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Extending the ethics of episiotomy to vaginal examination: no place for opt-out consent
  1. Rebecca Brione
  1. Department of Philosophy, King's College London, London, UK
  1. Correspondence to Rebecca Brione, Department of Philosophy, King's College London, London WC2R 2LS, UK; rebecca.brione{at}

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van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation to VE; and third, the significant risk of perpetuating under-recognised harms associated with unwanted or unconsented VE. I argue that opt-out consent cannot be ethically justified for VE. Its use would result in further weakening of consent practices, circumvention of individuals’ autonomy, and greater harm for women and birthing people.

At the outset, it is important to recognise that the authors do not claim that their approach should be applied to VE, merely that their discussion may have relevance to consent for other interventions beyond episiotomy ‘where consent is also frequently lacking, and which are under-researched’, including VE.1 Nonetheless, it is easy to assume that episiotomy and VE are sufficiently similar that their analysis might be transferred wholesale. I disagree. There are similarities: both interventions are performed on ‘the most intimate and socially sensitive body parts’1; …

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  • Contributors RB is the sole author of this commentary.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RB is a PhD student supervised by Elselijn Kingma, one of the authors of the feature article and provided comments on the article when in draft. Professor Kingma has not commented on this commentary piece.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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