Response to the Case Study of Paul’s Dilemma

In the spring issue of this journal, there appeared several insightful commentaries on “Paul’s Dilemma” — a case addressing ethical issues pertaining to medical student training. In brief, the case unfolds as follows: Paul is a third-year medical student in a major teaching hospital doing a clerkship in OB/GYN. Learning to do an adequate pelvic examination that produces minimal discomfort to patients is an essential educational objective of the clerkship. One morning, after accompanying Mrs. Brown to surgery, Paul scrubs and prepares to assist in the surgical procedure, a D&C. After Mrs. Brown is anesthetized, the attending physician tells the junior resident and three medical students to do a pelvic examination on the patient to sharpen their clinical skills. He says that this practice will serve a basic educational need while resulting in no discomfort to Mrs. Brown and causing no harm. However, while standing in line, Paul worries, among other things, about the principle of respect for persons, patient autonomy, and the principle of reciprocity, and considers refusing to do the practice pelvic examination.