Legally, a medical care practitioner is held to the same standards of informed
consent for procedures affecting reproductive capacity as for any other type of
procedure. Realistically, a medical care practitioner 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
medical care practitioner who performs the hysterectomy may incur
considerable liability for rendering this woman sterile without her informed
Informed consent for sterilization requires the disclosure of the risks and
failures of the procedure involved and appropriate alternatives. A medical care
practitioner 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 medical care practitioners when the procedure
spontaneously reversed, resulting in an unwanted pregnancy. These
complaints are now joined by lawsuits alleging that the medical care
practitioner 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 medical care
practitioner must ensure that the woman is not already pregnant when the
sterilization is performed. [ACOG Technical Bulletin 113.
1988.] 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 medical care
practitioner who tells a vasectomy patient that he must be sterile, without
proper medical tests, 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
medical care practitioner may say, but the medical care practitioner should not
encourage the patient to think of sterilization as reversible. The medical care
practitioner who does surgical repairs of sterilizations should make sure that
the patient who is being sterilized does not assume that this medical care
practitioner has some special ability to do temporary sterilizations.