Monday, November 29, 2010
Lars G Petersson is a Swedish born human rights activist and author of many books. His book, Medical Rape, State Authorized German Perversion, can be obtained here.
'She has got nothing on but a pair of knickers. The same goes for the other few young women in the waiting room. They are all so lightly dressed - and they all seem uncomfortable with the situation. Constantly men with files are running back and forth, and some of them can’t help having a quick glance at the young ladies while passing.
After a long waiting at last it is Ursula Müller's turn. A man in a white coat stands in the door and calls her name. For the young woman it’s indeed quite stressful to walk across the room in such an almost naked state. However, she's got no choice: after all, the examination for which she has come is a legal duty, and if she hadn't turned up she could not only have been punished but, worse, police would have 'escorted' her to another 'appointment'. Would the young woman have tried to avoid even that, she could very well have ended up in prison. Not a nice prospect really. No, going to jail Ursula wouldn't fancy. After all, she hasn't done anything bad. In fact she has done nothing at all. She has only grown into an adult or at least almost so - that's all. Seventeen she is, and in another few months she will be eighteen.
As the young woman then finally enters the examination room she finds herself in the company of two men: one whom she believes is a doctor and another she reckons must be his assistant. However, it's all a guess; none of them has introduced themselves.
Now something will happen that Ursula never will forget: her body will be thoroughly inspected and assessed - that's why she was 'asked' to come. Nothing will go undetected: head to toe it will be - mouth, teeth, breasts... just everything. In the middle of it all, half naked as she is, she will be asked to do twenty squats - with blood pressure before and after. Bit strange really - as if her blood pressure, due to the forced condition, hasn't gone through the roof already, regardless of being 'asked' to do squats or run a marathon.
After the young woman had been through all the initial procedure something comes that she has feared all along, actually for years. The last protection of her privacy will be removed. 'Take off your knickers, please!' Ursula's cheeks turn red and hot; she stands there helpless, doesn’t know what to do. No, she doesn't want to do that. 'I don’t want to be stark naked in front of two men,' she thinks to herself. It's too embarrassing a prospect. 'No, don't do it!' a subconscious voice screams at her.
Ursula is gripped by a terrible anxiety as she notices the young man behind the desk looking in her direction with a slight smile on his face. In the same moment the now impatient doctor repeats his order. With sharpness in his voice he commands: 'KNICKERS OFF!' The young girl at this point obviously see no option but to do as she is told. The little resistance she might have had is gone; she is defenceless. Now she is completely naked; she stands in the middle of the room, totally exposed; she feels the last slight protection of her human dignity has disappeared. She wishes she could sink through the floor; she feels so embarrassed and humiliated.
Ursula's most intimate parts of the body are now to be zealously scrutinised und inspected. The doctor starts to check her genitals, and he is doing it with great thoroughness. After all, it must be tested as to its functionality, or so it seems. He repeats his movements not just once but twice. In this moment Ursula's most private parts sort of belong to another person, something she would never have allowed had she had had a choice. Then another order is heard: 'turn around, bend forward and spread the buttocks!' Automatically, now without resistance, the girl does as she is told. Her bum is now being thoroughly inspected with a little torch. She is, however, lucky: a finger in her anus she is spared (other 'patients' have to experience that to).
Ursula has had more luck this day as she has only been inspected by one doctor not two, which often can be the case. Sometimes also two assistants can be present, as new staff from time to time have to be trained for the job. Indeed, it can be quite crowded around the 'object'.
Finally Ursula is allowed to put back on her knickers and leave the room. As she returns to the waiting area the other girls out there note that her face is like a tomato. Rest assured, they will soon, one after another, have the same experience.'
Of course, this story never happened as it was here told. After all, that's not a way to treat young women. Completely out of order it would have been - impossible, simply perverse. Most people would share that view. Some might even ask: what fucking pervert has written such nonsense?
Yes, what do I actually want to tell with such a story? In fact this: that a story like the one about Ursula not exclusively is to be found in the sick fantasy world of a sadomasochistic old bugger - actually it has all a very real background. To make the story true we only need to swap the genders of all people involved. Having done so, it all turns into reality. Then we can also give it a name: a 'military medical induction' or, in German, 'musterung'. We now talk about a legally enforced medical where young men, mainly by women, as cattle on a market place, are examined, inspected and assessed for forced military or civilian service.
At least one thousand times this scenario has been repeated all across Germany every day for the last one hundred and fifty years. The number of similar examinations and controls has, however, been much higher, as not only have young men been selected this way or discarded as possible candidates for forced service, a process which can mean repeated requests to make one self available for scrutiny, but in all barracks and by all civilian authorities responsible for 'employing' conscientious objectors all of it in every detail have been repeated not only when starting but also when leaving service - and sometimes even in between. On top of that comes and will continue to come thousands of identical checks of young men who, for one reason or another, totally voluntarily or due to civilian unemployment, have chosen the military as a temporary or permanent employer. Also these individuals (contrary to their female colleagues...) are constantly exposed to the same kind of intrusive 'examinations'.
Of course, testicles and backsides of young people can hardly have anything to do with defence of a country. Even for the defence authorities themselves that seems to make sense, as, certainly, nothing in this area would serve as a reason for anybody to be excluded from forced service or for that sake not to be accepted as a volunteer. Despite that, however, eager officials continue to order these parts of the body to be checked as to their optimal function - as said not only repeatedly before but also after ending the service. After all, the foreskin might have got stuck since the last examination.... Better make sure it hasn't.
No matter what, how odd it all might seem, all what we talk about here is in Germany fully legitimate and established. All right, economic woes due to the recession (not calls for human rights) will soon end conscription. But, on a smaller scale the abuse will continue as usual – now with ‘volunteers’ as sole victims. Again and again the call will sound: strip! Again and again the state and its willing helpers will reach out after young men's testicles and foreskins, and again and again they will be commanded to turn around, bend forward and spread their buttocks. And (isn't it remarkable?), all of a sudden nobody seems to see a problem in it any longer. Nobody will see it as an assault - as they certainly would, had 'Ursula' really been the victim. No, 'so are the rules, and that has to be tolerated.’
All right, this particular story was about Germany, but, unfortunately, that country has no monopoly on degrading military medicals: for hundreds of years, all around the world, willing doctors have ‘forgotten’ the oaths they once swore, joined the armed forces and allowed themselves to be used to humiliate and abuse their ‘patients’ – all of it with only one purpose: to create obedient, subservient soldiers.
Mental anguish due to such humiliation is widespread. After having researched the subject in Germany, I would state it's pandemic (though very well hidden away). And, why should it not be the same elsewhere? After all, many Americans will remember the days of the Vietnam War draft offices, and most Russian men will be painfully aware of their own armed forces’ outstanding abilities in the field of degrading strip examinations. For them it can hardly be a surprise that (according to official statistic) 231 recruits committed suicide in 2008 alone. There will be other reasons behind that shocking number - mainly bullying and extremely harsh conditions - but I am certain that perverted medical 'examinations' played a big part in why many of those young men tragically chose to end their own lives.
Due to all this, in the name of millions of defenceless victims and victims to be, no matter if conscripts or volunteers, the civilised world must demand that at least health professionals refuse to further participate in ruining young people’s lives. We must demand they stop performing abusive and degrading medical ‘examinations’ which pure objective is to remove the last remnant of dignity from vulnerable recruits. Also, we must openly recognise and acknowledge the harm this kind of universal abusive treatment through the years has done to millions of men’s mental well-being and sexual development. We must place the shame where it belongs – on the perpetrators, not on the victims. More than anything else, state authorised sadomasochistic abuse must stop no matter where it takes place. We can all help make that happen. A few words from you to responsible authorities could be a good start in that process. After all, that was how Amnesty International once started - a call in favour of the forgotten political prisoners and a call against torture and degrading treatment of people in captivity.
This is a call for help for all those forgotten and humiliated soldiers whose lives have been ruined not just by futile wars but also by perverted medical 'examinations' in the name of oppressive military establishments. On my website www.larsgpetersson.com (Military Abuse) you will find all addresses. Write a line or two, copy, paste and press 'send'. Future generations will be grateful for your help.
Lars G Petersson
Posted by Joel Sherman MD at 11:34 AM
Sunday, November 21, 2010
The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines. Most did more screenings than indicated, the worst record of the specialties tested. But the ACOG still recommends that nearly all women obtain regular screening at intervals of 1-3 years.
The facts are that cervical cancer is a rare disease in the US, a point which is never made. The American Cancer Society (ACS) predicts that there will be just over 11,000 cases in 2009. There will be nearly as many cases of testicular cancer, 8,400. In comparison both breast and prostate cancer are just under 200,000. Most women have been led to believe that cervical cancer is rampant and they need yearly screening to prevent it. Testicular cancer however, is rarely mentioned. Most physicians don’t even bother to recommend that young men self-examine.
Cervical cancer was once more common in this country and that accounts for some of the disparity. Pap screening has helped reduce the incidence, but far more is now known about the disease than when the Pap smear was introduced. Cervical cancer is in essence a sexually transmitted disease (STD) caused by the human papillomavirus (HPV). Thus any woman can estimate her personal risk. It’s high if a woman has had multiple sexual partners. With prior negative Paps it’s low if she abstains or if she is in a long term mutually monogamous relationship. The newer HPV DNA test will further increase safety.
For comparison’s sake, HIV (AIDS) is an even more dangerous STD with a five times greater incidence than cervical cancer. Yet no one ever suggests that everyone be tested for HIV, and there are laws in many states restricting testing. Testing is suggested only for those at risk, but this tactic is never used for cervical cancer.
I have seen a spontaneous outpouring of sentiment from women who are angry that the facts on cervical cancer have been hidden from them. They are pushed into getting Paps, but never told the pros and cons of screening. Never mentioned are the high incidence of abnormalities that resolve spontaneously, negative biopsies and colposcopies. It’s an uncommon doctor who even advises that every 2-3 year screening is considered appropriate in low risk women. My wife has had about 45 negative annual Paps and still her doctors haven’t said she can skip any. There are many recent recommendations suggesting that men be carefully told the options concerning prostate screening. We are just beginning to see that for breast cancer screening. But for cervical cancer screening there has been near silence on the issue.
Informed consent on cervical cancer screening is completely lacking in this country. Women are told that they need Pap tests, but rarely told if they might not need them or asked if they want them. The ratio of negative biopsies and colposcopies to cases of cervical cancer is very high given the rarity of cervical cancer. If women are given brochures, they are for the sole purpose of convincing them to get regular testing.
The negative aspects of mass cervical screening are never mentioned. Women should be given the facts and allowed to decide for themselves based on their individual risk benefit ratio whether or not they need regular cervical cancer screenings. The ACS and the ACOG could do a real service by providing pamphlets to providers’ offices that fully explain both the pros and cons of testing. Then let each individual woman decide for herself.
Links and extensive discussion of this topic can be found here.
Posted by Joel Sherman MD at 10:59 AM
Friday, November 12, 2010
CORE VALUES AND PATIENT RIGHTS & RESPONSIBILITIES
WHAT THEY “SAY” ABOUT PATIENT MODESTY
by Doug Capra (c) 2010
When you enter a hospital, do you have the right to expect same gender care for intimate needs if that‘s your desire? Note that I’m not wondering whether you have the right to request this, or whether the hospital has the obligation to attempt to grant your request. Of course you do and of course they should.
But first -- I want make it clear that I’m limiting this discussion to non emergency, non life-threatening situations. I’m not suggesting that modesty has no place in these other areas -- but I think their specific contexts need a separate discussion. For now, though, read this article to see how patient modesty can be handled in emergency situations. So often, when I’ve debated the modesty and gender preference issue with medical professionals, they quickly move the discussion to the ER or other extreme situations. I’ve gotten used to this diversion and bring them right back to the main issue. Let’s talk about basic exams that happen thousands of times every day in clinics and hospitals -- procedures and tests of the more intimate variety.
The question I pose is -- do hospitals have an ethical and legal obligation to accommodate you? Since I’m not a lawyer, I won’t go into the legal interpretations here -- but I will attempt to parse and deconstruct an example of a core value statement and another example of a patient bill of rights to see what the hospitals are implying about modesty and gender preference. My contention is that, although the word “modesty” is rarely used, the concept is present.
When you go to a hospital, you should be given these documents. I wonder how many patients actually read them. You should. In fact, although I won’t be delving into the “Your Responsibilities” part of the patients’ rights document, I don’t want to underestimate the importance of that section. It represents the other side of the same coin.
If you do a google search online using terms like “hospital or core values,” you’ll get many hits. These can vary considerably, but most seem to contain basic elements. As an example, I’ll be using the core values of the Providence Hospital system because I find them to be especially well-written with clear implications regarding patient modesty.
The Providence Hospital system divides their core values into five categories: Respect, Compassion, Justice, Excellence and Stewardship.
The first two are the most relevant to the modesty issue.
RESPECT -- “We welcome the uniqueness and honor the dignity of every person. We communicate openly and we act with integrity.”
Here’s how I read this relative to the modesty issue: Every human being is unique and that uniqueness must be respected by treating the patient with dignity. Since we’re unique, we may each define our dignity in different ways. Some may find it completely dignified to have intimate care done by the opposite gender. Others may find that undignified. The idea of “dignity” doesn’t rest within the mind and behavior of the medical provider. It rests primarily within the patient and their unique value as a human being.
COMPASSION -- “ We nurture the spiritual, physical and emotional well-being of one another and those we serve. We embrace those who are suffering.“
Here’s how I read this relative to the modesty issue: It’s not just about your body, your physical being. Your spiritual and emotional well-being are at least as important to us. Note that two out of three words in the first sentence represent the non physical -- spiritual and emotional. How patients feel (the emotional) about who sees and works with their bodies under especially private situations is embedded within these words. In some cases, one’s spiritual and/or religious beliefs and values are directly connected with the modesty issue. We will respect this. We realize that “suffering” doesn‘t just mean physical pain; it includes spiritual and emotional anguish as well. For some patients, this may involve modesty issues.
Of course, assumed in all this is that providers “know” your individual and unique concept of dignified treatment and your feelings and spiritual values. How will they know? Well -- you’ll either tell them, or they’ll ask. What benefit is there to such lofty core values unless polices are embedded within the health care system to find out individual patient values? The systems answer might be -- Well, it’s up to the patient to tell us, that’s their “responsibility.” There is some truth to that -- and that’s where patients need to speak up.
On the other hand, health care systems that want to insure that their core values filter down into everyday operations, need to create policies that specify how they will practically accomplish these lofty goals. I have been unable to find any specific policy statements from American hospitals (including Providence) that address how they will handle modesty issues and requests for opposite gender care. I have found several policy statements from the UK, Australia and Canada.
Providence does state in its first core value that “We communicate openly and we act with integrity.” That implies to me that they see their leadership role in opening up communication with patients about this issue. True empathy from providers involves leadership in communicating and helping to empower patients.
PATIENT RIGHTS & RESPONSIBILITIES
When you enter a hospital, you should also be given a copy of their Patient Rights and Responsibilities. Read it carefully. The example I’m using is from the Carolinas Medical Center-NorthEast in North Carolina. I find these to be especially well-written with clear implications regarding patient modesty.
Almost all patient rights documents say something about treating patients with dignity and respect -- using those specific words. Those words alone should be enough to cover basic modesty and even patient gender preference for intimate procedures. Unfortunately, that’s not always the case. Here are a few selected patient rights, given their assigned numbers, from Carolinas Medical Center-NorthEast, followed by my comments:
3. “A patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination, and treatment are considered confidential and shall be conducted discreetly.”
Note, “every consideration of his privacy.” That should pretty much cover it. Modesty and gender selection considerations are certainly aspects of any medical care program. “Examination” and “Treatment” would cover some of the issues patients bring up, such as gender of the examiner and those who do bed baths or procedures like foley catheterizations, as well as chaperone and/or observer issues.
Don’t let someone tell you that your choice of one gender over the other for intimate care is discrimination, in the legal sense of the word. Don’t let them compare it to racial discrimination. A racist is someone who negatively stereotypes a whole race and/or thinks that race is inferior to his own. If, as a man, you believe that all women are inferior to men and can’t do the kinds of procedures you need, then, indeed, you are practicing discrimination.
But that’s not what most people believe who request same gender care. Most patients welcome basic care from either gender. It’s only for the most sensitive, intimate care that they prefer a same gender provider. Their assumption isn’t that both genders can’t do the job equally as well. For modesty and privacy reasons, these patients just prefer a specific gender. So -- don’t accept this “discrimination” argument if it’s used.
13. “A patient has the right to medical and nursing services without discrimination based upon race, color, religion, sex, sexual preference, national origin or source of payment.”
Well, there are only two sexes (although there are various sexual preferences -- but let’s not go there for now). If one sex is granted gender preferences for whatever reason, the other sex should also be granted the same right. Pretty basic. Most hospital bills of rights provide this basic right in pretty much the same words. Just because they may not practice it regularly, doesn’t mean they haven’t stated it as foundational to their institution and the work they do. You may have to remind them.
18. “The patient has the right to medical treatment that avoids unnecessary physical and mental discomfort. “
Now, we can debate what constitutes “unnecessary.” But patients do have the right to ask:
“What have you done to ‘avoid” this kind of mental discomfort I feel with opposite gender intimate care?
Do you consider gender preference when you schedule? Have you made hiring efforts to balance out caregiver gender?
Why do you consider it ‘necessary’ for me to deal with this mental discomfort?”
In other words, if you need to debate, use the specific language found in the hospital’s core values and bill of rights. Have a copy handy that you’ve highlighted and annotated.
25. “A patient, and when appropriate, the patient’s representative has a right to have any concerns, complaints and grievances addressed. Sharing concerns, complaints and grievances will not compromise a patient’s care, treatment or services.”
Although this doesn’t address the modesty issue specifically, it does cover concerns some patients have about possible repercussions. I’ve included it because on Dr. Maurice Bernstein’s recent modesty blog, (on Wed., Nov. 10, 2010 at 11:52 a.m.) someone challenged me when I defended female nurses (Yes, I have great respect for nurses of both genders). The blogger called me naïve and stated that if a patient dares to “refuse the same female caregiver twice…she’ll throw a tantrum. This happens with female patients as well. And Heaven forbid you have an argument with them, because you will almost certainly face retaliation.”
I’m not saying this has never happens. It’s possible but, in my opinion, rare. I am saying that here you have a specific statement that protects you specifically from that kind of bullying behavior. If it does happen, don’t tolerate it.
30. “The patient has the right to personal privacy. Privacy includes a right to respect, dignity, and comfort as well as privacy during personal hygiene activities (e.g. toileting, bathing, dressing), during medical nursing treatments.”
Could this be any clearer in regards to your modesty and your desire for the gender of your caregiver for intimate needs? And remember, within reason, you get to define your own definition of “dignity” and “respect” as a patient. If challenged, ask the hospital for their definitions. I’m convinced you’ll find they have no definitions. That doesn’t mean they don’t care about dignity and respect. It does mean that little thought has gone into policy standards that cover patient modesty and gender preference under the umbrella of those overly used and idealistic words -- dignity and respect.
I will admit that I haven’t found this specific wording on any other patient bill of rights from other hospitals. That’s why I picked Carolinas Medical Center-NorthEast as my example. For a hospital to even use this wording suggests to me some thoughtful analysis of the modesty and gender preference issue.
A few closing thoughts.
1. If you have a choice of hospitals, go online and check various mission statements, core values, and bill of rights. They do vary.
2. Find a hospital whose values reflect yours.
3. Print out copies of those documents. Study them and bring copies with you to the hospital.
4. Don’t go looking for a fight. You’ve read the documents. You know the kind of care to expect. Expect it.
5. Finally, consider your responsibilities as a patient. Carolinas Medical Center-NorthEast lists this as a patient’s first responsibility: “Patients, and their families when appropriate, are responsible for providing correct and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to their health.”
If those “other matters” for you include modesty and gender preference, it’s your responsibility to provide that information to caregivers. Their responsibilities, as I see it, are quite clearly delineated in most core value and bill of rights statements. Unfortunately, you can’t depend upon them offering you these kinds of choices -- even though they should. So make sure you communicate your values to them.
Be proactive. Be an empowered patient. Know your rights and responsibilities and the values of the hospitals you choose.
NOTE -- How about readers providing some other specific core values and patient rights statements from other hospitals? Also, how about some examples of experiences you had with these documents.
Posted by Doug Capra at 1:03 AM