This is a debate my friend and I were having, and I thought I’d move it over here to get a wider spectrum of opinions.
We’re both very big on reproductive freedom for men and women, but I said that if I were a doctor who had a male pt seeking a vasectomy (or a female pt seeking a tubal ligation), I would ask if they were in a long-term relationship, and if so, how their partner felt about it. If they indicated that their partner did not know or disapproved, I would suggest that they work on this issue and come back. If the pt. refused, I would reserve the right not to perform the procedure and instead refer them to someone else.
I just would not want to be party to a deceit like that.
My friend said that I would be vastly overstepping my bounds as a doctor, acting like a marriage counselor when not qualified to do so, making assumptions and judgments about their marriage, infringing on the man’s reproductive freedom. I responded that doctors don’t have an obligation to dispense procedures/treatments at will.
I also don’t think that any physician or pharmacist who has moral qualms with abortion or birth control should be compelled to provide these treatments (although that is trickier as it gets into Constitutional territory).
For the record, I would perform an abortion or give birth control without the consent of a significant other, simply because that is a more emergent situation (there are other ways to prevent conception besides a vasectomy) and because it doesn’t permanently affect one partner’s ability to have children.
I think there is a relationship between doctor and patient. The doctor should advise the patient about what is best for the patient’s health and well-being. If patient wishes a vasectomy, doctor should advise patient of the risks of the surgery, make sure patient fully understands consequences of his actions, and if all that is agreed to, provide the service.
It is none of my doctor’s fucking business about any relationships I have or don’t have, or what or why I want a particular elective procedure done. If doctor wishes to interpose his/her morality upon me, however, I am glad to know it so that I can find a new doctor.
I would perform the procedure, after strongly counseling my patient that these decisions are best decided as a couple. But ultimately, this *person *is my patient, not the couple.
Would your feelings change if the person seeking the sterilization was in an abusive relationship? In physical danger if pregnancy occurred? Cheating on their spouse and wanting to prevent offspring from another party? Part of a religious sect forbidding birth control (yet nonetheless choosing it for themselves)?
One thing they keep pounding into us in nursing school is that it isn’t about us. We’re there to advise, to educate and to provide options, but ultimately, health care decisions are the right and responsibility of the patient. I don’t know if medical school teaches doctors the same thing, but I sure hope they do. I want no part of paternalistic healthcare.
I think any adult should be able to be sterilized if they want. I don’t think a doctor should be required to do the procedure, but I don’t think they have a good reason to refuse (okay, they do–the fear of being sued, but in my magical world, they can’t be sued for that as long as they give the patient all the info beforehand).
If my doctor wouldn’t give me a tubal when I wanted, I would just look for another doctor, but the issue does get tricky for people who can’t find any doctor willing to sterilize them (and I don’t know that I could, being young and single and having only one kid). And that’s not fair to anyone–the patient, their current or future partners, or any future babies they may conceive at a bad time.
I don’t care if they regret it one day. That’s their problem. We allow adults to make all kinds of decisions that they may one day regret, and this one shouldn’t be any different.
Related, isn’t it common for a doctor to refuse to perform a tubal ligation on a woman younger than her mid 30s because they’re convinced the silly girl just doesn’t know what’s right for her yet?
It’s not so much that I worry that the patient might regret it someday, as I feel like I would be indirectly making decisions for the pt’s SO regarding their reproductive future without the SO’s consent.
I had my SO present when the doctor talked about the vasectomy. It was STRONGLY recommended by the doc who explained the risks and expense if I changed my mind to both of us.
If someone wants to be sterilized at most you should advise them to ask their partner. The partner however has no right to actually veto such a procedure so if the patient wants it done anyway, do it.
I’ve certainly heard more than one woman complain about it, including on the SDMB IIRC.
I think it is a stretch. Each partner’s reproductive freedom is their own. Granted, I don’t believe they should make the decision without their partner’s input, and I would beyond pissed if my partner did something like that. But in the same vein, I’d be pissed if my partner cheated on me too, and it still would be nobody’s business but our own. I wouldn’t expect a hotel to require my permission before letting my husband book a room with his mistress.
Also, from what I’ve heard, many younger people can’t find a doctor willing to sterilize them even WITH the partner’s support, or if they don’t have a partner. I think the underlying attitude driving these policies is that everyone MUST want children at some point, even if they don’t realize it yet, so we have to protect from from their own misguided decisions. As if having a child you don’t want or aren’t prepared to care for doesn’t have its own consequences.
Same here. They also insisted my wife sign a form acknowledging she was informed about and approved of the procedure. They didn’t tell me what would happen if she refused to sign.
I don’t believe a doctor should be forced to perform a procedure (absent emergency situations, of course).
That said, I also don’t believe the patient’s private life is relevant in this matter. I don’t understand why you’re worried about the patient’s SO. The SO is not your patient. If there are issues in the relationship (and seeking permanent sterilisation secretly does imply that), the sterilisation itself is not the issue. The issue could be anything, a lack of trust, a fear of retaliation, deceit, fraud, etc, but none of those are the doctors concern. And none of them are in the doctors power to resolve.
My doctor asked about relationships, but did not need to meet my husband or get him to sign anything. He listened to his patient (me) and made a decision based on how I presented myself and how I responded to his questions (I know, because in the follow-up appointments I asked him, as many people report having difficulty in getting sterilised young).
So I guess I agree with both of you. I agree that you shouldn’t be forced to do the non-emergency procedure. But I also agree that you are overstepping your bounds. I believe you are concerning yourself with non-medical matters. It feels like you consider yourself as qualified to judge or weigh up non-medical factors. Frankly, it comes across as controlling, arrogant, superior.
If my doctor had’ve advised me to run along home and check with my husband before getting a medical procedure done, I would’ve been furious, but then I would’ve gone to the next doctor on the list and lied about any and all non-medical aspects, saying whatever I thought he wanted to hear, since non-medical stuff like my marriage isn’t his business IMO. And that’s not a good doctor-patient relationship. And brings up the problem of the patient then lying about things that actually are relevant, because they have no trust that their doctor has their best interests in mind.
I was unable to get a vasectomy in my early 20s for pretty much the same reason. 3 different doctors refused. I gave up for a long time and finally got it done at about age 35. At that point, no one asked me about relationships, whether I had children already, or any other personal thing.
Sterilisation is a little outside the ordinary run of medical procedures, in that (when performed for contraceptive purposes) it is typically not performed to treat any disease or abnormality. That’s not unique; much cosmetic surgery shares this characteristic. But fertility is not a disease. In fact, when you think about it, sterilisation is a surgical intervention to create a physical disability.
I think this means that, from an ethical point of view, doctors need to ask themselves why they are performing it, and whether they ought to. And evidently at least some doctors feel that they ought not to perform it without involving not only the person most directly affected but their partner who, although affected only indirectly, is nevertheless affected in a fairly significant way. I think they probably have a point; where there is no medical need to perform the procedure at all and yet you choose to perform it, you can’t disclaim all moral responsibility for the consequences on third parties of your decision.
I think that if I, as a hypothetical person in a hypothetical relationship, decide that I want to be sterile, I should be able to go to my doctor and have the procedure done. My body, my reproductive equipment. Not the doctor’s business whether I’m doing it to contravene my partner’s dearest wishes or to accomodate my partner’s dearest wishes or if I have no current partner. Or whether I have zero kids, thirteen kids, or somewhere in between. Or whether I am 21, 31, or 41.
In some jurisdictions it was required by law that a married person (or possibly just a married woman) had to obtain their spouses written consent before being sterilized. Are any of those laws still in effect? The latest I’ve heard of any those laws being enforced (at least in the US) was the late '70s.
Personally, if I was an MD, I think I would ask the patient if they talked with their SO. If they haven’t, I would say I would be uncomfortable performing the procedure, however, if they wanted it, I would give a referral to a doctor who would.
If I was an MD, it is my right to not perform a permanent elective procedure if I don’t want to. However, my rights end at my duty. My duty is to care for the patient, so if that is what the patient wanted, I would refer to a doctor who I know would perform the procedure. If this was the first time I was presented with the problem, and didn’t have a known doctor to refer to, I would tell them to give me 48 hours to find a doctor that would perform the procedure for them.
I also wouldn’t and don’t have any plans to practice in a rural area where a referral would be largely inconvenient.
Though, I’m going to be a Pharmacist, and luckly, I don’t have to worry about and moral issues like that. Birth Control Pills and the Morning After Pill don’t bother my conscious any, and Mifepristone (also known as RU-486, the abortion pill) is not distributed through pharmacies.