The New York Times
To the Editor:
Re “Doctors Fail Women Who Don’t Want Children,” by Alanna Weissman (Sunday Review, Dec. 3):
Study after study has demonstrated a very high incidence of post-sterilization regret in women in their 20s. I myself am guilty of gently turning down very young women’s requests for permanent sterilization.
So many things can happen to a young woman to make her change her mind about childbearing.
I have had patients who swore that they did not want children who then changed their minds. Although we doctors are cautioned against being paternalistic, we should be allowed to have our own safeguards against making patient-driven mistakes.
Get an I.U.D. or an implantable, long-acting contraceptive — even go on the pill if you have no contraindication to it — but please don’t expect us to knowingly sentence you to a childless life until we know that you really mean it.
Because as mature as you may think you are in your 20s, you’re a relative babe in the woods, and I refuse to accommodate your premature wish to be sterilized without a good medical reason.
JESSICA JACOB, GREAT NECK, N.Y.
The writer is an obstetrician-gynecologist.
To the Editor:
In 1978 I was absolutely sure that I never wanted another pregnancy. My son was 8, and I was in a committed relationship with a man with four children. I was 35.
I had a gynecologist who was both young and progressive. When I approached him to have a tubal ligation, his response was totally unexpected; he asked me if I wanted to be sterilized.
The word “sterilized” set me back. He sent me home with one directive: “When you can see me and actually use the word ‘sterilized,’ then we’ll proceed.”
It took another six months or so before I went back. With no hesitation I asked to be sterilized, and it was easy and positive to say.
That interim time allowed me to process all of my feelings — what it means to be a woman, to know for sure that I wouldn’t have to deal with birth control, and that my son would be my only child.
I had the procedure, and to my surprise I did experience a short time of mourning for any unborn child I might have had. Fortunately, that didn’t last long.
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I thank my wonderful and insightful doctor all the time.
BINKY LUCKHURST, TUCSON
To the Editor:
While the decision for sterilization is not an instance where the patient could be medically wrong, the hope that doctors will “not fear malpractice lawsuits by patients who change their minds, as long as the requirements for informed consent were met” is not the reality of our litigious society.
The tort system will rarely prevent a lawsuit; many doctors have lost malpractice cases not because of the result but because a claim was made that the patient did not understand the procedure.
In fact, most often, the plaintiff’s lawyer claims improper informed consent; it’s the fallback. The doctor may have furnished an informed consent form based on the highest medical and legal principles and still be sued; and even if he wins the lawsuit, the aggravation of depositions and courtroom trials can be daunting.
While the woman’s right to decide should always supersede the biases of the doctor, our malpractice system shares part of the blame for the limited Reddit forum of “childfree-friendly” providers.
IAN SCHORR, ENGLEWOOD, N.J.
The writer is a retired ophthalmologist.
To the Editor:
Women’s right to be the sole authors of their reproductive destiny is now the accepted standard of care.
The American College of Obstetrics and Gynecology’s Committee on Ethics declares that “respect for an individual woman’s reproductive autonomy should be the primary concern.” The guidelines suggest that “it is ethically permissible to perform a requested sterilization in nulliparous [never pregnant] women and young women who do not wish to have children.”
Almost twice as many couples choose female over male sterilization (30 percent versus 17 percent). In either case, sterilization can be successfully bypassed through in vitro fertilization if couples change their minds and want to conceive at a later stage in life.
Tubal ligation is the procedure of choice for permanent, reliable contraception, respecting a woman’s reproductive autonomy while providing her an opportunity to change her mind in the future.
AVNER HERSHLAG, MANHASSET, N.Y.
The writer is chief of Northwell Health Fertility, North Shore University Hospital.