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The Childless Patient

The childless patient who requests sterilization leads to a quandary for most physicians because some of these patients may later wish they had not been sterilized. In most cases, physicians have the right to refuse to perform the surgery. But too often the only reason for the refusal is the physician's imposing his own social values on the patient. Similarly, physicians may be too quick to agree to sterilize a patient if the patient has a number of children. The patient who wants a vasectomy because his marriage is in trouble and he does not trust his wife to take prescribed oral contraceptives may regret the decision just as much in his next marriage as the bachelor who thought he would not want children.

A teaching obstetrician-gynecologist developed a system for sterilization procedures that is a useful model of how to provide these services. The patients had a full range of services available and the opportunity to make informed decisions. This physician first arranged to provide vasectomies through other members of his physician group so that he could offer couples the choice of who would be sterilized without having to refer to an outside physician. Second, he made it a policy that all patients who requested sterilization give him a written explanation of why they wanted to be sterilized. This allowed him to be sure that the patient had considered the procedure carefully.

The single man in his early twenties who wrote on the note pad, "My father has Huntington's chorea," was scheduled for surgery immediately. But the single man who simply stated that he did not like children was also scheduled. The important point was that the patient was able to state reasons for making the decision. The reasons did not affect whether the patient would be operated on unless they were medically unsound. If a patient had unfounded fears of genetic disease, these could be discussed so the patient could reevaluate the decision in the light of accurate information. Many patients decided against sterilization when they were required to consider the decision carefully.

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