STERILIZATION

STERILIZATION

Legally a physician is held to the same standards of informed consent for procedures affecting reproductive capacity as for any other type of procedure. Realistically a physician should be particularly careful that the patient understands the procedure and its risks and limitations. It is also important to make sure that any patient undergoing treatment that will cause sterility or reproductive problems knows and understands this fact. A woman may freely consent to a hysterectomy for fibroid tumors without understanding that this will make her unable to bear a child. The level of knowledge of reproductive physiology in the general public is not high. The physician who performs the hysterectomy may incur considerable liability for rendering this woman sterile without her informed consent.

Informed consent for sterilization requires the disclosure of the risks and failures of the procedure involved and appropriate alternatives. A physician should be very careful not to overestimate the effectiveness of a particular procedure and not to oversell the patient. Most malpractice litigation arising from sterilizations concerns the reversibility of the procedure. Traditionally, patients sued physicians when the procedure spontaneously reversed, resulting in an unwanted pregnancy. These complaints are now joined by lawsuits alleging that the physician indicated that the sterilization could be reversed, but the reversal has been unsuccessful. Both of these claims arising from reversibility can be prevented by obtaining proper consent for the sterilization.

Every patient undergoing a sterilization procedure should understand that the procedure could fail and allow conception. The patient should be told that such failures may occur immediately or years in the future. The physician must ensure that the woman is not already pregnant when the sterilization is performed.[174] The couple deciding on a procedure should also understand that it is possible to check the success of the procedure in a man but not in a woman. This may alter their decision on which procedure to choose. It is unwise to assume that any patient is in fact sterile. If there is any question of conception after a sterilization, the patient should be evaluated thoroughly. A physician who tells a vasectomy patient that he must be sterile may precipitate a messy divorce and paternity actions as well as a lawsuit for malpractice.

Patients must understand the permanency of surgical sterilization. No one should undergo a sterilization procedure with the idea that it can be easily reversed with a change of mind. A patient may keep that idea whatever the physician may say, but the physician should not encourage the patient to think of sterilization as reversible. The physician who does surgical repairs of sterilizations should make sure that the patient who is being sterilized does not assume that this physician has some special ability to do temporary sterilizations.

[174]ACOG: Technical Bulletin 113, Sterilization. (Feb 1988).

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STERILIZATION