut between two sides of the pelvis to allow a baby to pass through unrestricted, often resulting in chronic pain, incontinence, walking difficulties, sexual problems, and other issues for the rest of their lives.

It is clear that, at one point, it was felt by a number in the medical establishment that you could do virtually anything you wished with a female patient. But we’ve had so much context in recent years — the debate surrounding the abortion referendum, the ongoing concentration on what occurred in mother and baby homes, the recent report into the Cervical Check scandal highlighting the paternalism and misogyny that exists in Irish medicine.

How unself aware now might an individual need to be not to consider patient consent each and every step of the way? A few months, ago the incredibly talented Colm Tóibín wrote a piece for the London Review of Books on his treatment for testicular cancer. Rereading it this week, I was again struck by his magnificence as an author, particularly tackling such a personal subject.

I was delighted to read that he had got through it and was apparently well again. There were a number of lines that stood out, but one in particular that seems apt in this context. He was writing about having an ultrasound conducted “by two young guys filled with kindness and sympathy”.

Both seemed fully aware, he said, that taking your trousers and underpants down and lying flat on your back and “then having some sort of gel poured on your junk before a type of prod begins to zoom around the outside of your balls is no fun, and they outdid each other in being nice to me”. They then told him they would have to go further and this meant removing his little towel.

“‘I know this is shaming for you,’ one of them said. I sat up, rested on my elbows, and looked at him. ‘When you get to my age,’ I told him, ‘nothing is shaming’,” wrote Tóibín with his usual brilliance.

Reading that last bit it, struck me that you’d search long and hard to find a woman in Ireland, regardless of what she was being asked to unveil below the bellybutton, for whatever test was underway, that would ever be told such a thing, or even close to it. It’s all just seen as part of the female lot.

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