title: Pastoral power and gynaecological examinations: a Foucauldian critique of clinician accounts of patient-centred consent.
abstract: Invasive non-sedated clinical procedures such as gynaecological examinations are normalised; however, there is limited research highlighting the relational and technical skills required for clinicians to ensure patients' continued consent. A considerable body of research emphasises that women dislike examinations, leading to their non-compliance or a delayed follow up for gynaecological and sexual health problems. However, medical research focuses on 'problem' women; the role of clinicians receives limited appraisal. This article draws on interviews with sexual health clinicians in New Zealand, from metropolitan and provincial locations. The gynaecological care of women in New Zealand attained international notoriety with the 1988 publication of Judge Cartwright's inquiry into ethical shortcomings in cervical cancer research at the National Women's Hospital. Judge Cartwright's recommendations included patient-centred care in order to ensure informed consent had been received for clinical procedures and research participation. This article's critical analysis is that, although clinicians' language draws on humanistic notions of patient-centredness, Foucault's notion of secularised pastoral power enables a more nuanced appreciation of the ethical work undertaken by clinicians when carrying out speculum examinations. The analysis highlights both the web of power relations present during examination practices and the strategies clinicians use to negotiate women's continued consent; which is significant because consent is usually conceptualised as an event, rather than an unfolding, unstable process.
authors: School of Nursing, Massey University, New Zealand.
authors: Catherine
authors: C
authors: Cook
authors: School of Communication, Journalism and Marketing, Massey University, New Zealand.
authors: Margaret
authors: M
authors: Brunton
mesh_terms: D000328:Adult; D005260:Female; D058869:Gynecological Examination / Q000523:psychology*; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007407:Interviews as Topic; D008875:Middle Aged; D008960:Models, Psychological; D009520:New Zealand; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D016387:Women's Health
keywords: Foucault; feminist; gynaecological examinations; pastoral power; patient-centred