19 ms·

"To control my body" is an absurd political spin on "because they expect me to regret it". Can she imagine that a doctor might actually think "I don't want to

by Jiro 4y ago

"To control my body" is an absurd political spin on "because they expect me to regret it". Can she imagine that a doctor might actually think "I don't want to perform an irreversible, life-alterring operation on someone who has a good chance of regretting it"?

schnebbau 4y ago
Why does the doctor get to decide whether another person may regret it or not? That isn't a medical decision.
- oneoff786 4y ago
  Ok devil’s advocate. Let’s say the doctor knows for a fact, magically, that they will want to have kids in 5 years. Is it ethical to do the procedure?
  - kelseyfrog 4y ago
    Let's say that magically devil's advocates don't exist. What argument do you want to make?
    - oneoff786 4y ago
      Deciding one wants kids later in life after thinking they would not is fairly common. Sterilizing young people means a great number of expected people who will be unable to conceive despite wanting to later on. The statistical expected utility of doing the operation may well be negative. Especially if abortion care is readily available (the fact that it is not is a key point here). People getting sterilized because they’re afraid of lack of birth control rights and abortions is tragic.
      - kelseyfrog 4y ago
        People make choices and then change their priorities or at least their minds about a great many things especially as they get older. Many of these choices have higher regret rates than sterilization. Yet, it seems that sterilization has a special status that gives license for people to make decisions about others. Why is this? As a bodily autonomy absolutist it's hard to understand a willingness to accept someone else's authority over my body. And why should one operationalization of utility be chosen out of the multitudes of conceivable[1] operationalizations? 1. yes, intentional. yw
        oneoff786 4y ago
        Like what? (Has higher regret rates)
        kelseyfrog 4y ago
        The first one that popped up is breast reconstruction after mastectomy, 47% of the sample at at least some regret[1]. Tubal ligation regret maxes at 20.3%[2]. While tubal ligation regret deminishes as age at the time of the procedure increases, my point is that it is still well below that of breast reconstruction. People seem to have no worries about reconstruction regret and large worries over people's sterilization regret. The paradox is hypocritical. There must be another factor at play. Prostate surgery has comparable regret rates(1 in 5)[3] to sterilization. Again, society seems to be perfectly ok with letting folks make decisions about prostate surgeries. Female sterilization in particular seems to be a lightning rod for public discourse. 1. https://www.tandfonline.com/doi/abs/10.1080/14768320601124899 https://www.tandfonline.com/doi/abs/10.1080/1476832060112489... 2. https://pubmed.ncbi.nlm.nih.gov/10362150/ https://pubmed.ncbi.nlm.nih.gov/10362150/ 3. https://archive.nytimes.com/well.blogs.nytimes.com/2008/08/27/regrets-after-prostate-surgery/ https://archive.nytimes.com/well.blogs.nytimes.com/2008/08/2...
        oneoff786 4y ago
        Breast reconstruction is reversible, minus some possible loss of nerves from the original tissue source.
        kelseyfrog 4y ago
        Why did you not address prostate surgery and do you have reversal rates on breast reconstruction surgery?
        oneoff786 4y ago
        I don’t know much about prostate surgery. I presume it’s largely for people who have cancer. All I really know is that prostate cancer is very common among older men and is typically non lethal and probably should be done less? They should probably communicate the effects of prostate removal more than they do. Unnecessary surgeries done on underinformed patients is a different but serious problem. The reversal rates are irrelevant. The fact is that it can be reversed whereas sterilization cannot, and frankly has much larger consequences than some body image issues. We don’t have a lot of studies on regret rates for young childless women because few young childless women get sterilized.
  - not2b 4y ago
    Since your premise is impossible (the doctor does not know this for a fact and cannot), the question isn't relevant. In any case, adoption is an option.
  - mikestew 4y ago
    If we're going to allow magic in this scenario, I suggest that the woman magically give herself a tubal ligation and skip the patronizing medical professionals altogether. Or if we're going to skip things, let's start with hypotheticals that will never happen.
  - deleted 4y ago
    [deleted]
  - porkbrain 4y ago
    And herewith The Laplace's doctor is born, bound to plague medical ethics for centuries to come.
- Jiro 4y ago
  Because the doctor is performing the operation, and people are always responsible for their own actions. "They told me they wouldn't ever regret it and I foolishly believed them" isn't an excuse for avoiding responsibility.
  - sascha_sl 4y ago
    That's the inversion of your prescription, not what anyone else is proposing. Nobody is telling anyone they will not regret an elective medical procedure. That's something you need to figure out. Stop being disingenuous.
  - balfirevic 4y ago
    Is the doctor responsible in the case of unwanted pregnancy after the refused sterilization?
    - gnicholas 4y ago
      If the doctor lied about performing the procedure, then presumably yes.
- nisegami 4y ago
  The common wisdom is that they're afraid of being sued. For example, imagine someone with Bipolar disorder in the midst of a manic episode scheduling and performing a tubal ligation. Then later on, they accuse the doctor of malpractice for not identifying them as being in a state of compromised decision making capacity and denying their request. It's really simple to say, that the patient asked for it and that the doctor acted as expected, but it doesn't prevent the lawsuit from being filed. If it's especially egregious, it might be dismissed with prejudice, but there's always a chance that it goes further than that.
  - yboris 4y ago
    I think you're right. Though a solution to this problem seems simple. Just like we ought to have timeouts from the moment you want to buy a firearm to the moment you can have it in your possession, we could have a procedure "fill out this form and sign in, have a consultation with your doctor, and if you come back 3 months later with the same request, after you sign one more form, you can have the procedure".
    - BrandoElFollito 4y ago
      This is how vasectomy works in France. You have to wait four months and confirm your choice after that.
causi 4y ago
Doctors seem to have little hesitation regarding other life-altering modifications like sticking silicone balls in your chest, carving your face up because you don't like the outline of your nose, or slicing pieces off your kid's genitals.
- happytoexplain 4y ago
  I think sterilization is both more life-altering than your examples, and also that doctors, on par, absolutely have some amount of "hesitation" (i.e. making sure they really want it) regarding plastic surgery.
  - causi 4y ago
    I would argue that anything up to and including assisted suicide performed with informed consent deserves less hesitation than performing arbitrary surgeries on unwilling and unconsenting children. Being willing to do that but not sterilize someone just makes you a hypocrite.
    - YawningAngel 4y ago
      I'm not sure this argument really works, because it's different doctors in both cases. There are lots of doctors who would be unwilling to do what you reference, but they're selected out of that area of practice. The difference here is simply that this selection effect isn't present here because this procedure is a minority of the field
    - jjeaff 4y ago
      Are you talking about male circumcision? It's hardly a blip on the radar of invasive procedures with no lasting side effects except some minor benefits.
      - causi 4y ago
        Cutting off an infant's outer ears or doing electrolysis on their armpit hair follicles or burning them with a hot iron also have no long lasting side effects but we don't allow those because of course we don't. Cutting off a male prepuce has just as much effect as cutting off a female prepuce. Can you imagine a doctor agreeing to removing a baby girl's clitoral hood? As someone who did have long-lasting effects from circumcision, I would delight in finding the son of a bitch that did it to me and seeing how he likes having pieces removed. You don't need a spreadsheet to know that causing agony to children is a bad thing.
sascha_sl 4y ago
Last I checked 26 was 8 years more than 18.
- Jiro 4y ago
  Doctors are not supposed to harm patients even if the patient is above the age of 18. If the patient is likely to regret the operation, doing the operation is causing harm.
anikan_vader 4y ago
On the other hand, she is asking for a form of birth control. Given that abortion is banned in many parts of the US, it's easy to see why she views the denial of birth control as an attempt to control her body.
ransom1538 4y ago
Age matters. If someone wanted me to tattoo a snake on their forehead I would be taking account their age.
advisedwang 4y ago
Sure, some doctors have a preference not to do it, but their stake in the situation is pretty low compared to the patient. Why do we let the doctors preference mean that the procedure becomes unavailable? Imagine if mail carriers could refuse to deliver to houses with the mailbox up stairs. Yes, its fair that they don't like it but the cost of that is people lose a vital service. In that case the mail carriers have to accept their job might include some elements they don't like.
- frumper 4y ago
  Some mail carriers do refuse to deliver at certain address for reasons that other carriers wouldn't refuse to deliver for.
briffle 4y ago
I have compared with a friend that wanted to get her tubes tied, and the doctor insisted she might change her mind, should wait a few years, and wanted her to speak to her partner about it. I asked for a vasectomy, and the doctor scheduled it 2 days later. It really is a double standard
- buscoquadnary 4y ago
  From my understanding vasectomies are much easier to reverse than the female equivalent that might account for some of it.
  - celeritascelery 4y ago
    And on top of the reversibility, vasectomy is a much simpler out-patient procedure compared to tubal ligation (which means lower risk of complications). There is not a double standard here, just medical reality.
    - AnIdiotOnTheNet 4y ago
      Then why are all the refusal statements we're hearing about "regret" instead of risk?
      - celeritascelery 4y ago
        Because the biggest consideration is the reversibility as GP said. If you have Tubal Ligation your odds of getting it successfully reversed is 1%[1]. It is effectively a permanent decision. [1]https://www.fertstert.org/article/S0015-0282(15)00292-7/pdf https://www.fertstert.org/article/S0015-0282(15)00292-7/pdf
    - hamburglar 4y ago
      My vasectomy doc made it very clear that vasectomies are not always reversible and you should absolutely not count on them being reversible if you anticipate changing your mind.
sophacles 4y ago
You can't have an abortion - you had sex deal with the consequences of your choice, even if it means your death from complications in pregnancy. vs You can't have your tubes tied - there might be consequences to your choice so you shouldn't have to deal with those. What's different here? Oh right, nothing if the goal is forcing birth.
28304283409234 4y ago
If only they applied the same logic to males then it would make sense. They don't. Men can get sterilized in the blink of an eye, while women are forced to "have time to think a out it" and such.

by Jiro 4y ago

schnebbau 4y ago

Why does the doctor get to decide whether another person may regret it or not? That isn't a medical decision.

oneoff786 4y ago
Ok devil’s advocate. Let’s say the doctor knows for a fact, magically, that they will want to have kids in 5 years. Is it ethical to do the procedure?
- kelseyfrog 4y ago
  Let's say that magically devil's advocates don't exist. What argument do you want to make?
  - oneoff786 4y ago
    Deciding one wants kids later in life after thinking they would not is fairly common. Sterilizing young people means a great number of expected people who will be unable to conceive despite wanting to later on. The statistical expected utility of doing the operation may well be negative. Especially if abortion care is readily available (the fact that it is not is a key point here). People getting sterilized because they’re afraid of lack of birth control rights and abortions is tragic.
    - kelseyfrog 4y ago
      People make choices and then change their priorities or at least their minds about a great many things especially as they get older. Many of these choices have higher regret rates than sterilization. Yet, it seems that sterilization has a special status that gives license for people to make decisions about others. Why is this? As a bodily autonomy absolutist it's hard to understand a willingness to accept someone else's authority over my body. And why should one operationalization of utility be chosen out of the multitudes of conceivable[1] operationalizations? 1. yes, intentional. yw
      - oneoff786 4y ago
        Like what? (Has higher regret rates)
        kelseyfrog 4y ago
        The first one that popped up is breast reconstruction after mastectomy, 47% of the sample at at least some regret[1]. Tubal ligation regret maxes at 20.3%[2]. While tubal ligation regret deminishes as age at the time of the procedure increases, my point is that it is still well below that of breast reconstruction. People seem to have no worries about reconstruction regret and large worries over people's sterilization regret. The paradox is hypocritical. There must be another factor at play. Prostate surgery has comparable regret rates(1 in 5)[3] to sterilization. Again, society seems to be perfectly ok with letting folks make decisions about prostate surgeries. Female sterilization in particular seems to be a lightning rod for public discourse. 1. https://www.tandfonline.com/doi/abs/10.1080/14768320601124899 https://www.tandfonline.com/doi/abs/10.1080/1476832060112489... 2. https://pubmed.ncbi.nlm.nih.gov/10362150/ https://pubmed.ncbi.nlm.nih.gov/10362150/ 3. https://archive.nytimes.com/well.blogs.nytimes.com/2008/08/27/regrets-after-prostate-surgery/ https://archive.nytimes.com/well.blogs.nytimes.com/2008/08/2...
        oneoff786 4y ago
        Breast reconstruction is reversible, minus some possible loss of nerves from the original tissue source.
        kelseyfrog 4y ago
        Why did you not address prostate surgery and do you have reversal rates on breast reconstruction surgery?
        oneoff786 4y ago
        I don’t know much about prostate surgery. I presume it’s largely for people who have cancer. All I really know is that prostate cancer is very common among older men and is typically non lethal and probably should be done less? They should probably communicate the effects of prostate removal more than they do. Unnecessary surgeries done on underinformed patients is a different but serious problem. The reversal rates are irrelevant. The fact is that it can be reversed whereas sterilization cannot, and frankly has much larger consequences than some body image issues. We don’t have a lot of studies on regret rates for young childless women because few young childless women get sterilized.
- not2b 4y ago
  Since your premise is impossible (the doctor does not know this for a fact and cannot), the question isn't relevant. In any case, adoption is an option.
- mikestew 4y ago
  If we're going to allow magic in this scenario, I suggest that the woman magically give herself a tubal ligation and skip the patronizing medical professionals altogether. Or if we're going to skip things, let's start with hypotheticals that will never happen.
- deleted 4y ago
  [deleted]
- porkbrain 4y ago
  And herewith The Laplace's doctor is born, bound to plague medical ethics for centuries to come.
Jiro 4y ago
Because the doctor is performing the operation, and people are always responsible for their own actions. "They told me they wouldn't ever regret it and I foolishly believed them" isn't an excuse for avoiding responsibility.
- sascha_sl 4y ago
  That's the inversion of your prescription, not what anyone else is proposing. Nobody is telling anyone they will not regret an elective medical procedure. That's something you need to figure out. Stop being disingenuous.
- balfirevic 4y ago
  Is the doctor responsible in the case of unwanted pregnancy after the refused sterilization?
  - gnicholas 4y ago
    If the doctor lied about performing the procedure, then presumably yes.
nisegami 4y ago
The common wisdom is that they're afraid of being sued. For example, imagine someone with Bipolar disorder in the midst of a manic episode scheduling and performing a tubal ligation. Then later on, they accuse the doctor of malpractice for not identifying them as being in a state of compromised decision making capacity and denying their request. It's really simple to say, that the patient asked for it and that the doctor acted as expected, but it doesn't prevent the lawsuit from being filed. If it's especially egregious, it might be dismissed with prejudice, but there's always a chance that it goes further than that.
- yboris 4y ago
  I think you're right. Though a solution to this problem seems simple. Just like we ought to have timeouts from the moment you want to buy a firearm to the moment you can have it in your possession, we could have a procedure "fill out this form and sign in, have a consultation with your doctor, and if you come back 3 months later with the same request, after you sign one more form, you can have the procedure".
  - BrandoElFollito 4y ago
    This is how vasectomy works in France. You have to wait four months and confirm your choice after that.

causi 4y ago

Doctors seem to have little hesitation regarding other life-altering modifications like sticking silicone balls in your chest, carving your face up because you don't like the outline of your nose, or slicing pieces off your kid's genitals.

happytoexplain 4y ago
I think sterilization is both more life-altering than your examples, and also that doctors, on par, absolutely have some amount of "hesitation" (i.e. making sure they really want it) regarding plastic surgery.
- causi 4y ago
  I would argue that anything up to and including assisted suicide performed with informed consent deserves less hesitation than performing arbitrary surgeries on unwilling and unconsenting children. Being willing to do that but not sterilize someone just makes you a hypocrite.
  - YawningAngel 4y ago
    I'm not sure this argument really works, because it's different doctors in both cases. There are lots of doctors who would be unwilling to do what you reference, but they're selected out of that area of practice. The difference here is simply that this selection effect isn't present here because this procedure is a minority of the field
  - jjeaff 4y ago
    Are you talking about male circumcision? It's hardly a blip on the radar of invasive procedures with no lasting side effects except some minor benefits.
    - causi 4y ago
      Cutting off an infant's outer ears or doing electrolysis on their armpit hair follicles or burning them with a hot iron also have no long lasting side effects but we don't allow those because of course we don't. Cutting off a male prepuce has just as much effect as cutting off a female prepuce. Can you imagine a doctor agreeing to removing a baby girl's clitoral hood? As someone who did have long-lasting effects from circumcision, I would delight in finding the son of a bitch that did it to me and seeing how he likes having pieces removed. You don't need a spreadsheet to know that causing agony to children is a bad thing.

sascha_sl 4y ago

Last I checked 26 was 8 years more than 18.

Jiro 4y ago
Doctors are not supposed to harm patients even if the patient is above the age of 18. If the patient is likely to regret the operation, doing the operation is causing harm.

anikan_vader 4y ago

On the other hand, she is asking for a form of birth control. Given that abortion is banned in many parts of the US, it's easy to see why she views the denial of birth control as an attempt to control her body.

ransom1538 4y ago

Age matters. If someone wanted me to tattoo a snake on their forehead I would be taking account their age.

advisedwang 4y ago

Sure, some doctors have a preference not to do it, but their stake in the situation is pretty low compared to the patient. Why do we let the doctors preference mean that the procedure becomes unavailable? Imagine if mail carriers could refuse to deliver to houses with the mailbox up stairs. Yes, its fair that they don't like it but the cost of that is people lose a vital service. In that case the mail carriers have to accept their job might include some elements they don't like.

frumper 4y ago
Some mail carriers do refuse to deliver at certain address for reasons that other carriers wouldn't refuse to deliver for.

briffle 4y ago

I have compared with a friend that wanted to get her tubes tied, and the doctor insisted she might change her mind, should wait a few years, and wanted her to speak to her partner about it. I asked for a vasectomy, and the doctor scheduled it 2 days later. It really is a double standard

buscoquadnary 4y ago
From my understanding vasectomies are much easier to reverse than the female equivalent that might account for some of it.
- celeritascelery 4y ago
  And on top of the reversibility, vasectomy is a much simpler out-patient procedure compared to tubal ligation (which means lower risk of complications). There is not a double standard here, just medical reality.
  - AnIdiotOnTheNet 4y ago
    Then why are all the refusal statements we're hearing about "regret" instead of risk?
    - celeritascelery 4y ago
      Because the biggest consideration is the reversibility as GP said. If you have Tubal Ligation your odds of getting it successfully reversed is 1%[1]. It is effectively a permanent decision. [1]https://www.fertstert.org/article/S0015-0282(15)00292-7/pdf https://www.fertstert.org/article/S0015-0282(15)00292-7/pdf
  - hamburglar 4y ago
    My vasectomy doc made it very clear that vasectomies are not always reversible and you should absolutely not count on them being reversible if you anticipate changing your mind.

sophacles 4y ago

You can't have an abortion - you had sex deal with the consequences of your choice, even if it means your death from complications in pregnancy. vs You can't have your tubes tied - there might be consequences to your choice so you shouldn't have to deal with those. What's different here? Oh right, nothing if the goal is forcing birth.

28304283409234 4y ago

If only they applied the same logic to males then it would make sense. They don't. Men can get sterilized in the blink of an eye, while women are forced to "have time to think a out it" and such.