Ethics of Physical Examination for Women

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The principle of autonomy, or respect for each individual person, may form the underlying basis for resolving many ethical questions and will determine appropriate attitudes toward confidentiality, privacy, right to information, and the ultimate primacy of the patient in making treatment decisions. Since caring for women necessarily involves information regarding sensitive and intimate relationships and activities, as well as access to a woman’s thoughts, feelings, and emotions, full disclosure of such information by the patient places a burden of trust on the health care provider to protect the rights and privacy of each patient. The relationship established at an initial gynecologic visit between a young adolescent and the physician may potentially extend throughout her adult life and include such major life events as education about reproductive health, assistance in family planning and childbearing, and preservation of physical fitness and well-being through the postmenopausal years. To successfully establish such an enduring clinical relationship requires a sensitivity to the changing goals and needs of the individual patient. Offering care to some patients or providing some types of services may not be comfortable for all practitioners. For example, establishing a rapport with an adolescent seeking birth control or providing health care for a lesbian woman may require a nonjudgmental approach when one is interviewing the patient and a balanced consideration of lifestyle options. The recognition of these special needs has led to a compartmentalization of health care in some regions, so that specialty practices or clinics directed toward adolescent health care, family planning, fertility, oncology, and menopausal care are frequently available. These resources can best be utilized by referral, with guidance provided by a primary provider, so that appropriate use of such resources can be an integral part of the general health care of each woman.