I previously discussed the Federation of State Medical Boards here and here. Its policy on sexual misconduct targets physicians, but its ethical standards would (or should) apply to all medical workers. The nursing community does have its own sexual misconduct guidelines outlined by the National Council of State Boards of Nursing. And it actually mentions that its definitions are “designed for all health care providers.” So let’s look at some of them and compare them to those espoused by the FSMB.
First, the NCSBN states that sexual misconduct involves:
Engaging in conduct with a patient that is sexual or may reasonably be
interpreted by the patient as sexual; any verbal behavior that is seductive
or sexually demeaning to a patient; or engaging in sexual exploitation of
a patient or former patient
And also:
A specific type of professional misconduct which involves the use of
power, influence and/or special knowledge that is inherent in one’s
profession in order to obtain sexual gratification from the people that
a particular profession is intended to serve. Any and all sexual, sexually
demeaning, or seductive behaviors, both physical and verbal, between a
service provider (i.e., a nurse) and an individual who seeks or receives the
service of that provider (i.e., client), is unethical and constitutes sexual
misconduct.
This is similar to the FSMB that states that:
More severe forms of misconduct include sexually inappropriate or improper gestures or language that are seductive, sexually suggestive, disrespectful of patient privacy, or sexually demeaning to a patient. These may not necessarily involve physical contact, but can have the effect of embarrassing, shaming, humiliating or demeaning the patient. Instances of such sexual impropriety can take place in person, online, by mail, by phone, and through texting.
Like the NCSBN, the FSMB also mentions that sexual misconduct may be behavior that “a patient or surrogate may reasonably construe as sexual.”
As I learned, you as a patient don’t actually get to reasonably construe or interpret their behavior as sexual, demeaning, embarrassing, shaming, or humiliating. They and their cadre tell you that it’s not and you’re unreasonable if you do, simply because the intimate contact occurred in a medical setting.
One glaring difference between the two policies is that the NCSBN notes that misconduct “involves the use of power….in order to obtain sexual gratification” whereas the FSMB states that “Sexual misconduct often occurs for reasons related to power, rather than because of a sexual attraction.” The latter is more commonly accepted. Sexual gratification is not necessarily a motivating factor in sexual misconduct behavior. It can be. But it doesn’t have to. In my case, the doctor and her staff abused their position of power when they decided that intimate access should not be important to me and that they didn’t need to get my consent for removing my underwear and clipping my pubic hair for a non-intimate procedure. They made decisions for me that they should not have regarding sexual areas of my body. That is sexual abuse. There is no moral difference between what was done to me within hospital walls versus in a private residence.
With regards to “common practice,” the NCSBN further states that sexual misconduct involves
Touching of the breasts, genitals, anus or any sexualized body part, except as consistent with accepted community standards of practice for examination, diagnosis and treatment within the health care practitioner’s scope of practice
The sexulized areas of my body were not being examined, involved in diagnosis, or treatment. And there’s that whole “standards of practice” nonsense that they use as their get-out-of-jail-free card. Just because it’s within the standard of care doesn’t mean it’s ethical. It just means that countless patients have been intimately violated in the name of the “standard of care.” We patients don’t even know what that is until they cross a line and throw that out there as a lazy and inadequate excuse for not getting expressed consent for the intimate prep they subject you to. It’s like the whole “just following orders” excuse. It’s indefensible. Do the right thing.
Another example of sexual misconduct according to the NCSBN is “Examination of, or touching genitals without using gloves.” The FSMB also has a policy regarding gloves. I discussed this topic here. Gloves don’t make contact less sexual or offensive. Do you think that a rapist doesn’t defile a woman if he wears a condom?
Another part of the NCSBN sexual misconduct policy includes:
Not allowing a patient or client privacy to dress or undress, except as may be necessary in emergencies or custodial situation.
The FSMB also mentions this in an earlier version of their policy:
neglecting to employ disrobing or draping practices respecting the patient’s privacy, or deliberately watching a patient dress or undress
So it’s unacceptable to watch someone undress, but it’s okay to cut off that same patient’s underwear a few minutes later and expose his or her genitals in the presence of a number of other people in the OR without that patient’s knowledge or expressed consent. No, it’s not. What happened to me is not okay. It’s absurd to protect a patient’s privacy when they are conscious and then it’s anything goes when that same patient is incapacitated. It’s deceptive, shady, and sexual abuse. Let’s call it what it is
Along those lines, the NCSBN mentions that someone is guilty of sexual misconduct by
Removing a patient’s or client’s clothing, gown or draping without consent,
emergent medical necessity or being in a custodial setting
There it is in black and white. And no, anesthetized patients are not in a custodial setting. That is a whole different situation. And no, my underwear wasn’t removed due to a sudden medical necessity. A resident waited for me to go to sleep and then cut off my underwear to prep my groin for a reason that wasn’t emergent. It was to prepare for a contingency that was highly unlikely to occur. So this policy says that if anybody removes a patient’s underwear or gown without consent barring an emergency, they are guilty of sexual misconduct. And rightfully so. Of course, the medical community and their cadre will just say that underwear and gown removal are necessary for a procedure involving a leg or any other body part completely unhindered by the garments. That’s not what the policy says. The policy focuses on consent as it should. There is absolutely no reasonable (since they like to use that word) excuse why they can’t explain to patients the need for – and to obtain expressed consent for – underwear and/or gown removal before they sign the consent form. Again, why does a patient’s state of consciousness dictate how he or she is treated with regards to his or her bodily privacy and dignity? It shouldn’t. If anything, the standards should be much higher, and the policies more strict, the more vulnerable a patient is.
I’ve pointed out just how the doctor and her staff violated a number of policies from the university and medical organizations, in addition to laws. So you can now add the National Council of State Boards of Nursing’s policy to that list. But just like with all of the other policies, these directives are just as unenforceable and worthless. They even say that “BONs (boards of nursing) can select the guidelines that best meet their needs.” So hey, pick out what you want. Ignore the rest.
Or ignore all of it when it actually comes to enforcing any of the policies like in my case.
#MedicalMeToo 