It was a pleasure to be invited to speak in Adelaide last week at the RANZCOG SA-NT Case-based Discussion Dinner. The dinner was an opportunity to meet with colleagues and discuss some of the important ethical issues that gynaecologists face in practice.
We had the opportunity to discuss with Avant at the meet about the recent Victorian Supreme Court case of Gawthrop v Bendigo Health [2026] VSC 157. It involved a pregnant patient that presented to a maternity unit with contractions requesting pain relief and that the midwife be called. She was told that neither could be done without first assessing her with a vaginal examination. She did not want a vaginal examination unless it was medically necessary (as was her birth plan). She was told that it was hospital procedure. She eventually consented to the examination, but later (after the baby was born) claimed that her consent to that first vaginal examination was not valid because it was not given freely. She succeeded in her argument that the examination was trespass.
This case has prompted some really important reflections about how we practice in O&G and maternity care. Everyone should be able to make decisions about their body, their health, and their lives. While there are always constraints on complete freedom to make any choice, especially in a resource-limited public health care system, the exercise of personal agency to the fullest extent possible is something care providers should prioritise. There are certainly compelling reasons for considering and preserving the health care system and we should follow our hospital policies and guidelines. When those external factors fundamentally clash with our obligation to the individual patient, I argue that the obligation to the patient should take precedence.
Our discussion then moved to making clinical decisions that involve new technologies, treatments, or techniques. This was the focus of my PhD and is a topic that I have had the opportunity to speak about on several occasions now. The balance between advancing gynaecological practice through new solutions that improve care and the obligation to provide care that is safe and effective always opens a rich conversation. It is not mere balance that ensures that there is responsible innovation in clinical practice. We require more robust clinical reasoning practices to justify those decisions, and we must ensure that decision-making is shared with patients as fully as possible.
