To issue this opinion, the ethics committee interviewed 33 people, patients and professionals. This opinion responds to a request from the Prime Minister last summer, after numerous testimonies of gynecological and obstetric violence.
“We recommend that the consent be explicit”, estimated Wednesday March 29 on franceinfo Karine Lefeuvre, professor at the School of Advanced Studies in Public Health in the Department of Human and Social Sciences, vice-president of the National Consultative Ethics Committee (CCNE), co-rapporteur of the opinion 142 of CCNE. The National Ethics Advisory Committee recommends increased attention to know-how at each stage of gynecological examinations, in an opinion published on Wednesday. It’s necessary “Express and not tacit consent”insists Karine Lefeuvre.
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franceinfo: Who is this review for? What does a reinforced attention to know-how mean?
Karine Lefeuvre: This opinion is addressed to healthcare professionals, but also to all citizens and patients who are affected by these issues. With this referral from the Prime Minister, on a particularly sensitive subject, we felt that we had to calm things down and bring both sides closer together on mutual consideration and listening. It concerns all examinations of the area that has been described as “extremely intimate”, that is to say everything related to the uro-genital and ring-rectal sphere. These examinations are carried out by professionals of very different natures and not only gynecologists and obstetricians. From the moment we touch on intimacy, we felt, in relation to this really very particular zone of extreme intimacy, that we had to redouble our attention, including elsewhere, and perhaps even more. towards the most vulnerable people. And we have seen associations, professional orders and colleges which have drafted charters, recommendations, for example vis-à-vis minors, saying that for a first consultation, it is recommended not to carry out the examination but explain things and ask him to come back so that he or she understands. There is also a particular intention towards people with disabilities, for example.
Until now, consent was tacit?
In some states, including the United States, written consent is required. We insisted on the fact that the consent should not be written, because we considered that this would reinforce the procedure too drastically and damage the relationship of trust. But we recommend a consent that is explicit, differentiated, which is collected in several stages. So express and not tacit consent. When a patient crosses the threshold of the doctor’s office for a gynecological consultation, she does not necessarily consent to everything. It does not necessarily have all the data. So you have to explain each step very precisely.
What came out of these hearings?
So the first observation we made was that there was anger on both sides, both on the side of the professionals who felt cornered, questioned in a global way, while the vast majority of them invest and do everything possible to provide better care. And anger from patient associations who felt they were not heard enough. And what we finally retained is that it was important not to minimize the suffering evoked by certain patients who were able to go as far as penal qualifications, such as rape, in abnormally serious things. So we had to calm down and try to better understand each other’s arguments. In a very pragmatic way, we can consider that professionals who have already drafted charters and recommendations will also rely on CCNE’s opinion so that each professional appropriates these new practices, even if there has already been real progress.