Goo, you certainly may NOT call me an old fart. We reserve that for Mr P. BTW can you email me? Something totally unrelated.
OK WRT the life stages thing. At 18 most people are not looking to settle down and breed. Most people are travelling, working, setting up a career, having fun. Contraception is fairly reliable and easily available. Making an irreversible decision to be sterilised in that lifestage is for most people not going to be appropriate IMO.
I think psychological assessment could be a valuable adjunct to making the decision (but then I tend to think that about any major life decision). WRT the kneejerk thing – would you say that gender reassignment should be done with no psychological assessment, just because the client asked? I know gender reassignment is more major but I think the loss of fertility when it is regretted is way more major than you accept. I’m not talking about women like you – I’m talking about women who are more ambivalent and whose ambivalence is not picked up.
Fining or penalising a doctor is just loony if they refuse to perform an elective procedure, no matter how much the client wants it.
I think that we largely agree with each other here, except that I don’t really feel that any sort of objective psychological evaluation could possibly be critical factor in making such a decision: I just don’t feel like psychology is sufficently advanced to the point where any scientific observation is going to be more effective at predicting whether or not someone is making a sound decision than the opinion of a doctor who has known the patient for an extended period of of time.
It seems to me that one solution to the problem is to make it possible, but a pain in the ass. Therefore, people who are really serious, really commited, who really know there own minds can have the procedure done, but ambivilant or whimsical people will, presumably, not be willing to do the legwork. For example, it seems to me that if a doctor were to tell a 21 year old woman who wanted to be sterilized “Here’s the deal. If you still want to be sterilized in two years, I’ll do it, no problem”, that would seem pretty reasonable to me. A person who was really serious about having it done would keep track ofhtat doctor and hunt him/her down in two years. Someone who was feeling ambigous would have time to change thier mind.
The problem with using the doctor’s judgement is that in general these procedures are done by a specialist who sees the person briefly. I think a psychologist seeing a person for a series of sessions has to be able to make a better job of helping a person reach clarity about the permanence of the decision. Actually that’s probably more how I would see the role of a psych in this – as a support for a person to be clear about the ramifications of the decision.
A primary care physician like a GP who has a sustained relationship with the client could also meet my criteria of helping make sure the person is clear.
A criterion I’d be absolute on would be that the person would have had to have used contraception religiously and have done everything possible to avoid conception. Not using contraception to me is a red flag of ambivalence.
Under California law, no one but yourself is allowed to decide whether a vasectomy (or a tubal ligation) is right for you. I’m guessing the main purpose of this law was to prevent people from feeling “pressured” into having sterilization surgery, but it also has the effect that if your health-insurance company covers vasectomies and tubal ligations, they have to cover them regardless of the reason you chose to have said operation. (And if it’s an HMO like Kaiser Permanente, their doctors cannot turn you down for non-medical reasons.)
I really think that it is too simplistic to reduce a doctor’s reluctance to do a TL to simple fear of lawsuits. OB/Gyn’s work with infertile women all day who suffer terrible pain because of their infertility. Now, then, obviously, that dosen’t mean that all women, or most women, who do not have children or cannot have children suffer serious emotional pain, but it would disingenous to deny that infertility is an extremely painful condition for many women, and OB/Gyns see a squewed sample. I can see how someone, having spent all day talking to women who in their 30s discovered they were infertile and were devestated by it, could be reluctant to perform an elective TL on a 20-something year old, out of fear that she will change her mind later and suffer really severe regret. Like I said before, I still think the doctor should be open to the possiblity of performing the TL ifthe patient can convince him she is in earnest, but I understand why the doctor’s default answer might be “No TL before 30”.
I agree: my point (which I did not make clear) is that I wouldn’t be comfortable with using a psychological evaluation as the only, authoritative, criterion: it shouldn’t be possible to use a psychologist’s evaluation to compel a doctor to perform a surgery he /she does not want to perform.
Yes, it is. However, choosing to have a child is ALSO a huge decision, fraught with all kinds of long-term ramifications, but I don’t see anybody interfering with an 18 year old’s decision if she chooses to become pregnant. If an 18 year old isn’t considered mature enough to make a wise decision regarding elective sterilization, they how can we consider her wise enough to competently make the much more serious decision to bear and raise a child?
But artemis, sterilisation at 18 is a closed decision. If an 18 yo gets pregnant, there’s a series of decisions she can make. Termination, adoption or keeping the baby. I’d think you’d find that most 18 yo’s who planned a pregnancy at the age of 18 would be faced with some discussion from their nearest and dearest.
I don’t think that forced abortion or forced adoption is the flipside to not routinely doing sterilisation on request for 18 yo’s.
Yep, I think that before performing any elective procedure that interferes with the body functions (eg gender reassignment or sterilisation) that psychological counselling is probably necessary to ascertain whether or not the person is clear on the ramifications of their decision. To me, that’s a part of informed consent.
However I don’t see the same issues before say, an emergency appendectomy or an emergency removal of a limb. An elective removal of a limb I’d say definitely would need psychological assessment ;).
Cosmetic surgery – yeah, in some cases, if not most cases. Someone who thinks a breast enhancement or a breast reduction will fix all the issues in their life probably needs a reality check.
Note I’m not advocating that the psych has a power of veto, rather that the person is given the chance to examine their decision with support.
Primaflora, do you think that psychological counselling is really necessary is all cases of sterilization? My mom got her tubes tied in 83 or 84: at that point she was 35 years old with six kids ranging in age from 7 to 18. (and all of us were planned, though a few of the earlier ones were, perhaps, a bit earlier than expected). To the best of my knowledge, she didn’t have any sort of counseling before the procedure: it’s very common amoung women at that age. I tend to feel like mandatory counselling for women over 35 would be an unnecessary pain in the ass.
Manda Jo – no, I’m more thinking of very young women and/or women who have not had children. Sorry, goo ::ouch, stop hitting me!:: but to me there’s a qualitative difference between women who have, for want of a better word, used their fertility and women who have not had children and who are closing that avenue for themselves. I’m not arguing against their access to it, I just think that part of informed consent involves the client demonstrating that they are in fact informed. FWIW if I ruled the world, women opting for elective caesarean sections would need to demonstrate informed consent as well ;).
Elective = making a choice to do something not medically necessary. I’m thinking that sometimes elective can also mean an operation which is not a medical emergency. Is that right? I’m not using elective in that sense anyway.
Sure an 18 year old who decides to become pregnant and keep the baby would face some discussion from her nearest and dearest - but that’s ALL she would face. She cannot be legally forced by anyone to terminate the pregnancy, nor can she be legally forced to place the infant up for adoption. The law allows her to unilaterally make the decision to become a parent. And the last time I checked, becoming a parent was also an irreversible decision, one with even more profound consequences than elective sterilization. If 18 year olds are considered mature enough to make the decision to procreate, then they are mature enough to make the decision to be sterilized. If they are NOT mature enough to make the decision to undergo sterilization, then they certainly aren’t mature enough to become parents.
Part of being an adult is having control over one’s body and one’s reproductive decisions. And legally, 18 year olds are adults. I’m fine with the idea of trying to talk an 18 year old who wants her tubes tied out of making that decision - but if she continues to insist that she wants a tubal ligation, I think that choice should be respected. She’s the one who has to live with her choice in the end.
This has long been a big topic in our household. (For the record, we’re 27, and we’ve been married for two weeks but together and “practically married” for quite a bit longer.)
We are both reasonably certain and adamant at this point that we do not want kids, and that we never will. CrazyCatLady would go have her tubes tied tomorrow if someone would do it. I’m more hesitant, because I know that a large chunk of people who get permanent sterilization eventually want it reversed, and that it isn’t easy. Like I said, I don’t think I’ll ever want kids, but obviously none of those people thought they would, either.
We’re in a pretty dynamic time in our lives right now, and I don’t think it’s a good time to make a decision like that when other, less permanent solutions are available. (She has had trouble with BCPs, but she’s an ideal candidate for an IUD.) I hate that my not getting a vasectomy leaves the contraception basically up to her, but that’s where we are.
I think the doctor has not only the right, but the responsibility to do everything possible in a situation like this to encourage less permanent options, and to give the individual in question time to think about it before proceeding. If there were a hint of wavering in either party, I’d back off. I think that is the doctor’s discretion. It’s pretty silly, though, to have blanket policies on this sort of thing (say, “no TL for anyone under 30”), since all cases are different.
Oh, and regarding the failure rate of TL’s–my understanding is that one woman in 250 who gets a TL (and who doesn’t get it reversed) will eventually have a child, and that half of those are pregnant at the time of the TL.
Even if your TL can’t be reversed, it doesn’t stop you from having kids. Some forms of IVF can be done (I think most). And you could try to adopt. It will be less simple and more expensive, but it isn’t like you are closing the door, locking it, and throwing the key into Mount Doom.
And then there is the double standard. Why should my friend be able to walk into a urologist, have an “informational appointment” and set up a successive appointment for a vascectomy as a single under 30 guy with no kids, but IDBB can’t find a provider? Why should people with health issues that make carrying kids difficult (or near impossible) have to fight the same battle (a girlfriend with diabetes, another with liver disease – both had trouble finding doctors willing to do a tubal, even through they were highly discouraged from having children).
But I don’t think doctors should have to perform procedures they aren’t comfortable with. I do think that they should be required to refer you to someone who does. (I don’t do abortions, but here is the name of a clinic. I don’t do tubal ligations on anyone under 30, but my collegue does.) Or at least refer you to a professional organization who could refer you on to someone who will do the legal procedures you are looking for.
I’d consider both of those to be reasonable definitions. If you’re not using the term that way, it would really be helpful if you explained what you do mean, as it wouldn’t be part of the standard definition.
Another thing I forgot to mention, in case it’s relevant to why I"m so sloppy with BC. I have an extremely mild form of the aging disorder progenera. I age faster than most of the people around me. When I was born, my brains and internal organs were already like those of a two year old in an infant body. I matured extremely quickly, surprising all the doctors. I was poked and prodded and studied from the time I was born until my mom called it quits when I was 5. I am seriously thinking about going to a genetic counselor and finding out if that sort of thing is something I could possibly pass on to any future children. If it is…it only furthers my resolve to not have kids. I would not want my health problems that have been caused by this to be passed on to my children. This is also the reason I think I am infertile…I’ve heard that for girls who get progenera,the ones who survive to adulthood are more likely to be infertile than not.
I was curious about your disease, so did a search for it. (I think it is spelled progeria, at least that was what I found). It sounds like a terribly sad and difficult thing to be suffering, severe or not. I hope that you have lots of love and support and that you will also find support here.
I was always told it was called progenera but whatever it’s called, yeah it’s harsh. Imagine being a young girl and developing not just boobs but a Dolly Parton-like chest at the age of 10 or 11(which I did thanks to an overabundance of teenage hormoes raging through my body and a genetic predisposition to massive chestiness…gee thanks Mom:rolleyes:) and having to suffer the taunts and torments of kids in school. I have a lot of problems because of the progenera.Not only am I already beginning to get wrinkles where there should be none but I already have mild arthritis in my hips,knees and lower back. I have the internal organs of someone who is almost 30 when I am only 24. Trust me this SUCKS big time. But you learn to deal with it. I have. It’s something that even if you don’t want to live with it, you don’t quite get a choice and you learn to deal. shrug
We reserve that for Mr P. BTW can you email me? Something totally unrelated.