Perspectives on consent

Robert Byrick, president of the College of Physicians and Surgeons of Ontario, wrote a letter to CMAJ,1 titled “Consent requirements for pelvic examinations.” In his letter he states that, “express consent of the patient must be obtained (whether the patient is conscious during the examination). The policy also clearly states that if, for any reason, express consent cannot be obtained, the examination cannot be performed.” I have 2 questions for Dr. Byrick based on the following scenario: a 23-year-old female patient presents in an emergency department with acute lower abdominal pain, is in shock and unconscious and unable to give consent for a pelvic exam. Is your policy flexible enough to permit a pelvic exam under these circumstances? And if the patient died while the doctor was diligently searching for the next of kin to give consent for the pelvic exam, could the family sue the doctor, and the College of Physicians and Surgeons of Ontario for negligence for exercising “the authority to hold physicians accountable” for a poorly worded or inflexible policy?