Public Health Law Map - Beta 5 - Medical and Public Health Law Site

among them the sterilization of the other partner. Many couples are not aware that
tubal ligation on a woman is major surgery requiring general anesthesia, while
vasectomy on a man is minor surgery that can be done under local anesthesia. A
gynecologist should offer the alternative to a woman before doing a tubal ligation.
Gynecologists who do not do vasectomies should refer the couple to a medical care
practitioner who can provide the service they desire. The limits of a particular
medical care practitioner are no excuse for limiting a patient’s choices.
2. The Childless Patient
The childless patient who requests sterilization leads to a quandary for most medical
care practitioners because some of these patients may later wish they had not been
sterilized. In most cases, medical care practitioners have the right to refuse to
perform the surgery. But too often the only reason for the refusal is the medical care
practitioner’s imposing his own social values on the patient. Similarly, medical care
practitioners may be too quick to agree to sterilize a patient if the patient has a
number of children. The patient who wants a vasectomy because his marriage is in
trouble and he does not trust his wife to take prescribed oral contraceptives may
regret the decision just as much in his next marriage as the bachelor who thought he
would not want children.
A teaching obstetrician-gynecologist developed a system for sterilization procedures
that is a useful model of how to provide these services. The patients had a full range
of services available and the opportunity to make informed decisions. This medical
care practitioner first arranged to provide vasectomies through other members of his
medical care practitioner group so that he could offer couples the choice of who
would be sterilized without having to refer to an outside medical care practitioner.
Second, he made it a policy that all patients who requested sterilization give him a
written explanation of why they wanted to be sterilized. This allowed him to be sure
that the patient had considered the procedure carefully.
The single man in his early twenties who wrote on the note pad, “My father has
Huntington’s Chorea,” was scheduled for surgery immediately. But the single man
who simply stated that he did not like children was also scheduled. The important
point was that the patient was able to state reasons for making the decision. The
reasons did not affect whether the patient would be operated on unless they were
medically unsound. If a patient had unfounded fears of genetic disease, these could
be discussed so the patient could reevaluate the decision in the light of accurate
information. Many patients decided against sterilization when they were required to
consider the decision carefully.
3. Sterilizing Minors and Incompetents
The sterilization of legal and mental incompetents is a legally risky endeavor because
of a strong societal policy against forcing or coercing individuals to be sterilized. If a
medical care practitioner or other person uses the threat of withdrawal of federally
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