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for procedures affecting reproductive capacity as for any other type of procedure.
Realistically, a medical care practitioner should be particularly careful that the patient
understands the procedure and its risks and limitations. It is also important to make
sure that any patient undergoing treatment that will cause sterility or reproductive
problems knows and understands this fact. A woman may freely consent to a
hysterectomy for fibroid tumors without understanding that this will make her unable
to bear a child. The level of knowledge of reproductive physiology in the general
public is not high. The medical care practitioner who performs the hysterectomy may
incur considerable liability for rendering this woman sterile without her informed
consent.
Informed consent for sterilization requires the disclosure of the risks and failures of the
procedure involved and appropriate alternatives. A medical care practitioner should be
very careful not to overestimate the effectiveness of a particular procedure and not to
oversell the patient. Most malpractice litigation arising from sterilizations concerns the
reversibility of the procedure. Traditionally, patients sued medical care practitioners
when the procedure spontaneously reversed, resulting in an unwanted pregnancy.
These complaints are now joined by lawsuits alleging that the medical care practitioner
indicated that the sterilization could be reversed, but the reversal has been
unsuccessful. Both of these claims arising from reversibility can be prevented by
obtaining proper consent for the sterilization.
Every patient undergoing a sterilization procedure should understand that the
procedure could fail and allow conception. The patient should be told that such failures
may occur immediately or years in the future. The medical care practitioner must
ensure that the woman is not already pregnant when the sterilization is performed.
[ACOG Technical Bulletin 113. Sterilization. February 1988.] The couple deciding on
a procedure should also understand that it is possible to check the success of the
procedure in a man but not in a woman. This may alter their decision on which
procedure to choose. It is unwise to assume that any patient is in fact sterile. If there is
any question of conception after a sterilization, the patient should be evaluated
thoroughly. A medical care practitioner who tells a vasectomy patient that he must be
sterile, without proper medical tests, may precipitate a messy divorce and paternity
actions as well as a lawsuit for malpractice.
Patients must understand the permanency of surgical sterilization. No one should
undergo a sterilization procedure with the idea that it can be easily reversed with a
change of mind. A patient may keep that idea whatever the medical care practitioner
may say, but the medical care practitioner should not encourage the patient to think of
sterilization as reversible. The medical care practitioner who does surgical repairs of
sterilizations should make sure that the patient who is being sterilized does not assume
that this medical care practitioner has some special ability to do temporary
sterilizations.
1. Determining Which Partner To Sterilize
Informed consent to a sterilization should include information on the alternatives,
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