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Author Topic: Doctors and Sterilizations  (Read 550 times)

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Offline CaelaTopic starter

Doctors and Sterilizations
« on: November 29, 2012, 09:22:47 AM »
Right off, I'll admit that this is a bit of mini-rant so if the Mods want to move I totally understand. I just also thought it was a controversial and political topic as well so put it here initially.

We've all discussed the law and the arrogance of politicians thinking they have any business getting between a doctor and their patient and what the patient chooses to do with their own bodies. But what about when it's the doctors getting between you and the medical choices you want to make regarding your own body?

I work at a teaching hospital, in L&D, and this has been percolating inside my head for a few days since some of our residents were all up in arms over doing a post-partum tubal on a woman they felt was too young! I don't recall her exact age but it was somewhere between 18-20 and she already had three children and had been pregnant more than that so they, very grudgingly, said they'd do it (not that they really had a choice, the attending had signed off on it and they didn't do it she simply would have) but only because she'd been pregnant so often.

They then started talking about how a young woman couldn't possibly know what she wanted to do with her body for the rest of her life at such a young age and how, when they were attendings, they wouldn't deign to perform a tubal on someone so young for any reason! The arrogance in that statement boggled my mind.

Now I know that in some places the law would actually prohibit them from doing sterilizations on anyone under a certain or who hadn't had a certain number of children. That isn't the case here. Here, as long as all the paperwork is filled out properly and you can find a doctor to do it, there is nothing to stop a young woman from having control her her reproductive choice.

Nothing but the doctors themselves.

That conversation made me all the more grateful for a doctor who listens and feels it is her JOB to fulfill her patients requests so long as they are reasonable ( ex. being sterilized because you don't want children ) and if they aren't then to explain why and what some other options might be to get the same desired effect.

Anyway, thoughts? Comments?

Offline Torch

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Re: Doctors and Sterilizations
« Reply #1 on: November 29, 2012, 09:36:18 AM »
Purely anecdotal information here, but I know of a number of folks in my social circle (male and female) who've had sterilizations reversed, or I should say, attempted to have them reversed. New marriages, new circumstances, or they just plain changed their minds.

Does this mean I think physicians shouldn't take someone at their word when they say they want to be sterilized? Absolutely not. As long as a patient knows the risks, consequences, and realizes that sterilization is permanent and should never be considered reversable, their wishes should be followed.

I should also say that the number of folks who have chosen sterilization and been happy with their choice (that includes Mr. Torch and I) far outweighs the number who've changed their minds.
« Last Edit: November 29, 2012, 09:39:38 AM by Torch »

Offline CaelaTopic starter

Re: Doctors and Sterilizations
« Reply #2 on: November 29, 2012, 10:20:19 AM »
Purely anecdotal information here, but I know of a number of folks in my social circle (male and female) who've had sterilizations reversed, or I should say, attempted to have them reversed. New marriages, new circumstances, or they just plain changed their minds.

Does this mean I think physicians shouldn't take someone at their word when they say they want to be sterilized? Absolutely not. As long as a patient knows the risks, consequences, and realizes that sterilization is permanent and should never be considered reversable, their wishes should be followed.

I should also say that the number of folks who have chosen sterilization and been happy with their choice (that includes Mr. Torch and I) far outweighs the number who've changed their minds.

Bolded for my own benefit.

This I totally agree with!

Offline DarklingAlice

Re: Doctors and Sterilizations
« Reply #3 on: November 30, 2012, 08:36:56 AM »
It's a sticky issue. Doctors have a responsibility to act towards their patients interests rather than their patients wishes. Now a majority of the time these are in alignment, but occasionally there is a discrepancy. There are some medical choices that it is irresponsible for a patient to make and equally irresponsible for a doctor to honor (a classic example here is the patient who wants antibiotics for a viral disease, or a patient that wants their amateur self-diagnosis respected). That said, I really don't think sterilization is one of those issues.

Our society has an understandable, yet dumb, obsession with an individual's right and ability to reproduce. Taking that ability away, even at the individual's request, is seen as a huge thing. I had to go through a string of doctors before I found someone willing to sterilize a 24 year old with no children. My advice: find an older, single doctor with no kids of their own, he was the only one who seemed to understand when I explained to him. This reproduction fetish not only makes life difficult for those of us who firmly don't want kids and want that medical decision respected, it also contributes to the difficulty in finding adoptive and foster homes (Yet another argument I found useful: "Ummm...if I change my mind in 10 years and want kids there are a ton of pre-manufactured kids available to good homes. I know. I was one.")

Another consideration is that, because of this societal obsession, doctors who do perform sterilizations on younger patients with no kids might face legal repercussion. I am not sure of the exact situation when it is performed in a patient care context, but I do know that when doing medical research if you damage a female volunteer's ability to reproduce (and for some reason this only applies to females) it is treated uniquely so that there is no degree of informed consent, liability waivers, or supposed legal protection you can have in place that prevents them from demanding vast amounts of compensation. Which is actually really really bad for women's health as it means that novel procedures and medications are likely to be tested predominantly to exclusively on males (unless they are specifically gynecological) before receiving wide release. And in that environment I can totally see someone being able to come back at age 30, sue a doctor for "taking advantage of them when they were a naive 20 year old and denying them their right to childbirth", and have the legal system support them even if it were a voluntary procedure.

Offline Torch

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Re: Doctors and Sterilizations
« Reply #4 on: November 30, 2012, 10:54:01 AM »
It's a sticky issue. Doctors have a responsibility to act towards their patients interests rather than their patients wishes. Now a majority of the time these are in alignment, but occasionally there is a discrepancy. There are some medical choices that it is irresponsible for a patient to make and equally irresponsible for a doctor to honor (a classic example here is the patient who wants antibiotics for a viral disease, or a patient that wants their amateur self-diagnosis respected). That said, I really don't think sterilization is one of those issues.

I would agree. I used the word "wishes" in my previous post, because in almost all cases, sterilization is considered elective or not medically necessary, on a par with elective plastic surgery. I'm not well versed enough in physiology to know if there are cases in which sterilization would be medically necessary, though there could be certain circumstances in which this is the case. But it certainly would not be the norm.

Quote
Our society has an understandable, yet dumb, obsession with an individual's right and ability to reproduce.

I wouldn't call it dumb. It's a fundamental right to privacy to control our own bodies, including when, where, how and if we choose to reproduce.

Offline Oniya

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Re: Doctors and Sterilizations
« Reply #5 on: November 30, 2012, 07:56:47 PM »
I wouldn't call it dumb. It's a fundamental right to privacy to control our own bodies, including when, where, how and if we choose to reproduce.

It's a right for the individual to choose whether or not to reproduce.  It is at the very least, an irritating obsession when society tries to get involved in it.

Offline CaelaTopic starter

Re: Doctors and Sterilizations
« Reply #6 on: November 30, 2012, 08:29:34 PM »
I would agree. I used the word "wishes" in my previous post, because in almost all cases, sterilization is considered elective or not medically necessary, on a par with elective plastic surgery. I'm not well versed enough in physiology to know if there are cases in which sterilization would be medically necessary, though there could be certain circumstances in which this is the case. But it certainly would not be the norm.

I wouldn't call it dumb. It's a fundamental right to privacy to control our own bodies, including when, where, how and if we choose to reproduce.

A tubal itself isn't usually medically necessary. However some doctors will recommend them to patients who have had multiple c-sections and whose uterus is no longer healing well enough to withstand the pressures of being pregnant. If they have what is called a "window" (a section of the uterus that has healed so thinly you can actually see the child inside through it) the many physicians will let them know that some form of permanent bc (whether sterilization, or being on the pill or other method indefinitely) is a good idea because another pregnancy, when no longer healing well, would have a vastly higher chance of rupturing; possibly killing both mom and any other baby conceived in the process. Most people have stopped having kids before they get to that point, but there are a few who are there after their first c-section.

It is WAY eerie to be assisting the Doc and be able to look down at an organ we haven't cut into yet, and be able to seethe baby's head, or a hand drifting by in the amniotic fluid!

I don't know that society, as a whole, being concerned with reproduction is dumb - it's a basic human drive generally speaking - but I do think being obsessed with whether someone else is reproducing or not is dumb! People should worry about passing on their own genes and not worry so much about other peoples decision to, or not, do so.

It's a sticky issue. Doctors have a responsibility to act towards their patients interests rather than their patients wishes. Now a majority of the time these are in alignment, but occasionally there is a discrepancy. There are some medical choices that it is irresponsible for a patient to make and equally irresponsible for a doctor to honor (a classic example here is the patient who wants antibiotics for a viral disease, or a patient that wants their amateur self-diagnosis respected). That said, I really don't think sterilization is one of those issues.

Our society has an understandable, yet dumb, obsession with an individual's right and ability to reproduce. Taking that ability away, even at the individual's request, is seen as a huge thing. I had to go through a string of doctors before I found someone willing to sterilize a 24 year old with no children. My advice: find an older, single doctor with no kids of their own, he was the only one who seemed to understand when I explained to him. This reproduction fetish not only makes life difficult for those of us who firmly don't want kids and want that medical decision respected, it also contributes to the difficulty in finding adoptive and foster homes (Yet another argument I found useful: "Ummm...if I change my mind in 10 years and want kids there are a ton of pre-manufactured kids available to good homes. I know. I was one.")

Another consideration is that, because of this societal obsession, doctors who do perform sterilizations on younger patients with no kids might face legal repercussion. I am not sure of the exact situation when it is performed in a patient care context, but I do know that when doing medical research if you damage a female volunteer's ability to reproduce (and for some reason this only applies to females) it is treated uniquely so that there is no degree of informed consent, liability waivers, or supposed legal protection you can have in place that prevents them from demanding vast amounts of compensation. Which is actually really really bad for women's health as it means that novel procedures and medications are likely to be tested predominantly to exclusively on males (unless they are specifically gynecological) before receiving wide release. And in that environment I can totally see someone being able to come back at age 30, sue a doctor for "taking advantage of them when they were a naive 20 year old and denying them their right to childbirth", and have the legal system support them even if it were a voluntary procedure.

It's weird how you find the Docs that will do what you need/want for you. My own GYN is a younger, married woman, with two kids of her own and has no problem with taking her patients at their word when they say they don't want more (or any) children. She makes sure they understand that it's a permanent decision and will ask, repeatedly, before she does it if the patient is sure...but she does it because she views her patients as adults able to make their own decisions about their lives. I think there is an arrogance in a lot of doctors that because they have a certain level of education, they must know more about how to make decisions for peoples lives than the people living them...that irritates me to NO end!

As for being sued, there is a vast difference between making an informed decision about an elective procedure and having something go bad because of an experimental procedure/research. In the one, all the side effects and the fact that a permanent change is being made is totally laid out for you, in the other you are just sort of stuck with what may happen. I don't think you can sue a doctor for performing a tubal when you had to sign off that you were duly informed of the repercussions and risks in it, but can see being able to sue for an unforseen consequence to some experimental treatment.

Offline Trieste

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Re: Doctors and Sterilizations
« Reply #7 on: November 30, 2012, 08:53:43 PM »
This is a subject about which I am heavily biased. I have been attempting, on and off, to have myself sterilized for years. Because I have no children and because I am still young, I have had a bitch of a time finding a doctor who will do it for me. I am very, very bitter about this subject. Very bitter.



I feel like motherhood is so tied to feminine identity in the eyes of many people (including doctors) that it becomes this huge thing. With the advancement of non-invasive sterilization procedures, it essentially becomes like getting a tattoo.

It is permanent (attempts at reversion are costly and have a very spotty effectiveness rate).

A poorly thought out decision will stay with you the rest of your life.

It can affect your employability.

It can affect your health with complications.

... I know a lot of people will object to the comparison between body art and sterilization, and I would like to ask why. Both have potentially far-reaching social and health consequences, but those consequences are far, far, far lesser than the consequences of having an actual child. It is uncommon to hear anyone, even a doctor, say to a pregnant woman, "Are you really sure this is the right decision for you?" Instead, news of pregnancy is met with congratulations and general celebration. I question why it is common practice to make such a commotion out of the choice not to have children, when it is common practice not to do so regarding the choice to have children.

If it's not a doctor's place to say "Are you sure?" about pregnancy - and a lot of doctors seem to think it's not their place - then it more than certainly is not their place to ask the same question about the comparatively harmless decision to undergo permanent sterilization.

Offline CaelaTopic starter

Re: Doctors and Sterilizations
« Reply #8 on: November 30, 2012, 09:02:35 PM »
This is a subject about which I am heavily biased. I have been attempting, on and off, to have myself sterilized for years. Because I have no children and because I am still young, I have had a bitch of a time finding a doctor who will do it for me. I am very, very bitter about this subject. Very bitter.



I'm sorry you've had such a hard time Trieste. If you were at all in my area I'd know a doc to send you too, but there are too damned many that think they have a right...hell even an obligation...to question the choices of patients asking for something that is perfectly reasonable.

Offline Oniya

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Re: Doctors and Sterilizations
« Reply #9 on: November 30, 2012, 09:04:47 PM »
How can it affect your employability if you choose to be infertile?

Offline Trieste

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Re: Doctors and Sterilizations
« Reply #10 on: November 30, 2012, 09:07:59 PM »
I'm sorry you've had such a hard time Trieste. If you were at all in my area I'd know a doc to send you too, but there are too damned many that think they have a right...hell even an obligation...to question the choices of patients asking for something that is perfectly reasonable.

It is very frustrating, to say the least.

How can it affect your employability if you choose to be infertile?

My thought process was that having kids makes job flexibility more difficult. You have to think in terms of child care, if your child becomes sick you have decide whether to stay home with them, etc.

So choosing to become infertile affects your employability the other way.

And getting a tattoo has a pretty variable effect on employability depending on placement and content, etc.

That was the train of thought, anyway.

Offline Oniya

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Re: Doctors and Sterilizations
« Reply #11 on: November 30, 2012, 09:09:12 PM »
Ah - okay.   I thought you were drawing a parallel that they were equally negative.  All clear :-)