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Most doctors refuse to perform sterilization procedures on young people, at least until after they have had children. After all, what if they change their minds

Most doctors refuse to perform sterilization procedures on young people, at least until after they have had children. After all, what if they change their minds? My girlfriend couldn’t get hers done until she was over 30.

toomuchtodo 2y ago
This is a topic near and dear to my heart, because unwanted children leads to enormous suffering (which I have seen up close as a volunteer Guardian ad Litem, a legal advocate for children in the system). A recent thread on the topic of unwanted children at scale [1]. So I bought and operate a domain which points to the r/childfree subreddit wiki list of doctors [2] who will provide permanent birth control to people who want it without onerous conditions such as partner approval, being over 30, or having at least two or three kids first. I run marketing campaigns on socials with this digital property. Next steps are building a site to act as a "store locator" app for this data. My partner and I also contribute in r/sterilization for those seeking permanent birth control, helping folks navigate insurance (bisalps in the US are free under most insurance situations, and vasectomies are covered at 100% in 10 states) and logistics. High level, we should collectively be robustly supporting parents who want to be parents, but we must aggressively assist though who would rather not. 40% of US domestic pregnancies every year are unintended [3]. ~600k children are in the foster care system [4], very roughly half of which are adoptable but are never adopted. It costs ~$310k to raise a child from 0-18 in the US [5], and this does not include daycare or college costs. [1] https://news.ycombinator.com/item?id=40053774 https://news.ycombinator.com/item?id=40053774 [2] https://www.reddit.com/r/childfree/wiki/doctors https://www.reddit.com/r/childfree/wiki/doctors [3] https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states https://www.guttmacher.org/fact-sheet/unintended-pregnancy-u... [4] https://usafacts.org/articles/how-many-kids-are-in-foster-care/ https://usafacts.org/articles/how-many-kids-are-in-foster-ca... [5] https://www.brookings.edu/wp-content/uploads/2022/08/Brookings_Cost-to-raise-a-child_inflation-adjusted-2.pdf https://www.brookings.edu/wp-content/uploads/2022/08/Brookin...
- mensetmanusman 2y ago
  Bandaid solutions to societal ills probably just prolong the suffering.
  - toomuchtodo 2y ago
    On the contrary, this is a pipeline problem. If you get to the root of the problem by avoiding unwanted children, the effort to paper over the suffering in the future is never needed. Society ain't changing on any meaningful timeline (based on all available evidence), "the purpose of the system is what it does," so attack the root cause in earnest. It is a choice to not actively solve for the suffering, so find an inexpensive point of leverage to attempt to solve for it. Folks seeking this healthcare are being marginalized by the system at great cost realized as externalities, and therefore require empowerment (with strong positive second order effects). Like vaccinations, prevention is far cheaper than the alternatives. Tangentially, it's kind of wild to think that the global population boom, billions of people, over the last ~100 years was because of women not being empowered [1], broadly speaking. Because as soon as women are empowered [2], educated, and have robust access to contraceptives, boom, fertility rate plummets off a cliff. Turns out, society (economic pyramid schemes leading to pearl clutching about rapidly declining populations) and men [3] [4] want more children than women do. Ergo, we must empower the human, because all available evidence demonstrates the system is built and operated to subjugate rather than empower (from a first principles systems analysis). [1] https://ourworldindata.org/fertility-rate#what-explains-the-declining-fertility-rate https://ourworldindata.org/fertility-rate#what-explains-the-... [2] https://news.ycombinator.com/item?id=40982392 https://news.ycombinator.com/item?id=40982392 (citations) [3] https://www.cbc.ca/news/canada/women-children-study-1.7119845 https://www.cbc.ca/news/canada/women-children-study-1.711984... [4] https://www.theguardian.com/world/2019/may/20/paid-paternity-leave-study-spain-men-fewer-children https://www.theguardian.com/world/2019/may/20/paid-paternity...
    - codr7 2y ago
      A society that doesn't support having children won't lead anywhere worth going. I'm pretty sure that given the support they needed, and a society that didn't program them all the way to want other things in life more; the numbers would look very different. And that IS the long term problem. Which is not at all an excuse for not solving other problems, I don't feel it has to be one or the other. Society very much has, and is, changing; drastically, exponentially. And in an increasingly destructive direction for quite a while now. And it will have to change into something more constructive, humane, rational; if it wants to survive at all.
ryandrake 2y ago
This decision really needs to be removed from the hands of doctors, as long as there is no physical risk to the patient.
- deleted 2y ago
  [deleted]
- philwelch 2y ago
  You think doctors should be forced to perform procedures they don’t want to perform?
  - ryandrake 2y ago
    At the very least the doctor should be required to refer the patient to a different doctor who is capable of performing it. This question is kind of similar to "Should pharmacists be able to deny birth control (or other medicine like vaccines) to people because of the pharmacist's personal religious belief?"
    - philwelch 2y ago
      Except it’s not a question of the doctor’s personal religious belief or preference, but rather a question of professional judgment. It is technically possible for a physician to prescribe methamphetamine or fentanyl. Many adults in the United States want to consume methamphetamine or fentanyl. (Sometimes both at the same time!) But it is very hard to find a physician who will write those prescriptions purely on the basis of “the patient asked for it”. Like it or not, some degree of paternalism is an inherent part of the practice of medicine.
  - axoltl 2y ago
    The current version of the Hippocratic Oath says this: """ I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism. """ Which does not include "except those I don't feel like doing". The Declaration of Geneva states the following: """ THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration; I WILL RESPECT the autonomy and dignity of my patient; """ Which I read to similarly state that a doctor's own preferences as to the procedures is necessarily secondary.
pwthornton 2y ago
I got mine done at 37, after having two kids, and they still asked me if I was sure. I can see why you'd be hesitant to do it on a 22-year-old. If you asked me at 22, I'd probably say I don't want kids. But I completely changed my mind as I approached 30.' Also, vasectomies are less reversible than people think.
- mock-possum 2y ago
  Why not adopt? There are plenty of kids already who need a parent or two.
  - pwthornton 2y ago
    I already have two kids.
  - kelipso 2y ago
    Pretty sure adoption is very difficult nowadays. Also people do change their minds about having their biologically own kids.
    - pwthornton 2y ago
      It's difficult and expensive, and my wife and I have no issues conceiving. Why make it even more competitive for people who can't conceive?
  - CleanRoomClub 2y ago
    Why question a human’s innate desire to raise their own off-spring like we’ve evolved to do for millions of years? So often people chime in with the “just adopt” and while I agree in a perfect world, that’s exactly what would happen, but in reality it goes against a very fundamental part or human nature to opt to raise someone else’s child instead of your own. It just completely misses the human element of why people are so naturally driven have kids and families to begin with.
    - squigz 2y ago
FireBeyond 2y ago
Or we still have physicians with the mindset of "What does your husband say?" And then more and more schools, not less and less, are teaching abstinence-only sex ed. And politicians pushing it. Including Lauren Boebert, 4th generation teen mom, who has a son who got his girlfriend pregnant at a ... questionable ... age. And Sarah Palin, who works with her daughter while her daughter has had two kids out of marriage. (To be clear, my perspective on sex ed and morality is not saying there's issue with sex and children out of marriage, quite the opposite. But you have people who are being held up as rolemodels doing ... not what they preach.)
alex_lav 2y ago
Curious if the doctors are actually just proxies for insurance providers in this case?

toomuchtodo 2y ago

This is a topic near and dear to my heart, because unwanted children leads to enormous suffering (which I have seen up close as a volunteer Guardian ad Litem, a legal advocate for children in the system). A recent thread on the topic of unwanted children at scale [1]. So I bought and operate a domain which points to the r/childfree subreddit wiki list of doctors [2] who will provide permanent birth control to people who want it without onerous conditions such as partner approval, being over 30, or having at least two or three kids first. I run marketing campaigns on socials with this digital property. Next steps are building a site to act as a "store locator" app for this data. My partner and I also contribute in r/sterilization for those seeking permanent birth control, helping folks navigate insurance (bisalps in the US are free under most insurance situations, and vasectomies are covered at 100% in 10 states) and logistics. High level, we should collectively be robustly supporting parents who want to be parents, but we must aggressively assist though who would rather not. 40% of US domestic pregnancies every year are unintended [3]. ~600k children are in the foster care system [4], very roughly half of which are adoptable but are never adopted. It costs ~$310k to raise a child from 0-18 in the US [5], and this does not include daycare or college costs. [1] https://news.ycombinator.com/item?id=40053774 https://news.ycombinator.com/item?id=40053774 [2] https://www.reddit.com/r/childfree/wiki/doctors https://www.reddit.com/r/childfree/wiki/doctors [3] https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states https://www.guttmacher.org/fact-sheet/unintended-pregnancy-u... [4] https://usafacts.org/articles/how-many-kids-are-in-foster-care/ https://usafacts.org/articles/how-many-kids-are-in-foster-ca... [5] https://www.brookings.edu/wp-content/uploads/2022/08/Brookings_Cost-to-raise-a-child_inflation-adjusted-2.pdf https://www.brookings.edu/wp-content/uploads/2022/08/Brookin...

mensetmanusman 2y ago
Bandaid solutions to societal ills probably just prolong the suffering.
- toomuchtodo 2y ago
  On the contrary, this is a pipeline problem. If you get to the root of the problem by avoiding unwanted children, the effort to paper over the suffering in the future is never needed. Society ain't changing on any meaningful timeline (based on all available evidence), "the purpose of the system is what it does," so attack the root cause in earnest. It is a choice to not actively solve for the suffering, so find an inexpensive point of leverage to attempt to solve for it. Folks seeking this healthcare are being marginalized by the system at great cost realized as externalities, and therefore require empowerment (with strong positive second order effects). Like vaccinations, prevention is far cheaper than the alternatives. Tangentially, it's kind of wild to think that the global population boom, billions of people, over the last ~100 years was because of women not being empowered [1], broadly speaking. Because as soon as women are empowered [2], educated, and have robust access to contraceptives, boom, fertility rate plummets off a cliff. Turns out, society (economic pyramid schemes leading to pearl clutching about rapidly declining populations) and men [3] [4] want more children than women do. Ergo, we must empower the human, because all available evidence demonstrates the system is built and operated to subjugate rather than empower (from a first principles systems analysis). [1] https://ourworldindata.org/fertility-rate#what-explains-the-declining-fertility-rate https://ourworldindata.org/fertility-rate#what-explains-the-... [2] https://news.ycombinator.com/item?id=40982392 https://news.ycombinator.com/item?id=40982392 (citations) [3] https://www.cbc.ca/news/canada/women-children-study-1.7119845 https://www.cbc.ca/news/canada/women-children-study-1.711984... [4] https://www.theguardian.com/world/2019/may/20/paid-paternity-leave-study-spain-men-fewer-children https://www.theguardian.com/world/2019/may/20/paid-paternity...
  - codr7 2y ago
    A society that doesn't support having children won't lead anywhere worth going. I'm pretty sure that given the support they needed, and a society that didn't program them all the way to want other things in life more; the numbers would look very different. And that IS the long term problem. Which is not at all an excuse for not solving other problems, I don't feel it has to be one or the other. Society very much has, and is, changing; drastically, exponentially. And in an increasingly destructive direction for quite a while now. And it will have to change into something more constructive, humane, rational; if it wants to survive at all.

ryandrake 2y ago

This decision really needs to be removed from the hands of doctors, as long as there is no physical risk to the patient.

deleted 2y ago
[deleted]
philwelch 2y ago
You think doctors should be forced to perform procedures they don’t want to perform?
- ryandrake 2y ago
  At the very least the doctor should be required to refer the patient to a different doctor who is capable of performing it. This question is kind of similar to "Should pharmacists be able to deny birth control (or other medicine like vaccines) to people because of the pharmacist's personal religious belief?"
  - philwelch 2y ago
    Except it’s not a question of the doctor’s personal religious belief or preference, but rather a question of professional judgment. It is technically possible for a physician to prescribe methamphetamine or fentanyl. Many adults in the United States want to consume methamphetamine or fentanyl. (Sometimes both at the same time!) But it is very hard to find a physician who will write those prescriptions purely on the basis of “the patient asked for it”. Like it or not, some degree of paternalism is an inherent part of the practice of medicine.
- axoltl 2y ago
  The current version of the Hippocratic Oath says this: """ I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism. """ Which does not include "except those I don't feel like doing". The Declaration of Geneva states the following: """ THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration; I WILL RESPECT the autonomy and dignity of my patient; """ Which I read to similarly state that a doctor's own preferences as to the procedures is necessarily secondary.

pwthornton 2y ago

I got mine done at 37, after having two kids, and they still asked me if I was sure. I can see why you'd be hesitant to do it on a 22-year-old. If you asked me at 22, I'd probably say I don't want kids. But I completely changed my mind as I approached 30.' Also, vasectomies are less reversible than people think.

mock-possum 2y ago
Why not adopt? There are plenty of kids already who need a parent or two.
- pwthornton 2y ago
  I already have two kids.
- kelipso 2y ago
  Pretty sure adoption is very difficult nowadays. Also people do change their minds about having their biologically own kids.
  - pwthornton 2y ago
    It's difficult and expensive, and my wife and I have no issues conceiving. Why make it even more competitive for people who can't conceive?
- CleanRoomClub 2y ago
  Why question a human’s innate desire to raise their own off-spring like we’ve evolved to do for millions of years? So often people chime in with the “just adopt” and while I agree in a perfect world, that’s exactly what would happen, but in reality it goes against a very fundamental part or human nature to opt to raise someone else’s child instead of your own. It just completely misses the human element of why people are so naturally driven have kids and families to begin with.
  - squigz 2y ago

FireBeyond 2y ago

Or we still have physicians with the mindset of "What does your husband say?" And then more and more schools, not less and less, are teaching abstinence-only sex ed. And politicians pushing it. Including Lauren Boebert, 4th generation teen mom, who has a son who got his girlfriend pregnant at a ... questionable ... age. And Sarah Palin, who works with her daughter while her daughter has had two kids out of marriage. (To be clear, my perspective on sex ed and morality is not saying there's issue with sex and children out of marriage, quite the opposite. But you have people who are being held up as rolemodels doing ... not what they preach.)

alex_lav 2y ago

Curious if the doctors are actually just proxies for insurance providers in this case?