In an opinion issued in March, the CCNE advises professionals to move from tacit or presumed consent to explicit and differentiated consent, and thus ask the patient’s permission at each stage of an examination.
“I think I ask 25 times a day, but I don’t even realize it anymore.” It’s been a long time since the question of consent was invited in the office of Dr. Marie Msika-Razon. This Parisian general practitioner did not wait for the National Consultative Ethics Committee (CCNE) examines this notion to change the way it performs medical acts in order to ensure that they respect the patient’s privacy.
“The idea is just to say, ‘Are you okay with going to the gynecological exam?’”, explains the practitioner.
A detail that nevertheless changes quite radically the way of thinking about the medical act, which until now could sometimes give little consideration to the well-being of the patient.
“We were there to treat, and so it was necessarily good what we were doing”, explains to BFMTV Marie Msika-Razon in a self-criticism of her profession.
Newly appointed Prime Minister, Élisabeth Borne had thus, in July 2022, asked the CCNE to comment on how to integrate the notion of consent into the practice of medicine. A request made after the proliferation of testimonies from women who claimed to be victims of gynecological violence, and which resulted in an opinion of the organization published last March on the good behavior to hold.
Consent throughout the exam
In more detail, in March 2023, CCNE issued, in the form of a avis named “Consent and respect for the person in the practice of gynecological examinations or affecting intimacy”, its conclusions on this subject.
After hearing about thirty patients and professionals, the organization believes that it is now preferable to move from tacit or presumed consent to explicit and differentiated consent, in particular for the most intimate examinations.
“It means that we precede the examination with explanations, what it will consist of, why we are doing it, if it is likely to generate pain, discomfort”, details, to BFMTV, Fabrice Gzil , philosopher, member of the National Consultative Ethics Committee (CCNE).
According to him, these checks must continue “at the different stages of the examination.” “We check the person’s agreement on the various acts that are carried out,” he adds.
In this opinion, the CCNE also recalls that on average, a woman has “between 50 and 80 gynecological consultations during her life.” Consultations “asymmetrical by nature”, for which it is necessary “to respect the possible refusal” of this one. It also recommends “the intervention of patients in the training of health professionals.”
On the side of the medical profession, the requests of the National Consultative Ethics Committee are well received. Invited this Tuesday morning on the antenna of BFMTV, doctor Aurel Guedj, emergency doctor at the Ambroise-Paré hospital in Boulogne-Billancourt (AP-HP), recalls that “if for us certain gestures may seem banal, they are not.”
“Throughout our training, we are trained to desacralize the body and we forget the patient’s perception of care,” he recalls, adding that “what matters, and with the new generations arriving, is is increasingly taught, it is not the nature of care, but its perception.”
During this intervention, Aurel Guedj welcomed “an evolution of morals” on this subject and encouraged his colleagues to “take humility.” “When you see the very old doctors, and the culture of the doctor who knows everything, you have learned to question yourself,” he says.
In June 2022, in a column published in the columns of Sunday newspaperhowever, several gynecologists had called to be “beware of the great confusion” and asked for a distinction between “medical examinations and rapes.” With BFMTV.com, several of them had complained of a profession “complicated to practice.”
