I have kind of a thing when it comes to, well, things happening to me when I’m unconscious. In short, I persist in maintaining the petty and outdated belief that even though I am not awake, I still maintain the right to bodily autonomy and think that people shouldn’t be doing things to my body when I'm not awake to consent to them, within reasonable limits.
In other words, if I’ve sagged over in my seat and started drooling on you on a plane, feel free to push me back into my own little zone (and oh my stars, I am so sorry, please let me pay for your dry cleaning). If I appear to have stopped breathing, I encourage you to initiate CPR.
Or if something demands my attention (the building we are in is on fire, someone is loudly calling my name, there’s an earthquake), gently shaking me is a-okay. I might be a little startled, but in the long run, I’ll appreciate it.
Things I am definitely not okay with, unless prior consent has been specifically negotiated? Pretty anything happening near my private parts, people undressing me, and people doing essentially anything to my body that they doubt I’d approve of if I was awake. In other words, yeah, I have a big problem with raping unconscious people. And I don’t think it’s okay to perform pelvic exams on unconscious patients.
"REAPING THE BENEFITS" OF UNCONSCIOUS WOMEN
Other people seem to think differently, which sends a deep chill down my spine and makes me despair for the state of society. Back in March, a professor at the University of Rochester by the name of Steven Landsburg posed a cutesy little thought experiment on his blog with some public policy dilemmas. Number three attracted considerable attention.
Let’s suppose that you, or I, or someone we love, or someone we care about from afar, is raped while unconscious in a way that causes no direct physical harm — no injury, no pregnancy, no disease transmission. (Note: The Steubenville rape victim, according to all the accounts I’ve read, was not even aware that she’d been sexually assaulted until she learned about it from the Internet some days later.) Despite the lack of physical damage, we are shocked, appalled and horrified at the thought of being treated in this way, and suffer deep trauma as a result. Ought the law discourage such acts of rape? Should they be illegal?
His thoughts on the matter?
As long as I’m safely unconsious [sic] and therefore shielded from the costs of an assault, why shouldn’t the rest of the world (or more specifically my attackers) be allowed to reap the benefits? (ed. note: emphasis mine.)
So you know, have at it, folks! If you see someone unconscious and you can rape them without causing direct physical harm and that person will never find out, the world’s your oyster!
Mr. Landsburg seemed surprised that a number of people objected to his post, to the point of petitions to the college for a firing. In an editorial note added after the fact at the top of his post, he said: “Some readers missed the point of this post very badly.” You silly readers!
Keep in mind that this is a professor who adores Rush Limbaugh, and during the Sandra Fluke controversy, he said that her position “deserves only to be ridiculed, mocked, and jeered.” So you know, not exactly starting from a woman or feminist-friendly place to begin with, but his “apology” was truly amazing. It was a long, rambling, sneering post essentially saying that anyone who was troubled by his “hypotheticals” obviously just had too small a brain to grasp the issue.
Hrm, maybe he should have chosen a less-charged social issue for his hypothetical? Because the fact is that for many people, especially women, particularly marginalized women like women of color and trans women, these questions are not “hypothetical.” They’re actually very real and very scary. Some of his very readers and students might have been personally affected by this “hypothetical.”
Landsburg got upset when he was playing games with people’s lives and they fought back. He made an appeal to emotion, suggesting that those lowly people clearly couldn’t respond in a “rational” way and they ruined the fun for everyone else, when the larger question should be why these things are being subjected to a debate in a forum like this, one clearly hostile to questions of bodily autonomy.
Questions like this obviously come up in ethics classes, and there are good arguments for discussing them, not least because some attendees of ethics classes have undoubtedly considered sexually assaulting unconscious people and should learn that’s not okay. But these conversations need to be conducted with care, and not on the premise that people who have personal experience don’t have valuable insights into the matter.
YE OLDE SLEEPY MORNING SEX CONUNDRUM
I also see a related conversation coming up around the context of initiating sexual activity on an unconscious partner; if you’re in a relationship with someone, is it OK to initiate sex when your partner’s asleep?
The reactions to this question are often hugely interesting to me, and say a lot about issues with consent and autonomy in our culture. Often the answers seem to revolve around the idea that being in a sexual relationship with someone entitles you to access to sex at all times, like the bar is always open and your favorite beer is constantly on tap.
Is it OK to have sex with your unconscious partner? I’d argue it’s not, unless you’ve negotiated that beforehand. It’s also kind of creepy and weird -- like, isn’t the whole point of sex the connection and enthusiastic cooperation between both partners? What is fun about having sex with someone who isn’t responsive?
What about some canoodling to wake a partner up and gauge interest? Well, I know I’d be annoyed as a stack of hornets if someone started canoodling my ass when I wasn’t awake, because I need my beauty sleep, but hey, other people are into that, and again, if that’s something they’d negotiated (and the canoodler respect’s the canoodlee’s right to say “bugger off, I’m going back to bed), well, more power to them.
But why do so many conversations about this complex, and sometimes fraught, issue seem to start on the assumption that everyone in a relationship is down for sex all the time?
ETHICS ON THE OR TABLE
This issue came up for me again yesterday when we ran Tasneem’s piece on unconscious pelvic exams, a practice that can and does occur at teaching hospitals. Many commenters were horrified by the practice, expressing shock and surprise that this happens and reasonably asking what can be done about it. melodyjoy90, however, commented that:
I'm sorry this is traumatizing, but from a medical/health profession student standpoint this is an ethical question that has been taught and answered in various health issues courses. We still argue it, and institutions still argue it, but for the most part there hasn't been an argument that overpowers the "they signed a general consent form" pro-argument.
Now, I don’t want to be putting words into anyone’s mouth here, but I’m troubled by the wording in this paragraph, which seems essentially to imply that this is common practice, and people should deal with it. Various commenters immediately responded; people with legal experience pointed out that no, this argument stank, and rionator said:
My own legal education and also I sent this article to my ex (in med school) with a giant WHAT THE FUCK and he said they talk about it in their ethics classes but it is indeed a very real thing. Then he added that they only do it on older, less conventionally attractive women because they don't want sexual battery suits from young pretty ones. That's not taught in the ethics class, but that's how it plays out in practice. You should've seen my face.
Gee, it sounds a lot like many people are aware that this supposedly standard and ethically okay practice is in fact a potential legal quagmire. If it’s totally okay to perform pelvics on unconscious patients, and the goal is to expose medical trainees to a diversity of anatomy and physiology, surely any unconscious patient should be an appropriate “teaching tool,” right? Interesting that there are concerns about “sexual battery suits” if everyone thinks this practice isn’t a problem.
(And don't even get me started on the idea that old ugly ladies aren't considered potential sources of suits, or are considered low-risk if they file suits.)
Now, here’s the thing. I go to a lot of teaching hospitals for medical care, and there are often medical trainees at my rural health center as well. As a conscious patient, I always consent to allowing trainees to observe and participate, and I encourage them to ask questions. I like the opportunity provided to offer experience to people learning medicine, and my experiences have been universally positive (I know this isn’t the same for everyone).
I’m always provided with the opportunity to consent and to draw the line. Am I okay with a student nurse sitting in on a pelvic? I am? Okay, does the nurse’s gender matter? No? Okay, am I okay with the student nurse touching some part of my body or participating in the exam? Yes? Okay, would I be comfortable with the student nurse performing the entire exam while under observation? Etc. I’ve always felt empowered as a patient to make the choices I’m comfortable with and I’ve never been discriminated against or denied care as a consequence.
Again, I know this isn’t the same for everyone.
I’ve also consented to the presence of medical trainees in the OR or in other situations when I’m unconscious or sedated, and I have been very, very careful when it comes to drawing the line in those cases. Because, you know what? No, I am not comfortable with someone performing an unnecessary pelvic exam on me while I am unconscious, just as I would object if I came to the clinic with a skin infection and someone casually asked if a medical student could pop in and do a pelvic.
If I’m in for a gynecological procedure, well, you’re in there, have at it. I don’t really care who places the catheter or does the pre-surgical exam, since I've already consented to the presence of medical trainees in the OR and as participants in the procedure. It’s a medically necessary part of the surgery, and my surgeon’s explained the surgery step by step to me so I know beforehand that it’s going to happen.
But my unconscious body is not a teaching tool. I’d be pissed to wake up from a procedure to find that someone had used some part of me as an anatomical lesson, because I am not a mannequin. I’m a human being. And I have the right to refuse or accept medical procedures and to determine who participates in my care -- especially when using me as a teaching tool might put me at risk.
For example, as someone with variant BRCA1 and 2, I know that I’m going to be getting more mammograms than usual over the course of my lifetime. Which means that I need to balance the frequency of radiation exposure (a cancer risk) with my desire to catch malignant growths early. Would I be angry to learn that I’d been used as a mammography teaching tool while I was unconscious, an example brought up by Carolyn? Hell yes, especially since I’d be more than happy to let someone use my actual mammogram as a learning experience while I’m conscious.
For that matter, there are people who actually actively provide these services to medical people in training. Those who handle gynecological exams and related clinical work, for instance, are known as pelvic educators, and they do an amazing and important job by volunteering to come into teaching facilities as model patients so people can practice exams and learn how to interact with patients.
Their work gives medical practitioners a chance to get comfortable with exam room conduct, patients, and the details of the anatomy involved: and guess what, working with a conscious patient helps you develop a more effective exam technique and better patient rapport because you’re getting continuous patient feedback.
The very idea that people somehow lose some of their autonomy or the right to live their lives undisturbed by surprise!pelvics, sexual assault, and other unsavory things when they’re unconscious is really troubling to me. And I’m terribly frightened by the frequent defense of “well, if people never know, it won’t hurt them.”
This strikes me as a terribly wrong way of looking at things. There are plenty of things I don’t know about that are undoubtedly hurting me right now. Being treated like an object while unconscious would definitely be one of them, no matter how many ethics classes deemed it okay -- because the dehumanisation of unconscious people is part of a larger culture that also dehumanises conscious people.