4 ms·

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.

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.