On Becoming Infertile - by an Anonymous Feminist Philosopher

January 24, 2012 5:43 PM

Let's Talk About Reproductive Norm Enforcement, Baby. An anonymous philoso-blogger recounts, in an honest, intelligent, compelling, and occasionally poignant way, the process of undergoing medically necessary surgery that would cause infertility. If you care about the reproductive expectations with which women are saddled by contemporary society, you should read this. You should also read this if you care about bioethics, medical decorum, feminism, women in academia, the ethical behavior of philosophers, or, you know, justice. If you care about those last four things, you should have been reading Feminist Philosophers already.
posted by MultiplyDrafted (114 comments total)

You should also read this if you care about...you know, justice.

This is not an effective way to entice people to read your post.
posted by Dasein at 5:50 PM on January 24 [35 favorites]

Thanks for posting this--that was quite well-written and thought-provoking.
posted by iminurmefi at 5:54 PM on January 24 [1 favorite]

I'm having a hard time understanding where justice fits into these three blog posts. Can someone perhaps explain to me? Is my understanding of the meaning of the word "justice" incorrect? I understand there may be issues about societal norms and expectations of others about one's life (none of their business if you ask me), but justice? I'm just a tad confused.
posted by hippybear at 5:56 PM on January 24 [1 favorite]

Thanks for the post -- it puts together well a lot of things I've been thinking about with all the different sides and aspects of reproductive justice for women.
posted by circle_b at 5:59 PM on January 24 [1 favorite]

It's interesting that despite the much lower risk of complication for vasectomies than for tubal ligation, couples still seem to primarily pursue the latter.

When I got a vasectomy I actually had surprisingly few hoops to jump through for a guy in his 20s with no children. I expected to have to go back many times to convince them.

Unfortunately reproductive norm enforcement is reinforced by the number of individuals who turn around and sue years later because their vasectomy or tubal ligation can't be successfully reversed.
posted by BrotherCaine at 6:07 PM on January 24

This is perfect timing. I've recently been diagnosed with fibroids and can't find a doctor who will give me the surgical treatment I want because I don't have kids (and don't want any.) They're all in CYA mode in case I turn around and sue them for rendering me infertile. It's infuriating that being able to pop out a kid is more important than my overall health.
posted by never nice at 6:08 PM on January 24 [1 favorite]

Never Nice, I'm seeing red just thinking about what they are putting you through. I hope you can find some kind of patient advocate or hospital ombudsman to fight on your behalf.
posted by BrotherCaine at 6:17 PM on January 24

I hope you can find some kind of patient advocate or hospital ombudsman to fight on your behalf.

How does that work? Do they testify on behalf of the doctor or something if needed down the road?

I ask because my uncle is in reproductive medicine and lives in terror of getting sued again.
posted by codswallop at 6:26 PM on January 24

When my mother had a tubal ligation (at 30, after having two children) the surgeon had to phone my father at work to get HIS permission to do the surgery.

While this was 30 years ago, it speaks directly to the kind of paternalistic attitude about women and their reproductive choices the blog posts are about.
posted by pantarei70 at 6:30 PM on January 24 [4 favorites]

@Dasein - I hope you're wrong. I can definitely report that seeing such a list in a post would be a damn fine way of getting me, and at least a few other Mefites I know, to read said post.
But maybe you're right. I do have to admit that I'm a little confused about what exactly you meant. Maybe you meant that a list of relevant concepts is an ineffective way of enticing readers. Alternately, you may have been suggesting that signposting the fact that issues of justice are in play in a post is not a good way to go about getting folks on MeFi to read it. If either of these is true, so much the worse for The Blue.


@hippybear - I'm going to link you to a page on the site of a group I support here in Atlanta. It has a little chart. Charts are good. My quippy response, though is this: issues surrounding the treatment of women and their access to basic conditions of well-being are centrally relevant to questions of justice. What we've got in these three posts is a vivid description of a woman whose health care was compromised because of prevailing attitudes about reproduction.
posted by MultiplyDrafted at 6:32 PM on January 24 [1 favorite]

I understand there may be issues about societal norms and expectations of others about one's life (none of their business if you ask me), but justice? I'm just a tad confused.


From the first article:

"And so I had my operation, and am now unable to get pregnant. Because of the delay, I ended up having to have a more invasive, riskier procedure than I would otherwise have needed. And, of course, I had the long months of lots of medicine, lots of pain, and nagging awareness of the list of 'things you must go to the emergency room ASAP if you notice” that the surgeons’ stalling incurred."

The fact that she had to endure this because she did not have children is unjust.
posted by the young rope-rider at 6:34 PM on January 24 [20 favorites]

MultiplyDrafted, if you don't see what I'm getting at, I suggest you need to think about your tone. Nobody like to be hectored into reading something by being told that if you're not interested in reading it, you must just not care about justice, or truth, or suffering, or whatever. You're coming off sounding like a self-righterous undergraduate who wants to convert people to your way of seeing the world and pass judgment on those not inclined to spend their free time reading through the blogs of your choosing. Talking about something being "centrally relevant to questions of justice" just comes off as pompous.
posted by Dasein at 6:42 PM on January 24 [21 favorites]

Fascinating blog -- heartbreaking to read, especially to hear that someone's already fraught decision was made more fraught by her surgeons' attitudes. (Having said that I can understand their desire not to be sued by making sure she was sure, although perhaps that was taken a little too far.)

In the last few years, I've come across something similar in my pursuit of (a) information about freezing my eggs and (b) genetic testing for deafness so I have a chance to predict same in my future children.

In case of (a), I didn't do it -- apart from the fact that it was prohibitively expensive I was made to feel guilty for not having children NOW -- in fact I was told by the fertility doctor that if I wanted to have children I should ask my boyfriend (at the time, now ex) to impregnate me and that I shouldn't be selfish and worry too much about my career and just get on with making babies now. Never mind the fact that I was unsure about having children with my partner at the time and ambivalent about having children in general.

I then had some testing to see whether my eggs were worth freezing and it seemed his attitude was held by pretty much everyone I came across as part of that process. I was looked upon with pity. (I understand that there are other places in Melbourne that are much more understanding and kind about this sort of thing -- unfortunately I went to the wrong one!).

In the case of (b), I'm currently seeking genetic counseling to see if I carry a gene for deafness so my potential (maybe possibly) future children can be tested and let me tell you the people I am dealing with could not be nicer. It feels to me (and I'm willing to admit this could be a response to my very negative experience in (a)) like because I'm talking about the prospect of having children, thus staying within the norms, my wants and questions are being facilitated with pleasure rather than the reluctance I experienced before.

It's hard not to feel like the world values the desire to have children as being more important than whether those children are brought up by people who want them and who can give them what they need.

So yes, clearly this blog resonates -- thanks it's fascinating stuff.
posted by prettypretty at 6:49 PM on January 24 [2 favorites]

If you're not interested in reading it and/or you didn't read it, why are you commenting? Come on. Their tone is fine.
posted by the young rope-rider at 6:49 PM on January 24 [4 favorites]

(that was directed at dasein)
posted by the young rope-rider at 6:50 PM on January 24

Their tone is fine.

Their wording is full of "should" statements which detract from the strength of the actual link. It's pedantic, or even insulting, in its implications about those who may not be interested in reading it, and even goes further to say that if you are interested in W, X, Y, and Z, then there is implied shame upon you for having not been reading this other thing linked.

I found the linked blog in the FPP interesting to read, but agree with Dasein that the tone of the post could be better.
posted by hippybear at 6:54 PM on January 24 [2 favorites]

It's interesting that despite the much lower risk of complication for vasectomies than for tubal ligation, couples still seem to primarily pursue the latter.

Is is true that more people have tubal ligations than have vasectomies? That seems hard to believe, if for no other reason than that a vasectomy is usually a couple orders of magnitude cheaper.
posted by enn at 6:55 PM on January 24

If you're not interested in reading it and/or you didn't read it, why are you commenting?

I'm commenting because Metafilter is, or used to be, about self-policing. If the front page were full of posts telling us that we should read the links if we care about basic human values, the site would be unbearable. It's not a good way to frame a post, but neither is it worth a MeTa thread. Hence my choosing to comment in-thread.
posted by Dasein at 6:59 PM on January 24 [9 favorites]

Hearsay and anecdata, but during a recent doctor's visit, the medical technician started talking to me about an experience she had at a well-respected NYC hospital. Her PCOS is causing her to get very heavy, painful periods that are only nine days apart, and her doctor scheduled her for ovarian surgery that could result in infertility. At 6 a.m. on the morning of the surgery, with her already in a gown and on the gurney, she was informed that the hospital would not be performing the operation, because she does not yet have children. She said that she had already been over it with her doctor, and that she does not want children. They told her it was too bad, and that she had to go home, and just keep bleeding and cringing and letting the PCOS screw up her fertility anyway.

They also told her that, in order to get the surgery, her husband would need to attend a series of classes over the course of a year, before he could give full consent. Because his consent was required.

I thought she was making it up to scare me.
posted by evidenceofabsence at 6:59 PM on January 24 [44 favorites]

Wikipedia says that tubal ligations are more common, but doesn't provide any reference for that.
posted by hippybear at 7:00 PM on January 24

Oops. Sorry. The Wikipedia page which states that is the one on vasectomies, and is close to the top of the page, under "Gender Comparison".
posted by hippybear at 7:05 PM on January 24

Yeah, babies everywhere, that's what this world needs! Fucking christ. These docs are just like those asshole pharmacists who won't fill prescriptions for birth control.
posted by exogenous at 7:05 PM on January 24 [1 favorite]

This sort of thing frustrates and infuriates me. I went through some gynecological problems and a hysterectomy was one of the possible outcomes. But it was made very clear to me by my (female) doctor, that they wouldn't really consider that for a very long time because I didn't have kids.

That I didn't want kids, that I didn't anticipate ever wanting kids, was irrelevant. They wouldn't risk my fertility, even if it was medically necessary to relieve my other ongoing problems, despite the fact that I valued my fertility not at all, and valued not constantly bleeding and being in pain rather a lot.

That was 8 or 9 years ago, and it turned out that the situation was able to be resolved with less invasive measures. But I still don't want kids, and it still pisses me off that they took treatment options off the table on my behalf.

The same year, a male friend of mine who was unattached and had no children had an elective vasectomy. Because he didn't want kids and didn't want to have to worry about birth control failures. It was totally no problem, and no one questioned his decision at all.
posted by jacquilynne at 7:06 PM on January 24 [11 favorites]

Numbers on vasectomies vs. tubal ligations from Guttmacher.

(More than 2x as many tubal ligations than vasectomies.)
posted by pantarei70 at 7:08 PM on January 24 [1 favorite]

A recent article:
Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilization.
Anderson JE, Jamieson DJ, Warner L, Kissin DM, Nangia AK, Macaluso M.
Source
Women's Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 303041, USA.
Abstract
BACKGROUND:
Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population.
STUDY DESIGN:
We conducted an analysis of data from male and female samples of the 2006-2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15-44 years.
RESULTS:
Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%-16.3%), compared to 21.1% (17.8%-24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization.
CONCLUSIONS:
Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits.
posted by nasayre at 7:11 PM on January 24

I'm willing to forgive the wording of the post, even though the tone of this one post completely ruined the front page, because the content that was linked to is really fantastic and more people should be reading and thinking about the way reproductive norms are enforced. In this thread, I'd like to see more insight and anecdotes about people's experience, and less shrill bitching about tone. This is a really interesting and important topic and people interested in the OP's list of topics will be interested in this. I knew that vasectomies were ... 'challenging' to get, I want one, I'd love to afford it and I'd love to not have people questioning my long-thought-out decisions. To have this questioning and bullshit before a medically necessarily procedure is appalling.

Also: WATCH OUT! MEN MANPLAINING! NEWSFLASH: Men complaining about procedural issues in the face of gender issues! Offended by tone, not by prejudice against women! Film at never because the men walked out of the studio.
posted by fuq at 7:12 PM on January 24 [6 favorites]

(More than 2x as many tubal ligations than vasectomies.)

They measure it as the portion of total contraceptive use among women (10.4 million "users" of tubal ligation vs 3.8 million "users" of vasectomies). That's interesting and useful, but it doesn't tell us very much about the current rate at which the procedures are performed. A historical preference for tubal ligation would continue to affect "use" data for many years even if vasectomies subsequently became as popular or more popular due to the existing population of tubal ligation recipients.
posted by enn at 7:15 PM on January 24 [1 favorite]

I ask because my uncle is in reproductive medicine and lives in terror of getting sued again.

I can understand not wanting to get sued, but if I'm paying a doctor to take care of me, I would like them to put my health and well being ahead of a hypothetical lawsuit, or their personal opinions about childbearing.
posted by evidenceofabsence at 7:20 PM on January 24 [3 favorites]

Jesus. If you're a woman and you're in a situation like this, couldn't you threaten to sue them for malpractice? I realize that surgeons are afraid of being sued for rendering someone infertile, but couldn't they also be sued for delaying surgery in opposition to both patient wishes and standard medical procedures? You'd think this "terrified of being sued" excuse that doctors and surgeons are using could be turned around on its head and used in the patient's favor.
posted by infinitywaltz at 7:21 PM on January 24 [4 favorites]

Just to be fair, I had to sign a paper before my HUSBAND got his vasectomy.
posted by St. Alia of the Bunnies at 7:21 PM on January 24 [1 favorite]

The funny thing about malpractice lawsuits is that they don't have to prove they did the best thing for you, or even an adequate thing for you -- they just have to demonstrate that your treatments fell within the normal standard of care.

And since the normal standard of care is to treat women like wanna-be brood mares regardless of their actual opinions on the subject, you won't win the suit. Tricksy, no?
posted by jacquilynne at 7:26 PM on January 24 [7 favorites]

I don't want children of my own and I never have. I still get the "you will change your mind" but at 32 I think I'm near the peak of any biological clock.

I still felt guilt when I got an abortion- my body was able to do what so many other women's bodies couldn't. And yet it felt good to know that I could, even though I don't want to. So I can relate to the author's conflicted feelings.

And even though our society may be children-centric, I think it is also very isolating to the primary care provider (typically the mother). My sister is a stay at home mom, and her husband doesn't want her to have a side business so she can make some money. Her job is to stay home with the kids. And even though they are upper middle class, she is very isolated. I think it would be even worse if she didn't have a car or the means to go out and meet up with a friend and not stay at home and cook.

In every partnered parenting relationship I've seen up close has been hugely unequal. One parent typically bears the brunt of the burden. No way will I let that happen to me. And I can tell my parents are disappointed in my choice (and since I'm a woman in the US it is my choice), but I think my mother (who was the primary caretaker) understands why I don't want to take her path of a career and children. I don't think most women can have it all in our current setup in the US, and I'm not going to even try.
posted by Monday at 7:27 PM on January 24 [8 favorites]

Well now, it's not about "tone", it's that the MeFi standard is: posts are framed impartially. I would say in large part because if they are not, discussions inevitably derail into discussing the framing of the post rather than the content of the post. The post is supposed to stand on its own without the poster trying to convince everyone of its worth or that they should agree with it.

As to this post, aside from the framing (which I didn't like - not because I necessarily disagree with it, but I prefer posts that are impartially framed as do most members of MeFi) - I was interested in it and the link is good. Of course I find attempts to control women's reproductive choices abhorrent (especially at the risk of their health). When I read about stuff like this, it reminds me that even though things have obviously come a long way, it was not very long ago that everything was so different and we still have a long way to go. I bristle when people tell me feminism is not relevant, we are equal now; it's not true, and pieces like this bear the proof of that.

On the disparity between vasectomies and tubal ligation (when vasectomies are much cheaper, and easier to recover from), I suspect there is a connection with the number of C-sections performed in the US. Offering to do a tubal ligation "while we're in there and it's convenient, if you're done having kids" is pretty standard, I thought. And the C-section rate in the US is higher than it is in other countries. Here in Ontario, vasectomies are so common, that (anecdotally) it seems to be the standard in birth control among the couples I know, when they are done having children. That may be because it's covered under the provincial health insurance (read: free, I think).
posted by flex at 7:37 PM on January 24 [2 favorites]

[Folks - further tone argument stuff can go to MeTa, it's starting to get derailly here. Thank you.]
posted by jessamyn at 7:42 PM on January 24 [3 favorites]

How funny that the "Oh we have to ignore your wishes or we'll be sued," argument is used in this case as well as in decisions about how (or even when) to give birth. And by funny I mean rage-inducing. The only difference is that it's possible for some women to just give the establishment the finger and give birth at home/with a midwife if you're determined enough, (and boy do lots of OBs hate that) whereas you can't tie your own tubes.

They hold all the power, and OH NO LAWSUIT may be their excuse, but c'mon. SURELY it would be possible to draw up a legal document that covers their asses? I mean, you can sign a contract to go on a reality show and get nibbled by rats. You can sign a contract to work at a nuclear plant fer cryin out loud. But no legal document in the world is capable of protecting a doctor against a patient who regrets getting her tubes tied, therefore all women have to just wait for the Menopause Fairy? I don't buy it. I call Patriarchal Bullshit.
posted by emjaybee at 7:43 PM on January 24 [36 favorites]

I was never one of those women who knew she wanted kids. I figured if some point I ended up in a situation where it seemed the right thing to do, I would, but it was never something I felt needed to happen. So when I needed a hysterectomy, I didn't find myself crushed by becoming infertile. After the fact, I'm delighted by my hysterectomy and not just because it meant I didn't have cancer. (well, not for another few years when i had a second go-round but that's a different thing)

In some way, it sort of simplified things. The fertility decision was now made, irrevocably, in my life. Sure, there were possible workarounds for getting kids, but I would not make them myself from parts around the house.

But I have to say, at the time, hearing the phrase "preventative hysterectomy" - in the context of historical injustice and ad-hoc eugenics and general disrespect that much of the medical profession and industry have been known to have for women... The phrase "preventative hysterectomy" pretty much freaked me out. So I went and got a second opinion from a fairly young female doctor at a hospital unaffiliated with the practice my regular gyn (who was older and male) worked at.
posted by rmd1023 at 7:43 PM on January 24 [1 favorite]

In the early 1990s, my partner at the time was diagnosed with really horrible fibroids. Various treatments did not shrink them much, and mostly just made her bleed like she'd been stabbed, for weeks on end. She asked early and often about a hysterectomy, and got nothing but pushback, all of it of the "But you might want children someday!" variety. She was in her late 20s, and her feelings on having children were pretty settled (no). She went and found a doctor who would listen to her, and had a hysterectomy.
posted by rtha at 7:48 PM on January 24 [3 favorites]

The funny thing about malpractice lawsuits is that they don't have to prove they did the best thing for you, or even an adequate thing for you -- they just have to demonstrate that your treatments fell within the normal standard of care.

Yeah, but it seems like doctors and surgeons are even terrified of groundless lawsuits, because it still makes their malpractice insurance go up. You'd think you'd be able to turn that "But we're so scared of being SUED" excuse and turn it around on its head.

(Not that I suppose you'd want someone operating on you after you've threatened to sue them, of course, but still.)
posted by infinitywaltz at 7:55 PM on January 24

Whoa, that's horrifying. I fully intend to have child(ren) at some point-- a point of my and my partner's choosing-- in the not-near-future, but this post has really clarified how baby-focused medicine tends to be, even when the patient specifically wants what her own body needs. And here I thought the incessant pregnancy tests and questions at every health center and doctor's office visit were bad (What, you're a virgin? But you're in college! Potential Babies! Everywhere! Even if you're a lesbian! Paraphrasing, here, from various friends, but the consistency was remarkable.) I have a friend who needed a surgery more commonly used for women who are having severe difficulties conceiving; her own symptoms included crippling pain, bleeding, hospital stays, etc. She and her primary doctors had to argue for over a month with her insurance that she couldn't prove a year's worth of failed conception, because she needed it for something else entirely....just, you know, not babies.

My thoughts are with the author of the article: I hope she finds her path, medically, professionally, and personally, easier in the future. She seems like she's part of a freaking fantastic family.
posted by jetlagaddict at 8:00 PM on January 24

emjaybee a determined enough lawyer can wiggle through any contract. And a contract that stated 'I release so-and-so from all indemnity for any action forever and ever, amen," would pretty clearly contravene standards of care, and I don't think anyone would sign it anyway.
posted by the man of twists and turns at 8:04 PM on January 24

MeTa.
posted by Brandon Blatcher at 8:23 PM on January 24 [1 favorite]

Fascinating piece; infuriating story.

That said, I didn't know infertility was taboo. My extended group of friends talk about it regularly. (Granted, we are of that age where some are having babies and some are having trouble having babies.) I think what's sort of taboo - in the sense that people don't know what to say or how to say it - is great sorrow. So if someone is infertile by choice - great. By luck but they're happy or indifferent - great. But if they are dealing with infertility and are devastated about it - well that's not something one would bring up casually be because one wouldn't want to be hurtful or otherwise step in it.
posted by semacd at 9:04 PM on January 24

Every time I read stories like the linked post and the ones in this thread, I'm grateful that I had such an easy (relatively) time getting my tubes tied. I admit to wondering whether it has to do with my health status, which has always been my fallback derail for anyone insisting I ought to have babies. (And yes, even though I never wanted kids, there was a sadness to giving that up. I'm happy without them but there's always sadness with a closing door in life.)
posted by immlass at 9:11 PM on January 24

How does that work? Do they testify on behalf of the doctor or something if needed down the road?

Any decent hospital should have a separate "Patient Care" (or similar sounding name) department, where patients can directly take any complaints or compliments.
posted by Brandon Blatcher at 9:23 PM on January 24

emjaybee a determined enough lawyer can wiggle through any contract. And a contract that stated 'I release so-and-so from all indemnity for any action forever and ever, amen," would pretty clearly contravene standards of care, and I don't think anyone would sign it anyway.

I still don't buy this. We have ways of allowing people to do things that include risk in our society, and if we can't find a way to include "risk that I might regret a medical decision I signed off on," how can we include larger risks in contracts? Yet, we do. Every day. Except when it involves women making reproductive choices; somehow magically that becomes a greater risk than any other.

It's one thing for a patient to sue a doctor for doing something they didn't ask for. It's another entirely to sue them for something you gave full legal consent for. I refuse to believe our legal system is incapable of understanding the difference.

I do feel some sympathy for doctors in malpractice situations under our current system. I just don't agree that it's ok for them to defend themselves by sacrificing the bodies and liberties of half the population. Doctors who don't like our current system need to find another route to reform, because my autonomy is not an acceptable shortcut to their legal protection.
posted by emjaybee at 9:48 PM on January 24 [10 favorites]

I don't even have words for how upset and angry the linked blog post and some of the stories related above make me. It was weird in that as I began reading the blog post, my first thought was, well, sure, it makes sense to be hesitant about performing a procedure that will have irreversible consequences that might possibly cause the patient later regret. But then her story continued and the events blew right past any normal, reasonable, justifiable concerns and far into misogynistic seeing-women-as-baby-machines territory and it was simply nothing other than horrifying.

This has everything to do with how deeply sexist medicine has always been, and still is in many respects. It's within living memory that involuntary total hysterectomies were performed as "treatment" for female sexual promiscuity. The week-off of the birth-control pill was made the standard therapy in its development without regard to the preferences of any women but, rather, to ensure that the therapy didn't allow women to do anything so "unnatural" as to avoid the judeo-christian menstrual "punishment". Patriarchal thinking runs deep in scientific medicine's approach to women's health care; it's apparent in how it has traditionally, and still does, approach everything from regular gynecological exams to giving birth to medical recommendations about diet during pregnancy, to medical discussions about breast-feeding. And, of course, in general women's medical access to birth-control (or simply in that female birth control is thoroughly and exclusively medicalized!) is itself so vividly representative of the patriarchy of medicine.

I'm hard pressed to think of a more indisputable and extreme example of institutionalized sexism in our society outside of sex work or the institutionalized forms of sexual violence, of which at times medicine itself is arguably guilty.

And, by the way, I absolutely am not, in general, a critic of medicine or an advocate of so-called alternative medicine. For the most part, I think western scientific medicine is a very good thing. But in the particular context of how it has, and still does, view and treat women, in general? Not at all.

"Doctors who don't like our current system need to find another route to reform, because my autonomy is not an acceptable shortcut to their legal protection."

Amen.

In this case, or for example in the case of birth-control, what causes me to be forced to lean my head back and close my eyes and stifle a need to scream and hit things is I just don't understand why we tolerate this. And by "we", I mean both men and women. I mean all of us. Of course, I understand why men tolerate this: because for many men, it doesn't matter or it furthers their own personal interests. Or, mostly, they're just ignorant (often willfully). What's a bit harder to understand is why women tolerate this. But then, all people tend to tolerate what is "normal" and conventional. It's hard for most people to even imagine anything other than what is "normal" and conventional.

But still. We don't have to accept this. We don't.
posted by Ivan Fyodorovich at 10:19 PM on January 24 [21 favorites]

I fully support the right of a person to end their fertility, without having to justify it on health grounds. However, having been on the edges of fertility treatment - we skipped IVF, but an unplanned pregnancy much later on led to a highly medicalized pregnancy and any future pregnancies will likely require medical support - the doctors may have a broader perspective they're drawing on, where women who fully want to be childfree young are the exception, not the norm, and they're maybe mainly dealing with women who are infertile by choice or medical side-effects and very much wish not to be.

If the majority of your patients desperately want to be pregnant, you're going to hesitate on ending fertility early, having possibly just had a distraught woman leave your office after agreeing to expensive risky treatment to reverse her fertility loss right beforehand.

I'd be interested in actual percentages of opting in to infertility vs fertility treatment, although this still doesn't excuse medical staff being asses, maybe it explains some of their hesitation.
posted by viggorlijah at 10:21 PM on January 24

Not adhering to the standard of care out of fear of a future lawsuit 10 years down the line is understandable from a human perspective, but still a violation of the doctors role to act in the best interests of the patient's health.

It's one thing for a patient to sue a doctor for doing something they didn't ask for. It's another entirely to sue them for something you gave full legal consent for. I refuse to believe our legal system is incapable of understanding the difference.

I think if it came to trial the legal system would sort it out nicely, the issue seems to be that so many people have an emotional reaction and sue then settle that the malpractice insurance still skyrockets.

I hope someday that it is possible to have a standard disclaimer that is legislated to be sufficient informed consent for that kind of procedure (summary judgment against plaintiff?) I suspect the devil is in the details though.
posted by BrotherCaine at 10:22 PM on January 24

Our legal system is as good as the people who render its verdicts. If jurors in medical malpractice lawsuits (or judges, in bench trials) generally exhibit a BABIES FOREVER!! attitude when considering lawsuits relating to women's reproduction, insurers and doctors will be highly incented to avoid any circumstances which might provoke such a trial.

This could be indicative of bias at the societal level as well as within the medical profession.
posted by SakuraK at 10:26 PM on January 24 [5 favorites]

"If the majority of your patients desperately want to be pregnant, you're going to hesitate on ending fertility early, having possibly just had a distraught woman leave your office after agreeing to expensive risky treatment to reverse her fertility loss right beforehand. "

Well, sure. Right up until your patient strongly and clearly tells you otherwise. Then you listen to her. I don't think this is complicated.
posted by Ivan Fyodorovich at 10:31 PM on January 24 [9 favorites]

SakuraK, 95-98% of cases settle out of court. It could be that the jury never finds for the plaintiff in these kinds of cases and it's still a huge economic burden for doctors. Absent some legislative change that makes summary dismissal of these types of cases easier I don't think we can lessen the fiscal disincentive for surgeons to do procedures that end fertility in women or men.
posted by BrotherCaine at 10:37 PM on January 24

This is story is so incredibly infuriating, and I applaud the author's ability to present it so thoughtfully, if only because I know I would've just been pounding on the keyboard in rage past a certain point. I would say that I can't believe that her (initial) surgeons were putting off a necessary surgical intervention and telling her to try to get pregnant regardless of the medical reasons and her personal decision not to, but unfortunately I can believe it all too easily.

It's like there's this expectation that "biological imperative" (or the elusive "biological clock") will completely overrun any of the numerous reasons women cite for not wanting children, if not right at the moment they're saying they don't want children, then eventually. (I've heard this one before, on more than one occasion: "Oh, you say you don't want kids now, but once your biological clock starts ticking you'll change your mind!" Um, no. Also: hell no. I wasn't planning on ever having children before I became a quad, I sure as hell won't be changing my mind now). There seems to be a societal assumption going on, especially among certain populations, that if you're a young female it's your job to have babies, you'll want to have babies sooner or later, and that therefore it's okay to ignore what women themselves say they want now because surely they're going to change their mind later!. Which no, emphatically, it is not, even if you could know that they were going to change their mind down the road with any degree of certainty.
posted by clavier at 10:54 PM on January 24 [4 favorites]

What do you know - thirteen years later and I'm *still* pissed I had to get my (now) ex-husband's permission to get my tubes tied. Because his unemployed, alcoholic, cheating ass was clearly better equipped to make decisions about my own body than I was.

I can't even.

Man, did I know how to pick 'em?
posted by Space Kitty at 10:59 PM on January 24 [5 favorites]

"It's like there's this expectation that "biological imperative" (or the elusive "biological clock") will completely overrun any of the numerous reasons women cite for not wanting children, if not right at the moment they're saying they don't want children, then eventually."

Yeah.

To provide a bit of context from a very different perspective, as a 47 year-old man who's been married and divorced and been involved in a few other long-term serious relationships but never had kids, though always wanted one, I find myself now with a nearly constant profound sadness that I don't have a child, that I can't just have a child, that I'm old and that even were I to somehow have a child today, I'd be 65 when the child graduated from high school.

Which is to say, it seems to me that I feel quite a bit like how I've heard many childless women feel at my age. None I know among my peers, interestingly—because my peers are divided between the people I grew up with, who are all middle-aged small-town conservatives who have grown children, and people who are more my peers in life-experience and beliefs and they're either thirtysomething parents of younger children or childless with no regrets. So no one I know is in my position, male or female.

And, anyway, it's really weird because I feel like no one I know takes how I feel about this seriously. Not even a little bit. I often feel like if I were female, people would understand that this really bothers me a lot.

So, anyway, my point isn't to talk about this because I'm a special snowflake and all "let's talk about my problems as a male". Not at all. My point was to make it obvious how screwed up our culture really is with regard to these issues. On the one hand, it very often essentially views women as baby-machines and disregards individual women's beliefs and desires in service to that view. On the other hand, it hardly has any sense at all of an importance of children to men.

And doesn't that tell us quite a bit about how screwed up these beliefs and values are? How lopsided? How unjust? I'm unhappy in my particular circumstance, but at least I'm not dehumanized to some degree and seen as something that is subordinated to society's need to produce children.

You can see this not just in how people react to female infertility and women's choices to remain childless, but also how people react to pregnant women and mothers. Suddenly, they're community property. Pregnant women are told what to eat and how to behave. Mothers are judged incessantly.

In this context, it's no wonder that surgeons entirely disregard an individual woman's desire to have a medically necessary surgery that would result in infertility. As SakuraK point out, the notion that this is a malpractice tort problem is wrong. It's a social problem.

"What do you know - thirteen years later and I'm *still* pissed I had to get my (now) ex-husband's permission to get my tubes tied. Because his unemployed, alcoholic, cheating ass was clearly better equipped to make decisions about my own body than I was."

Alia mentioned that she had to sign something for her husband to get a vasectomy. But that doesn't make any of this right, assuming there is symmetry (which I don't assume). It's wrong. Totally and completely wrong, from either direction. I wasn't aware of this practice and it's...appalling. I don't even know how else to describe it.
posted by Ivan Fyodorovich at 11:15 PM on January 24 [12 favorites]

If the majority of your patients desperately want to be pregnant, you're going to hesitate on ending fertility early, having possibly just had a distraught woman leave your office after agreeing to expensive risky treatment to reverse her fertility loss right beforehand.

Even when that hesitation threatens the health of the women? Patients need to be addressed on a case-by-case basis. Nutritionists can somehow treat patients who desperately need to load calories, as well as those who desperately need to lose weight. I don't think it's too much to ask ob/gyns to remember the gyn half of their job description.
posted by evidenceofabsence at 12:13 AM on January 25 [5 favorites]

I guess we need sterilization clinics run by doctors who don't second-guess patient decisions. "You want a hysterectomy? Let's get started. I'll be your medical partner throughout the process, and we have volunteers on call to give you legal assistance if needed. Now let's go in here, have a cup of coffee, and talk about your health, your goals, and what you want to change about your life..."

How much do the laws differ from state to state? Judge to judge? There may be optimal places and less-than-optimal places in which to locate a sterilization clinic.
posted by pracowity at 12:43 AM on January 25

A friend of mine ran into something similar - absolutely sceaming debilitating cramps every month, but couldn't get the treatment she needed, because it would keep her from having kids. She knew she didn't want kids - she was dealing with some conditions that would actually make it pretty irresponsable of her to become a mother, but there it was - she wasn't allowed to make her own choice in the matter. grrr
posted by 5_13_23_42_69_666 at 3:13 AM on January 25

Part of the problem it that it's too easy to dismiss women who suffer from catastrophic menstrual pain. Periods are natural! Just eat some chocolate, ladies! I had to pass out from pain in the middle of a seminar to finally, finally, after suffering for years, be taken seriously by a doctor.
posted by prefpara at 5:46 AM on January 25 [8 favorites]

Regarding the lawsuit issue ... reproductive medicine is typically the highest- or second-highest-cost malpractice insurance in medicine. (Neurosurgery is usually the other.) Ob/gyns get sued a LOT. "There's a tort problem" isn't patriarchy hiding behind a flimsy excuse -- this is an actual and serious problem. There are tables you can look at to see how many times and for what specific doctors have been sued (actually, there are tables with this data that lawyers look at -- I'm not actually sure if the general public can see them or if they're internal data compiled by hospitals and insurers). Anyway, my point is, you can look at the data, you can look at the actuarial tables by the people whose job it is to price the risk of lawsuit, and doctors get sued for doing tubals (and related, fertility-ending procedures) on women who later change their minds a LOT.

The thing is, the cost isn't in the jury award, or in an unsympathetic, patriarchal judge, or even in a backwards legislature -- these cases get dismissed or settled. The cost is in that any idiot can bring a lawsuit for any thing they want. Angry, emotional patients bring lawsuits; and those are not always patients with real complaints and good lawsuits. Medical malpractice lawsuits are as much about striking back at the entity that made you angry as they are about actual medical practice. So Jane Doe, who had an elective tubal but has now changed her mind and can't afford to have it reversed, or it can't be reversed, gets in a new relationship and turns around and sues the hospital that did the tubal. It doesn't MATTER if the judge throws it out at the first hearing -- the hospital has to spend money and time responding to it (and these cases are traumatic for doctors, they get very upset). Your malpractice insurer tracks cases closely across the state, and they'll be able to tell you what types of patients are more likely to bring lawsuits, and women seeking permanent sterilization who have not had children are fairly highly likely to sue. (Another high-lawsuit patient is the woman seeking invasive fertility procedures; another is the elective plastic surgery patient, but they're very high-profit too.)

So, if I ran a hospital with today's constraints, and I were attempting to be more responsive to the childless women who are seeking surgical sterility, I'd probably put in place a counseling program where the a psychiatrist employed by the hospital examines the woman, maybe two or three times over a period of a couple of months, to ensure this is a well-thought-out, serious desire, and that the patient understands the implications and effects. Because the women who don't sue and the women who do sue look pretty much the same at the point of delivery, but fertility clinics that employ psychological screening have okay results at reducing (not removing) the number of lawsuits they get, so I'd give it a try. (I am sure, incidentally, this would be rejected as patriarchally insisting women don't know their own minds, but I, as the hospital administrator, have concerns about insurance, not patriarchy.)

So here's what would happen to my (imaginary) hospital -- the very fact that I was performing more sterility surgeries would increase my insurance rates. After probably a 2-5-year latency, the lawsuits would start coming in -- less than there would have been without my screening program, but more than there were before the hospital started accommodating elective sterility procedures on nulliparous women -- and every lawsuit that was filed would raise those rates more. And I'd be trying to defend to my board that the extra costs in lawyers and insurance rates was worth it to practice good medicine, and some of them would make the very fair point that if it's that expensive in lawsuits, it's probably not good medicine. At a certain point our malpractice insurer would refuse to insure us and we'd have to go out for bids on new insurance, and they would be ugly. And at some point there'd be a turnover in boards, probably before the new culture was fully established, and the board would say, we are bleeding money on this small subset of patients, go back to doing it the way everyone else who gets sued way less does it. I'd probably have the best luck convincing the board that the increased cost was good medicine at a non-religiously-affiliated private women's hospital with a board of all-women, but that's a pretty limited set of hospitals.

Yet on the flip side, measures to control malpractice insurance costs by capping recovery aren't good for consumers; they mostly make it so people with genuine malpractice cases can't get adequate recoveries to cover their costs, while frivolous little lawsuits continue to proliferate.

Not that there isn't a lot of patriarchal glurge clogging up the system. But it's hard to overstate how much an organization's activities are directed by insurance, particularly in a high-lawsuit area like medicine. Totally different organization, we had a completely baseless civil rights lawsuit brought against us (which is an ugly thing, because those are accusations of racism, sexism, etc.) but they take forever to have dismissed because judges give them careful scrutiny, and often go to trial even when clearly baseless because of the very high level of scrutiny. So by the time we were talking dismissal, opposing counsel had run up $750,000 in (clearly partly spurious) bills and our insurance limit was around $1.2 million, and in any settlement plaintiff was going to have lawyers' fees paid for, because otherwise what was the point of the settlement? Plaintiff's lawyer was making the point that by the time we got to trial, the fees would be over our insurance limit, and the insurer looked at it and said, "You can settle now within the limits, or, if you refuse a settlement offer that we direct you to take, the policy no longer applies and you're own your own." And basically forced us to settle, and then refused to insure is any longer because we settled such a huge case, and putting ourselves out for new bids jacked our rates through the roof. But we'd already spent $200,000 on our own lawyers and the trial hadn't started and we could settle and take the lumps, or go to court, eventually win, but take a lot MORE lumps before then and cost several more arms and legs, and divert time and resources, and expose employees to testifying about how racist they were, and so on. What's worse is that other attorneys will now try the same gambit, but it's tough to convince your insurer to take on additional exposure to just try ONE of these 8,000 copy-cat cases to show you're playing tough.

One suggestion I've seen is to force plaintiff's LAWYER to pay (a portion of) the defense's costs if the case is thrown out right away (not the plaintiff, because that disadvantages individual plaintiffs against big corporations), in theory to discourage lawyers from bringing frivolous lawsuits that the lawyer knows won't succeed in court -- but they may well get a settlement anyway from a gun-shy insurer. But I think that would actually make judges more reluctant to throw cases out early and stick the attorney with such a big penalty, and probably judges should be more spiritedly enforcing current sanctions against attorneys who bring frivolous lawsuits before we worry about new ones.

TL;dr: Sue-ers gonna sue, and this is an area where patients get upset (even in the article, she talks about the unexpected emotional fallout), and upset patients are more likely to sue.
posted by Eyebrows McGee at 6:07 AM on January 25 [20 favorites]

I also meant to say, I think the history of (extremely patriarchal and quite racist) forced sterilization in the U.S. makes laws encouraging summary dismissal (as BrotherCaine suggests) a tricky thing; it's not that long ago that hospitals in the U.S. were merrily sterilizing people on eugenic grounds. Someone complains that their doctor was too eager in counseling sterilization and their signature on the informed consent form wasn't fully informed, and you've got not just a lawsuit but a big frakking Constitutional lawsuit on your hands. I think the courts and legislatures will tend to want to scrutinize elective sterility MORE closely to prevent similar abuses, not less closely; and I think people forget that the ugly, ugly history of forced sterilizations is part of why the medical profession is jumpy about it as a profession.
posted by Eyebrows McGee at 6:15 AM on January 25 [3 favorites]

There are some stats on the recent trend toward voluntary childlessness in this thesis, in case anyone is interested.
posted by evidenceofabsence at 7:57 AM on January 25

Eyebrows McGee, it is a patriarchy problem though, in that it overwhelmingly affects women. I can't speak as to the forces leading to post-sterilization lawsuits, but it certainly seems like something that deserves further study, rather than just assuming that Women are Crazy and Irrational. I know that's not what you said, but the implication certainly comes through in what you outlined. Why do so many sue...what is this dynamic? What has been tried (other than denying requests for sterilization) to prevent it?

Shrugging and assuming nothing can change and women as a whole just have to keep putting up with this shit is not an option. It's inherently unjust.
posted by emjaybee at 8:35 AM on January 25 [3 favorites]

I find the attitudes of the doctors in this article disgusting. I've had people look askance at me when I say I don't ever want to be pregnant, but luckily have not received judgement from any medical professionals. Though one of my first OB-Gyns was an old, old guy who upon hearing I didn't want birth control because was only dating women (the case at the time I saw him, anyway) decided he needed to have a private talk with me in his office about whether I'd been abused by an ex-boyfriend and whether I "put things in my vagina."

I can't speak as to the forces leading to post-sterilization lawsuits, but it certainly seems like something that deserves further study, rather than just assuming that Women are Crazy and Irrational.

While I am a proponent of overhauling the sexist attitudes in the medical establishment, I don't think pointing out that a lot of people change their minds about having kids translates to "Women Are Crazy And Irrational." It just so happens that there are not a few young people who say they don't want kids in their early 20s, but change their mind later on. I know this is the case for most of my female friends.

There haven't been a few questions on AskMetafilter involving women commiserating over their confusion at suddenly being hit with an intense desire to have a kid in their late 20s or early 30s despite not wanting kids prior to that. Changing one's mind about having kids isn't unique to women either, a lot of guys change their minds as well. And for what it's worth, while I doubt they're confronted with the same level of resistance as women, young childless men seeking vasectomies often get the "Are you sure?" treatment from doctors.

Sterilization should be approached as a pretty serious procedure. If someone is seeking elective sterilization for non-medical reasons then I would understand if a doctor or hospital wanted pre-operative counseling or a waiting period of a few months, same as a responsible doctor would do for any serious elective operation. Emphasis on non-medical reasons though! If it is the case that the procedure is going to relieve pain and suffering and pregnancy would be dangerous for the mother, as in the case of the author, then obviously that's a different case.
posted by schroedinger at 8:59 AM on January 25

decided he needed to have a private talk with me in his office about whether I'd been abused by an ex-boyfriend and whether I "put things in my vagina."

*goes back in time and punches schroedinger's doctor in the nuts*

If it is the case that the procedure is going to relieve pain and suffering and pregnancy would be dangerous for the mother, as in the case of the author, then obviously that's a different case.

The thing that pissed me off almost more than anything else when my ex was going through this is that doctors told her that if she did get pregnant and want to carry to term, the pregnancy would be extremely difficult and quite dangerous because of the number and placement of her fibroids. And if she had the operation they were advocating, in which the worst of the fibroids would be removed, the resulting scar tissue would add to the risk of carrying a pregnancy to term. And there was no guarantee that the fibroids wouldn't come back. In fact, she was told, they probably would. But it took getting I think three opinions before she found a doc who was willing to do a hysterectomy.
posted by rtha at 9:47 AM on January 25 [1 favorite]

"Shrugging and assuming nothing can change and women as a whole just have to keep putting up with this shit is not an option. It's inherently unjust."

That's certainly not my attitude. My issue -- and I actually see this a lot in philosophy (though not in this particular blog post, but yes in this particular thread) -- is when people want to fix a problem -- nulliparous women seeking elective sterilization being denied a medical choice they ought to have -- and they go about fixing that problem in a wholly theoretical universe that is NOT THE ONE WE LIVE IN. I mean, yes, some of the doctors she quoted in her blog posts are appalling and ought to be spoken to sternly by HR at the very least and have the idea that women have brains too explained to them, since they missed it in anatomy class. But we can rail against the patriarchy and its negative influences on women's health choices until the cows (and bulls!) come home, but if you don't address the actuarial and insurance issue that is a HUGE driver of hospital policies on this, you won't have done anything.

When people want to fix things in the actual world, they often confuse "best of all possible worlds" philosophizing or idealistic rhetoric (both of which are good and useful things!) with how the world actually functions. If we want to talk about how women's health ought to be treated -- and that's an important and hopefully ongoing conversation -- great, and there's a lot to say about patriarchy and so on. But if we want to fix this specific problem in this specific time and place you have an actuarial problem. You have an insurance problem. You have a lawsuit problem. You have enough women seeking sterilization and then changing their minds and suing about it that you have to think of how to address that so that hospitals will be willing to change their policies and won't go bankrupt from insurance costs. And when you start considering that, you're considering an existing world of interlocking regulations, conditions, laws, etc. Because the world we live in isn't ideal; it's real.

As I said, if I were a hospital administrator, I'd start with pre-sterilization counseling, which I know a lot of people would find intrusive and patriarchal, but it's a method that's used in similar high-lawsuit areas of elective medicine (gender reassignment surgery, intrusive fertility treatments, certain kinds of plastic surgery) that does seem to reduce "regretful mind-changers" and resulting lawsuits. There are certainly other things one could try, but that one seems minimally invasive, part of a good standard of care, likely to appease insurers, and to have a decent chance of working. So that's where I, personally, would start if I were trying to fix this.

I'd also look at the strong class and race dimensions to female sterilization (mentioned with the Guttmacher links, above), and the strong class and race history of forced sterilization, and think real hard about that. I'm certainly willing to believe that poor women of color get encouraged to make a permanent decision while wealthy white women get told to protect their fertility. It's not a single story, and there are a lot of dimensions to it and messy realities. There's no easy fix. Sorry.
posted by Eyebrows McGee at 10:18 AM on January 25 [5 favorites]

I guess we need sterilization clinics run by doctors who don't second-guess patient decisions.

Yes.

(Although I'd never call them a "sterilization clinic," obviously, because they're more than that, and it feeds into reactionary propaganda.)
posted by Kadin2048 at 10:29 AM on January 25 [1 favorite]

Offering to do a tubal ligation "while we're in there and it's convenient, if you're done having kids" is pretty standard, I thought. - Happened to my mother in 1980 with her third (C-section) kid; I think they also offered to take out her appendix. (IIRC, she turned down both offers.)
posted by epersonae at 10:49 AM on January 25

It's frustrating to me the amount of crap we take from the medical professional in general. I didn't get a feel from the article as to how aggressively she told the male doctors to take a flying fuck, but so many people (especially those of the older baby boomer ages) still view a doctor as a god-like figure, and don't question or demand or walk away when they are unhappy. Me? I shop for doctors. If you make me wait more than a half hour in the waiting room? Gone. If you don't listen to me and talk condescendingly to me? Gone. If your front office is a mess and your nurses and clerical staff are rude and unorganized? Gone. It's never going to change unless there are consequences for it..and mostly money consequences. I am baffled why this woman didn't just leave and immediately find another surgeon after the first go-round. Your health is at risk and you're wasting time having philosophical discussions with Father Knows Best?
posted by Kokopuff at 10:51 AM on January 25

I am baffled why this woman didn't just leave and immediately find another surgeon after the first go-round.

This may not have been true specifically for her, but when my ex and I were doing this dance it took months to get appointments with in-network doctors for second and third opinions, since my ex wasn't in danger of keeling over dead in the next ten minutes. It wasn't like we had to money to just call up three random (not affiliated with our insurance) ob/gyn surgeons and demand they see us the next day.
posted by rtha at 11:00 AM on January 25 [1 favorite]

I wanted my tubes tied after my son was born. I was 38, it had been a tricky surprise pregnancy, and labor went on for 27 hours before I could get a c-section. But because it was a Baptist hospital, and I hadn't gone through counseling, I wasn't allowed to have the procedure, even though birth control pills are contraindicated in my case. So, not just young childless women, it's pretty much all women of gestational age.
posted by dejah420 at 12:14 PM on January 25

"This may not have been true specifically for her, but when my ex and I were doing this dance it took months to get appointments with in-network doctors for second and third opinions, since my ex wasn't in danger of keeling over dead in the next ten minutes. It wasn't like we had to money to just call up three random (not affiliated with our insurance) ob/gyn surgeons and demand they see us the next day."

Yeah, as a practical matter, there's a lot of barriers to patient empowerment.

That said, as someone with a chronic, genetic, lifelong medical condition who's dealt with doctors all my life, I can assert with confidence that the biggest problem with the "god-like figure" view of doctors isn't just that it's false and they're fallible, but that the very best patient care is dependent upon the patient and physician working together cooperatively. That depends upon patient empowerment and education.

A lot of doctors don't like this, of course. And to some degree it's understandable, given how stupid and ignorant people can be, in general. Given how the US system is working these days, working with a patient past that mountain of ignorance is something for which there's little or no time allotted. So I sympathize.

Even so, there are a couple of fundamental truths (among others) about medicine that are extremely important to remember. First, that medicine is still as much an art as a science and as much a craft as a technology; that is to say, we still know very little relative to what we'd like to know, or often think we know, and there's enormous uncertainty and insurmountable unknowns. Second, both essentially and especially in conjunction with the previous, no physician can ever know a patient's own body as well as the patient does. How well the patient understands both intuitively and intellectually what is happening with their body directly translates to their ability to communicate to the physician information that the physician would otherwise lack. In this sense, the best outcomes depend upon an actively cooperative and informed patient involved in their own care.

So it's vitally important that we, as patients, are activist in our own care, even though the system stacks the deck against us. And this is doubly important in the case of women's health care, because the culture itself further stacks the deck against empowerment. This is not a small part of why outcomes in women's health care are often statistically poorer than others.
posted by Ivan Fyodorovich at 12:24 PM on January 25 [1 favorite]

So, not just young childless women, it's pretty much all women of gestational age.

Sad but true. My mom, who was 42 and had had 6 kids still had trouble convincing her doctor to tie her tubes after my youngest sister was born (after a very, very difficult pregnancy). Because clearly birth control pills and waiting for menopause to set in was working so well for her.
posted by clavier at 12:39 PM on January 25 [1 favorite]

Wow, this is infuriating. Endangering someone's life so they can have something they don't even want? Is there some human shortage I haven't heard about? Is the world becoming dangerously underpopulated? Are people who don't want to grow their own humans crazy and selfish?

----

The tubal ligation vs. vasectomy thing doesn't sound that strange to me. It's seriously an individual choice and not a couples choice. There's no male-half and female-half, and they decide who's going to take the hit for the good of the team. They're just two people who are together for an amount of time, and it might be the case that both of them are done having children, or that one of them is REALLY done having children, and the other one is just done having children with you.
posted by TheKM at 2:39 PM on January 25 [1 favorite]

Also: Women endure pregnancy, if that was a risk for me I'd be looking to have some cutting done ASAP.
posted by TheKM at 2:40 PM on January 25

I am baffled why this woman didn't just leave and immediately find another surgeon after the first go-round.

I don't have insurance, because I am marginally employed. It's hard enough to make the decision to seek medical care, to begin with. As it happens, the base rate for my gynecologist (who I last saw when I had insurance) is $350 an appointment, before the cost of any and all tests. I don't want to know what it costs to consult with a surgeon, let alone several.

But if we want to fix this specific problem in this specific time and place you have an actuarial problem. You have an insurance problem. You have a lawsuit problem.

That's likely true, and I appreciate your thoughtful, well-written comments. But the patriarchal problem is just as real, and needs to be addressed just as much. Even if tort reform were to pass, after a long and onerous legislative process, lawsuits won't disappear entirely. Meanwhile, said tort reform isn't going to eliminate blanket dismissals of female patients' concerns (which extend to issues that have nothing to do with sensitive topics like fertility), or the resultant lack of provision of care.
posted by evidenceofabsence at 3:09 PM on January 25 [1 favorite]

I know one person who, in her 20s, managed to get her tubes tied. Twenty years later she decided she wanted kids (and adopted). She did not, as it turns out, regret that she got her tubes tied. So even if we assume (with some reason) that some women who get their tubes tied will change their minds about wanting kids, there is no reason to assume that they will be angry about this, much less go off and sue the doctor.
posted by jeather at 3:18 PM on January 25

Hey! I'm not reproductive any more! And I'm not enforcing anything either. *harumph*
posted by zomg at 3:34 PM on January 25

I read the article and considered myself incredibly lucky that when I had my "Hey we just found the thing that was wrong ... only you're not going to like this...." conversation with the endocrinologist, I was thinking brain tumor and he was thinking probably can't have babies and we were both so stupidly relieved when the other person wasn't flipped out at the news. I still get into occasional snarling arguments with doctors over treatment that they won't suggest because I may be "of childbearing age" [I especially like the "are you sure?" aspect to the "Are you pregnant?" questions] which most recently was nitrous at the dentist. And I've decided that it's okay for me to be a little less civil than I usually am in order to make the point that there is no medical reason for me to be treated differently just because of the off chance that I might be pregnant [without knowing] or might decide later to become pregnant and I'm offended that people think that might be the case. I totally get why people are flipped out that they will get righteously sued by very angry people, but it's a tough situation where the behavior that you take up as a result bears a striking resemblance to the very very unpopular "There there little lady" patronization that women have had to deal with in doctors' offices as a matter of course until recently, and clearly some are still having to deal with.
posted by jessamyn at 5:23 PM on January 25 [6 favorites]

I think I heard something about federal guidelines to treat all women between menarche and menopause as "pre-pregnant".
posted by BrotherCaine at 5:42 PM on January 25

No one should have to ask a partner for permission for anything. And any doctor who treats you like this, should be fired immediately (where insurance allows). Planned Parenthood should cover this, if you have one locally.

But schroedinger is also not wrong. A lot of people do change their minds about having kids, and sorry but more women than men. Frankly, if you and your friends are not yet 40, you aren't there yet. 32 is NOT by any stretch baby munchie age. I'd say median 38, and it's an amazing primal force. There's a lot of sadness out there, please tread lightly. No doctor should refuse anything, but it's not all BS or patriarchy.

Also; it's not vasectomy OR tubal ligation. A couple can get both.
posted by msalt at 12:15 AM on January 26

msalt, please give a citation for "A lot of people do change their minds about having kids, and sorry but more women than men." Particularly the part after the comma.
posted by Coatlicue at 6:04 AM on January 26

So at what point does a woman - or a man seeking a vasectomy - get to be treated as an adult who can say "I'm making this choice now, I acknowledge that in a decade or more I might wish I could go back in time to make a different choice, but right now, this is the choice I'm making."

In theory, since men remain fertile for pretty much their entire lives, I guess there should never be a point where a man can choose to get a vasectomy because hey, he might change his mind. Of course, that sounds absurd.
posted by rtha at 6:11 AM on January 26 [3 favorites]

msalt, please give a citation for "A lot of people do change their minds about having kids, and sorry but more women than men." Particularly the part after the comma.

I realize that it's not hip to acknowledge essential differences between men and women, but Shirley you can accept the fact that men and women are different in childbirth?
posted by msalt at 7:47 AM on January 26

"msalt, please give a citation for "A lot of people do change their minds about having kids, and sorry but more women than men." Particularly the part after the comma."

I realize that it's not hip to acknowledge essential differences between men and women, but Shirley you can accept the fact that men and women are different in childbirth?

That wasn't the question. They were asking what your cite was for "[a] lot of people [changing] their minds about having kids", and particularly a cite for "more women than men". Any studies, data, reports, other, with regard to changing one's mind on having kids?
posted by XtinaS at 7:55 AM on January 26 [1 favorite]

Shirley you can accept the fact that men and women are different in childbirth?

Surgical sterilization is not childbirth. Witness the fact that men can be surgically sterilized but cannot give birth.

Add me to the list of people who wants to see hard data for msalt's assertions. They don't match my personal experience (44, voluntarily sterilized at 32), nor have I seen a rash of previously childfree people in my circle changing their minds in their late 30s. The "you'll change your mind, girls!" warnings always come off to me as a matter of gender enforcement based on a prescription that femininity/womanliness = desire to bear children/parent.
posted by immlass at 8:19 AM on January 26 [2 favorites]

I can't fathom having a doctor needing my permission for my partners vasectomy. Wow. If I had been asked I would have thought that was so outside the ethical bounds, since that was his choice to make autonomous of what I might want, which is the way it should be.

msalt, women can still have kids at 40 so why make that the magic cut off date where people realize that the decision a woman makes about her own body is one that she wants to make without second guessing her?

rtha, I wonder if some of the difference is permanence since advances in surgery have made it possible to reverse a vasectomy.
posted by squeak at 8:52 AM on January 26

squeak - yeah, that's certainly possible.

The ex I've mentioned a couple of times in this thread now has a child, so I guess she did change her mind. She and her husband adopted, and judging by her facebook posts, they're all very happy.
posted by rtha at 9:00 AM on January 26

squeak: msalt, women can still have kids at 40 so why make that the magic cut off date where people realize that the decision a woman makes about her own body is one that she wants to make without second guessing her?

I don't believe I said anything along those lines. I did say this: No one should have to ask a partner for permission for anything. And any doctor who treats you like this, should be fired immediately (where insurance allows). Planned Parenthood should cover this, if you have one locally.

No one else has been asked to provide scientific support for their opinions here, and I don't have time to document widely accepted phenomena. If you don't want to believe that women's fertility declines and the desire to have a first child increases in the 35-40 age range, knock yourself out with skepticism. But please be careful about proclaiming your opinions loudly among people who might not share your opinion, because there is a lot of sadness about this issue.
posted by msalt at 9:01 AM on January 26

No one else has been asked to provide scientific support for their opinions here, and I don't have time to document widely accepted phenomena. If you don't want to believe that women's fertility declines and the desire to have a first child increases in the 35-40 age range, knock yourself out with skepticism. But please be careful about proclaiming your opinions loudly among people who might not share your opinion, because there is a lot of sadness about this issue.

If you want to believe things without having any way of backing up your opinions, knock yourself out. But please be careful proclaiming your opinions, because people might ask you to back up your claims (about changing one's mind re wanting children among both genders, not when women's fertility declines), and that would probably make you sad.
posted by XtinaS at 9:25 AM on January 26

women's fertility declines .... in the 35-40 age range

Declining fertility with age has nothing to do with women who voluntarily sterilize and only a limited amount to do with women whose choices are to have treatment that will result in sterilization or to continue to live with serious medical problems. I'm sympathetic to women who have fertility problems and want kids, but their problems and regrets are different to those of women who have their tubes tied/get a hysterectomy/etc. either voluntarily or for medical reasons.

(Also "widely accepted" in reproductive medicine without hard data is something I always side-eye. We used to widely accept that going to university shrivelled women's uteruses, too.)
posted by immlass at 9:29 AM on January 26 [1 favorite]

I suddenly want statistics about lawsuits brought against doctors for performing a sterilisation, by the patient's request, where the patient changed their mind later in life.

All I can find with a quick Google search are lawsuits for (a) compulsory sterilisation and (b) not providing requested sterilisations. And a bit in Wikipedia that says it's more likely that people don't regret their decision to be sterilised. (I am considering paying money to view the referenced abstract, I tell you what.)
posted by XtinaS at 9:37 AM on January 26 [2 favorites]

Horrifying, but not shocking, unfortunately. Feminism has a long way to go. And if this was about men being so easily dismissed and being put into real, medical DANGER, the outrage would be quite a bit louder. What can be done to change this?
posted by agregoli at 9:55 AM on January 26

XtinaS: where do you back up your snarky opinion? Nowhere. So lighten up on the snottiness.

Desire to have children is not something often or easily studied, but here is a study linking declining fertility to changed sexual behavior and desire for kids with age. And here is a discussion by an ob/gyn about her patients and her own experiences. Now where is your evidence that women do not want increasingly to have children as they approach the late 30s?

imlass: your point on "widely accepted" is well taken. But I've said nothing about voluntary sterilization, simply that the desire for children increases, especially among women, in the mid- to late-30s. Do you really disagree?
posted by msalt at 9:55 AM on January 26

msalt, I was responding to this, "Frankly, if you and your friends are not yet 40, you aren't there yet." I should have quoted it.

No one else has been asked to provide scientific support for their opinions here

But that's a problem though isn't it? Why is some statistical mean necessary when it comes down to an individual's health and/or request? Why should her decision be discounted because someone else made another choice? Why should her quality of life, and in some cases her health, suffer because some study found other women change their minds later? People make the wrong choice all the time, why do we feel the need to protect them in the off chance they'll reach another conclusion later?
posted by squeak at 10:38 AM on January 26 [2 favorites]

Stop calling me surely!
posted by evidenceofabsence at 10:40 AM on January 26 [1 favorite]

But I've said nothing about voluntary sterilization, simply that the desire for children increases, especially among women, in the mid- to late-30s. Do you really disagree?

I don't think it's relevant. That is not what you originally said. What you said is "A lot of people do change their minds about having kids" in the context of people choosing sterilization, which is not at all the same thing as "desire for children increases in mid to late 30s". What is your point? Because it sure sounds like your point is other people know better than (female) you about how to treat your medical conditions or make reproductive decisions than you do.
posted by immlass at 11:03 AM on January 26 [1 favorite]

imlass: other people know better than (female) you about how to treat your medical conditions or make reproductive decisions than you do.

I explicitly said that I did not mean that, and I repeated it for emphasis. I can repeat it a third time if you need: No one should have to ask a partner for permission for anything. And any doctor who treats you like this, should be fired immediately (where insurance allows). Planned Parenthood should cover this, if you have one locally. Can you see it now?

I was backing up schroedinger's experience.

"Frankly, if you and your friends are not yet 40, you aren't there yet."

I stand by that. There are things that change as we age, and this is one of them. Again, I'm not saying that any one should be denied the right to to do any medical procedure they choose. But it is not automatically patriarchy or medical facism that might make a medical professional want to ask someone in their 20s about this. There's something real there, and sometimes it's harder to see it when you are younger. That's all I'm saying.
posted by msalt at 11:22 AM on January 26

Can you see it now?

I understand that you don't think it should be legal to deny a woman sterilization, but that you think it's OK for doctors to assume their female patients requesting sterilization are incapable of giving informed consent without a lecture on the topic. Honestly, collectively we've all heard these stories before and we're aware of the risks. Assuming we haven't is treating us (women) like we're incapable of making major life decisions on our own, and it's infuriating even if it is well-intentioned.
posted by immlass at 11:56 AM on January 26 [1 favorite]

immlass:

You're acting as if doctors aren't also women, and that doctors are incapable of discussing care with their patients as humans, rather than as controlling condescending patriarchs. Did you read the link from the ob-gyn?

Yes, doctors who are condescending or don't listen to their patients or don't respect their wishes are terrible. Of course. In all areas of medicne. I've said they should be fired. What would you suggest -- making it illegal for a doctor to even discuss the subject of future children?
posted by msalt at 12:05 PM on January 26

"But it is not automatically patriarchy or medical facism that might make a medical professional want to ask someone in their 20s about this. There's something real there, and sometimes it's harder to see it when you are younger. That's all I'm saying."

I'm a dissenter among contemporary feminists with regard to human sexual behavioral differentiation, but I think you're not thinking about this carefully enough.

The very good reason why feminists get prickly about essentialist arguments is because they're inevitably used to rationalize and justify conventional gender norms in universalist and simplistic ways, which is both suspicious and harmful. Even if women, in general, inherently have some heightened desire to have children and even if childless women, in general, inherently experience an increasing regret as they move through middle-age, that doesn't mean that this is true of all women, that it's equally true of all women for whom it is true, that it's not true of men at all, or, most importantly, that this should be used as a justification for policies and conventions that trump individual autonomy in service of what is a questionable generalization.

You can't point to a presumed mass of experiences out there that you know validate your generalization while simultaneously disregarding the opposing experiences testified right here.

And it is patriarchal because the generalization and conventions privilege the point-of-view that sees procreation as a prior consideration for women in a way that it's not for men and it's generally been enforced by men. Unfortunately, you're acting in that capacity right now.

My first comment mentioned that as I read the first blog post, my initial reaction was that it makes sense to be reluctant to perform a procedure that is irreversible that many patients later come to regret. And that's true, as far as it goes. You keep repeating that you don't support a refusal to perform these procedures, but in repeatedly reinforcing the rationale for refusing to perform the procedure, you're getting as close as possible to supporting the refusal without literally supporting it. Why?

What is so infuriating about these attitudes and practices is that they're part of a larger pattern of paternalism with regard to women's reproductive choices. If we were talking about something else, but involved primarily women, then just maybe the issue would be ambiguous. But with reproductive choice and medicine and cultural norms, there's no ambiguity because there's an unambiguous larger pattern that this is just an instance of. Over and over women are told that their individual personal judgement about reproduction is suspect. That their choice to not reproduce is suspect, their choice to have sex is suspect, their choices about when and how to have children are suspect, their choices about raising children suspect, their choices about health care and diet when pregnant are suspect, every single damn thing about reproduction is presumed to be a matter of community responsibility and not the individual responsibility of each particular woman. This is a core part of, arguably the core, of patriarchy.
posted by Ivan Fyodorovich at 12:34 PM on January 26 [3 favorites]

What would you suggest -- making it illegal for a doctor to even discuss the subject of future children?

I would suggest that an appropriate time for discussions about fertility and family planning is long before the question of sterilization comes up, either voluntary or medically indicated. For instance: during annual physicals, when having regular examinations (e.g. Pap smear), when obtaining a birth control prescription. If it's only a concern once the patient is considering sterilization, it sure looks like there are other motives at work, whether that's fear of malpractice suits or just plain sexism.
posted by immlass at 12:54 PM on January 26 [1 favorite]

it's OK for doctors to assume their female patients requesting sterilization are incapable of giving informed consent without a lecture on the topic

No, it's not OK, it's required, or a quiz is required, or some other mechanism of making sure the consent is informed. What is reprehensible (but not necessarily personally sexist as opposed to institutionally sexist) is when it's done in a condescending way. If that is the implication of your choice of the word lectured than I guess we're in agreement.

I would suggest that an appropriate time for discussions about fertility and family planning is long before the question of sterilization comes up, either voluntary or medically indicated.

Agreed, but that doesn't change things as far as the surgeon is concerned, who wasn't necessarily part of that patient-doctor history, and still needs to obtain informed consent.

You keep repeating that you don't support a refusal to perform these procedures, but in repeatedly reinforcing the rationale for refusing to perform the procedure, you're getting as close as possible to supporting the refusal without literally supporting it. Why?

I assume here that msalt thinks that we have to address both the culture of patriarchy and the institutionalization over the years of reproductive norms in terms of liability and medical ethics. If there is a legitimate fiscal rationale (which I can't prove with cites), then doctors will just point to it and say they aren't sexist, they just want to make a living (even if they are sexist).
posted by BrotherCaine at 1:39 PM on January 26

If it's only a concern once the patient is considering sterilization, it sure looks like there are other motives at work, whether that's fear of malpractice suits or just plain sexism.

Or.... it's discussing a risk associated with this specific procedure, which is exactly what physicians are supposed to do before performing procedures? One risk associated with elective sterilization is intense regret. That's why this issue is discussed before this procedure, as opposed to at every annual examination.
posted by palliser at 4:25 PM on January 26

it's discussing a risk associated with this specific procedure, which is exactly what physicians are supposed to do before performing procedures?

The risk of decreased fertility as a person ages is not associated with any procedure; this is why it should be discussed as part of general family planning. Of course the risks of surgery should be discussed before surgery and individuals should understand the outcome of procedures. It's conflating the the general risks of aging and the specific risks of surgery into the idea that women under 40 can't possibly understand the full emotional risks of sterilization (e.g., she might change her mind later) that's so bloody condescending.

Apply that to a woman who's already in pain because she has horrible fibroids or severe endometriosis or PCOS or something that's already screwing her life and fertility up in some way and it's absolutely tragic. "You can't have the surgery you need to make your life better now because you might regret it down the road". That's what the article linked in the op is complaining about in the first place.
posted by immlass at 7:27 PM on January 26

I'm not sure we're understanding each other, immlass. I'm not endorsing msalt's theory on the timeline for women to be certain of their desire not to have children. I'm just making the narrower point that it makes sense for a physician to put before the patient all risks associated with a procedure, so if it's true that many women experience intense regret following elective sterilization, then that is a risk of the procedure that should be discussed. It seemed to me that you were saying that physicians shouldn't even mention this risk because "we've all heard these stories before and we're aware of the risks." I think that should never be assumed in the context of informed consent, and all significant risks should be discussed.

And it is possible for a risk to be so widespread and severe that it makes the procedure unethical to perform considering the benefit gained. I have no idea what the numbers on this actually are, but depending on the age of the woman and her circumstances (whether serious health problems would be alleviated, etc.), it's possible that it's legitimate for physicians to refuse to perform the procedure under certain circumstances. Again, as others have said, it would help to know what percentage of women actually experience regret after elective sterilization.
posted by palliser at 9:18 AM on January 27

palliser: I don't remember positing a "theory on the timeline for women to be certain of their desire not to have children."

All I said was, feelings about having children change as you age. And it's not crazy or patriarchal or fascist for a physician to discuss that with patients. It's medically responsible, and humanly considerate. That is all.

in repeatedly reinforcing the rationale for refusing to perform the procedure, you're getting as close as possible to supporting the refusal without literally supporting.

I'm not "reinforcing the rationale," I'm just pointing out that the desire to have children is real, age-influenced and causes a lot of heartache for good people, completely aside from the question of sterilization.

You apparently think I shouldn't even speak or think this truth, because some asshole doctors exaggerate it to justify their behavior. That's kind of ridiculous and offensive. I've said doctors who act like this should be fired. So kindly stop telling me what I should think or say.
posted by msalt at 1:34 PM on January 27

"I'm just pointing out that the desire to have children is real... [...] You apparently think I shouldn't even speak or think this truth..."

"Real" and "truth" are in dispute here. I entirely agree that this happens. And I am inclined to accept that there are likely inherent biological reasons for why this happens. I'm not inclined to accept that it's as universal or widespread as you seem to insist, and most especially not that it's as widespread or severe as to function as a means to subordinate an individual's medical and personal choices to the degree to which it clearly does.

This is exactly like the sex differences arguments in other areas, except that the stakes are much higher and the history much more unambiguous with regards to the sexism.

That is to say, to pick an example, it's not outside the range of scientific plausibility that women might not be as adept at higher math as men (I don't believe this, I'm just arguing that it's plausible). However, if the discussion is about disparate outcomes in education and employment between sexes with regard to math, then there are numerous other even more plausible forces involved that could be driving these outcomes. That being the case, and when there's been an inarguable history of institutional justification for such unequal outcomes on the basis of similar, but later proven false, arguments from biology, then it becomes very important to recognize that the promulgation of an argument from biology should obviously be suspect, given its track-record and how it functions.

There are good reasons why many of us here take exception to the "obvious truths" that you're so helpfully trying to convince us to stop willfully denying, as you clearly believe. Do you really believe that those with whom you're arguing haven't thought about this carefully, or, for that matter, that the women with whom you're arguing don't have personal experience of it that you lack? Again, there is testimony in this very thread by women who have been in the situation you describe but who did not and do not feel the things you insist most or all women feel. It's pretty convenient for you to disregard personal attestations right here at hand while holding to your more abstracted impressions of how most women feel.
posted by Ivan Fyodorovich at 2:10 PM on January 27 [1 favorite]

You're repeatedly putting words in my mouth that I have not said. And comparing gender differences over child bearing with saying that women are less good at math is ridiculous.

There are personal attestations on both sides of the issue we are discussing, in this topic here, and in the links I've provided. And both of us appear to be men, so you can spare me all your high horse "those of us" pomposity. Who do you think you are, Keith Olbermann?
posted by msalt at 5:03 PM on January 27

"And comparing gender differences over child bearing with saying that women are less good at math is ridiculous."

That's disingenuous. It's not comparing gender differences over child bearing with gender differences in math skills, it's comparing gender differences in cognition related to child bearing with gender differences in math skills. You're begging the question of that difference, probably because the reproductive differences themselves loom so large. But you oughn't be doing so.

"There are personal attestations on both sides of the issue we are discussing, in this topic here, and in the links I've provided."

Exactly. I'm not the person defending a default assumption on the basis of a generalization about how women feel, you are. A diversity of attested experiences supports my argument and undermines yours.

Similarly, I'm not generalizing about women and discounting the testimony of women present. You are. If I were doing so, my sex would be relevant, as yours is when you do so.
posted by Ivan Fyodorovich at 5:29 PM on January 27

What are you trying to accomplish here with this callout? I haven't discounted anyone's "testimony;" you're the one dismissing the very large number of women who care very much about having children, and observe age-related changes, because some women don't feel the same way.

Now, after I gave you the studies and testimonies you demanded for that pretty basic point, you want additional proof that women feel differently about childbearing than men do? You're being ridiculous (and you've derailed the thread, congrats). Find someone else to argue with.
posted by msalt at 10:45 PM on January 27

Okay, I give. Obviously, many people in this thread were forgetting that many women would like to have children and regret it when they've passed middle-age and haven't. In that you've ensured that we've all been reminded of this, when we'd all inexplicably forgotten it, you've made an incalculable contribution to the thread. Thanks ever so much!
posted by Ivan Fyodorovich at 11:03 PM on January 27

I've recently dealt with similar health issues and also never wanted children. The minute I sensed resistance from my gyn to do a hysterectomy--which would cure my pain and 24/7/365 bleeding--I dropped her like a hot potato. I showed up at a new doctor's office saying "I want a hysterectomy. I'm willing to go through some hoops to ensure it's the right thing medically and surgically, but that's my goal. I'm looking for a doctor who's willing to test the hypothesis and proceed when the data that we're on the right track is good enough."

I'm thankful every day that I found a new doctor who took me at my word. We immediately forged a great, collaborative relationship. I had a half hour long appointment to be informed of the risks of surgery, none of which addressed my possible regret, but she did stress that it was irreversible. In the OR the day of surgery, right before she put me under, she smiled warmly and said "No kids ever, right?" but that was partly because we had bonded over both of our being newlyweds. It felt more like a friend covering bases than a doctor covering her ass. Tone counts for a lot.

I know I'm lucky to have the type of health insurance that allows me to make my own choices and have them largely paid for. I'm also lucky to live in a city with multiple teaching & research hospitals and world-class doctors to choose from.

I also know the type of bullshit conversations I'm forced to be a part of as a result of my choosing to be childless. Just this week the lovely old guy who repairs my shoes took it upon himself to address my choice. He even referred to his sister in law as lazy because she's childless by choice: When she asked him to pick up her pharmacy meds because she's sick, he told her [imagine this in thick eastern European accent]: "No! You're too lazy to have children who can help you? Get your cat children Puffy and Tiger to pick up your medicine for you." When he really started to lecture me on why I should, at age 42, want to have children, I turned the tables and gently lectured the fuck out of him. He said he ended up seeing my side of things (gee, thanks, dude!) but it was just as likely as not that he said it just to get rid of me because I was damaging his ability to keep his worldview intact.

I'm horrified at what this woman went through, but it, sadly, doesn't surprise me.
posted by ImproviseOrDie at 5:56 AM on January 28 [6 favorites]

I have had women friends who, in our younger days, talked about not wanting kids, and who are now happily mothering.

None were in a position to 'put their money where their mouth is' - i.e., having to choose between a more effective medical treatment that might impair fertility in the future or a less effective one that wouldn't, and

Not a single one sought out any kind of permanent contraception.

My women friends who did seek out permanent contraception did not and have not changed their minds.

What this tells me is that talk is cheap, and we are all entitled to chat up and chat through a thousand different dreams and visions for the future, and change our minds even a thousand and one times, but that once it comes time to taking action (actively or passively), women can actually be trusted to know their own minds.

That said, Eyebrows McGee, I really appreciate your post about the reality of litigation for hospitals and doctors. Barring short term whole scale of reform of the malpractice industry, and/or of patriarchy itself, it seems to me that the best solution to this issue may be a technological one: some form of permanent but reversible contraception for women on the one end, and availability regulated, accessible egg/embryo freezing and surrogacy on the other.
posted by Salamandrous at 5:57 PM on January 28

Salamandrous, there is a form of permanent but reversible contraception called Essure which works a lot like an IUD would, but they're placed in the fallopian tubes instead.
posted by squeak at 7:43 PM on January 28