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 consent.
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. Sterilization. February 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.