Lack Of Informed Consent For Circumcision Procedure

Deputy Health and Disability Commissioner Dr Vanessa
Caldwell has found that a GP breached the Code of Health and
Disability Services Consumers’ Rights (the Code) for his
care of a teenager who underwent a circumcision procedure
for cultural reasons.

The teenager attended a medical
centre for the procedure. The teenager’s mother told HDC
that the GP examined the surgical site after the procedure
in the presence of whānau without any explanation or asking
for consent. In addition, the mother alleged that on several
occasions during the consultations the GP did not act in a
respectful and culturally sensitive way.

Dr Caldwell
found the GP breached Right 6, which gives consumers the
right to information | Whakamōhio, and Right 7, which gives
consumers the right to make a choice and give consent |
Whakaritenga mōu ake. However, she found that there were no
cultural issues because it is not appropriate in any
circumstance to undertake a sensitive examination without
first obtaining the consumer’s informed
consent.

“Given the teenager’s vulnerability as a
young person, the intimate nature of the post operative
examination and the presence of the teenager’s whānau in
the room at the time, I find the GP opening the teenager’s
sarong without consent unacceptable,” Dr Caldwell
said.

“In my view, although the teenager had consented
to undergo circumcision, this did not mean the GP could
continue further physical examinations without explicitly
gaining consent for each follow up examination.”

“The
teenager had the right to be informed about the GP’s
intention to examine his postoperative site, and the reasons
for that examination, and he had the right to give or
withhold his consent and indeed to request this examination
occur more privately.”

“Consenting is an ongoing
process and care must be taken to protect the privacy and
dignity of consumers,” Dr Caldwell said.

Dr Caldwell
made an additional comment about the GP’s advice to the
teenager to lose weight. “I encourage the GP to use
sympathetic and thoughtful language in the future when
advising his patients on sensitive matters including weight
loss,” she said.

Since the events, the GP has made
several changes to his practice, as outlined in the
report.

Dr Caldwell acknowledged these changes and
made several further recommendations, including that the GP
provide a formal written apology to the teenager and his
whānau and that he complete HDC’s online module on
informed consent.

The full report of this case can be
viewed on HDC’s website – see HDC’s ‘ Latest
Decisions‘.

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