Tuesday, November 29, 2011

Class: Physicians and Intimate Care of Patients

I expect to give a class next week on physicians and intimate examinations. I hope to cover the following vignettes, and I'd appreciate feedback on them:

A. Charles, a medical student, wishes to become an OB/GYN, but he knows that halachah severely restricts men from seeing female genitalia or touching the female body. May he train as an OB/GYN, or need he change medical tracks?

B. Sally is a physical therapist, and her job requires her to manipulate the limbs of patients, both male and female, but halachah prohibits physical contact between women and men who are not their husbands and this is not a life-saving treatment. May Sally treat male patients?

C. Jason, a resident doing an OB/GYN rotation, is on rounds when his group enters the room of an unconscious female patient. The physician leading rounds instructs Jason to perform a pelvic exam, but permission has not been requested from the patient. May Jason conduct the exam?

D. Jonathan, a psychologist, conducts therapy sessions for men and women in the privacy of his office. Halachah prohibits men from being secluded with women who are not their wives. How may he treat female patients?

[Regarding case C, I was floored to be shown articles here, here and here. Granted that the stories are not as simple as presented, it still shocks me. Gd bless the litigious American society, in which there would be strong repercussions for that sort of thing.]


  1. The first two links don't work.

  2. Great topic and good scenarios. I would point out that nurses and techs do most of the hands on care of patients in hospital. Introduction of a urinary catheter ('Foley') is a constantly recurring task; along with other hands-on intimate tasks like placing electrodes around the chest for an EKG, stripping and initially examining trauma patients, etc. Don't forget, too, that many of these same tasks and issues arise for EMTs and paramedics outside the hospital. Then of course a subset of all of this is children providing home care for elderly parents.

    I look forward to seeing what you present on this!

  3. Better (imho) question A would be, should he be encouraged to find another specialty given that the permissive examinations may be dchuya, not hutra and may stain his soul?
    Joel (not always the rationalist people think I am) Rich

  4. R' Joel,

    That's in fact what the Noda Bihuda says about being an OBGYN -- not a job for a nice Jewish boy.

    The questioner was a doctor who was going to deliver his wife's sister -- in halachic theory no different than any other married woman, but I could certainly see being weirded out by it. Certain mental images best blocked out every time you get together for shabbos ...

  5. With regards to B--how many PT/nurses do you know?
    but a more important shayla comes up while training(I think). In certain Pt schools, the tests and practicals are done on one's own body. Many places-not behind a curtain. Can a pt in training breach their own standard of tzniut simply for testing and training?
    Your thoughts

  6. Brad, I know and work with RTs who are nurses, and PTs who are nurses. Sure, not the majority; but they're out there. Why would that invalidate the rabbi's scenario for teaching purposes? I suppose for his scenario it could be a PT, and the 'nurse' addition is really necessary.

  7. American legal system turns litigation into a weapon against guilty and innocent alike, erodes individual responsibility enriches its participants at the everyone's expense, and resists even modest efforts at reform and accountability.

    It use to be based on natural law but no longer. Now it is based on judicial positivism which is against Torah and natural law.
    Don't compliment it. also as for your question--sometimes there is a decree from on high that a certain person can be cured only by a certain doctor. If a person feels a desire to be a gynecologist then it should be recommended that he/she pursues it

  8. Brad, R' Mordechai-
    Thanks for catching the "nurse" typo. That was actually a mistake which came from merging two scenarios. Duly edited.

  9. Shalom-
    Do you mean Binyan Tzion 1:75? That was his brother's wife, and the concern was that she is an ervah to him (beyond eishes ish).

  10. Woops Binyan Tzion not Noda Bihuda, sorry. Thanks.

    "Erva -- beyond eishes ish." -- But once it's prohibited as eishes ish, what difference does it make beyond that?

  11. Rabbi,
    Your scenarios, particularly those involving an OB/GYN, seem to be making an assumption that is not warranted, that only an OB/GYN would have occasion to be in contact with "intimate" portions of the female anatomy. The question to be asked is not if a frum man can be an OB/GYN but can he be virtually any kind of doctor or medical practitioner? Internists regularly may need to examine intimate parts of the anatomy, as would General Practitioners, and Orthopedists and Orthopedic surgeons and Gastroenterologists and Proctologists and Dermatologists and a wide variety of heart specialists. Emergency room physicians would also have this kind of contact. Pediatricians would run into this problem as well since many treat patients who are adolescents. PAs, nurse practitioners and nurses would also likely have this type of contact with patients. In short, the question is broader than your scenarios are showing.

  12. ProfK-
    Certainly true; these are vignettes only, and not a reflection of the breadth of application.

  13. Have any comments on the 2nd Question I asked? I have found this shayla to be the one addressed the least in my experience. Brad

  14. It's a good question, Brad; I'm not sure what to do with it. Have you put it to any poskim?

  15. I have--they've been ducking it--tuition is very expensive and not always refundable. If you want a full breakdown on which universities are the worst for this type of thing, message me.Brad