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Author Topic: Age and sterilization
lemming
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somewhatanonymous brought up his experiences with trying to obtain sterilization (a vasectomy) in another thread, and I thought this might make an interesting topic.

if you are 18, no longer a minor, and able to make decisions about your medical treatment, how is it that it is very difficult to get sterilization procedures from a provider?

what are some of the reasons a healthcare provider might deny sterilization to a young person?

do those reasons make sense to you? why, or why not?

what do you propose to make sterilization available for those who want it? a waiting period? complete subjectivity? should it be covered by healthcare?

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Laurel Lemming
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"Maypole/The ties that bind you will unwind/To free me one day/And everything decays..." - XTC, "The Wheel and the Maypole"


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Dzuunmod
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You raise some interesting questions Lem, but for the moment, I'm only going to address the last one.

No, sterilization shouldn't be covered by Medicare in Canada. It would be nice if my country's purse was overflowing with cash, but it just isn't - people wait in hospital hallways in the winter during the flu's peak season - and until the more serious problems have been worked out of our system, I'd say that this is something that will have to wait.

And, if I could just offer some advice to the U.S., it'd be that until every last one of the citizens down there has very basic health insurance to cover life and death stuff, there should be no talk of sterilization being on any health plan.

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"And when I'm gone, she'll never leave me. No, no she'll never, be untrue. And buddy if you do not believe me, you don't believe the sky is blue."
-Joel Plaskett, Down at the Khyber


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LilBlueSmurf
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I feel I have so much to say on this topic ... and i really do'nt mean to offend anyone. I'm sorry if i do.

I think sterilization is a HUGE issue ... at any age. And i don't think an 18 yr old can make that decision. I'm 18, and honestly don't know if i want kids for sure or not ... But ya know, i've got quite a while to decide that, and i don't want to do anything to my body that is going to take any choices away later. I don't want kids right now, so i use precautions. I really don't see how anyone could say for sure what they want in the future.

I think healthcare providers can refuse to do this for many reasons. I think a lot of it has to do w/ protecting themselves ... If people come back to them 10-15yrs later, saying they now want a family and can't have one, what happens then? Sterilization is very rarely reversible. Life situations can change, people may decide they do want kids after all ... I don't see why sterilization is the best choice here. We have worked so hard to improve condoms and birth control to delay reproduction, and now people want to halt it all together ... I just don't understand the reasons for it.

These reasons against it, however, make sense to me, and i tend to feel very strongly about it. Family is important to me, and given the chance, i'd like to have my own, biological family. I know this isn't the case for everyone, as many people would choose to adopt, and that's okay. But i don't think closing the door on all your options so early in life is the right way to do it.

There should defineatly be a waiting period, and probably some counseling to go w/ it. I don't think it's okay to disable body parts b/c we feel like it. Maybe after a couple has already had a child or two and has decided they don't want anymore, sure. Go for it. My mother and my grandmother did it. I may choose to do it if/after i decide to have children, but not before.

As Dzuun nicely pointed out, Canada's healthcare system is in no position to be putting such a procedure on it's coverage list. This is an elective procedure ... There are many other people waiting in line for life/death operations. I've also seen first hand what some of the hospitals are like ... I just started my clincial rotation at one of the hospitals here. Their med-surg floor is full of people waiting for placements in long term care facilities that we just dont have. Our population is aging, and accomadations need to be made. There are just so many other places this money could be spent ... It should defineatly not be covered. Face lifts and breast enlargements aren't.


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twiceagainyesterday
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LilBlueSmurf,

I am fourteen. I do not want kids. If I ever want kids, I will want to adopt an older child (8 or so), for many reasons.

How can someone be sure what they want in the future? They can't, for sure. For me, it is like how I know I want a carreer in liberal arts-- teaching and doing. In the same way, I have a strong sense that I will never want biological children- and, besides, I see no difference between biological and adopted children, other than their genes.

If, when I am 18, I still want no kids, I will go ahead with sterilization. Why? Well, 4 years of consideration is enough for me to be sure about anything. I may wait until I'm finished university, or I may not.

If a person is convinced, then they are convinced, at any age. Who says that a /mature/ 18-year-old cannot know what they want to do with their body?

It really is /their/ choice, and I can see why you are confused by it- it isn't your choice. Some people are very certain about this aspect of their lives, and are comfortable with doing something like that.

Considering that sterilization is a choice, and birth control is adequate, it shouldn't be covered by health care plans. Birth control should, however, but that is a different topic.

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Gumdrop Girl
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I don't see why there would be actual legislations in place to restrict sterilization access to people of legal age of majority. Are there such restrictions in Canada or elsewhere? I am in the dark as far as laws go.

With that said, even if an 18-year-old has legal right to obtain a sterilization, I can easily see why a doctor would opt not to perform that procedure on a young person. As Smurf mentioned, sterilizations are more difficult to reverse as time progresses. I can see this would be a big, fat lawsuit waiting to happen for whatever doctor performed the procedure if later in life the patient changes his/her mind and wants to have children. By then, the person can have been irrevocably robbed of his/her fertility. Even with waivers in place, that won't stop a person who is cometeply distraught over the prospect of never having kids. They'll sue anyway. Will they win? maybe, maybe not. But they can definitely sue, and that's a pain in the arse for the doctor.

I'm gonna have to side with the doctor's right to choose which procedures he/she performs (within sound ethical judgement, of course). After all, a doctor can opt to refuse to give an 18-year old woman breast implants. Or a doctor can refuse to practice/perform abortions for religious reasons. If the doc refuses to sterilize a young adult, the patient's gonna have to keep looking.

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LilBlueSmurf
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quote:
Originally posted by twiceagainyesterday:
...and, besides, I see no difference between biological and adopted children, other than their genes.

Good. I'm happy for you ... Honest. But for some people, this isn't the case ... and people may change their minds and decide they want biological children. There's nothing wrong w/ either. If you choose sterilization tho, you're taking your options away.

quote:
If a person is convinced, then they are convinced, at any age. Who says that a /mature/ 18-year-old cannot know what they want to do with their body?

It's about making a seriously life altering decision. Tattoo's can be removed, piercings can be taken out, but your reproductive organs will likely never work the same again ... and i don't care how old you are. Age has nothing to do w/ it.

quote:
It really is /their/ choice, and I can see why you are confused by it- it isn't your choice. Some people are very certain about this aspect of their lives, and are comfortable with doing something like that.

You're absolutely right ... This is not my decision, this is yours ... But you asked for opinions, and i'm giving you mine. I would absolutely hate to see anyone wanting biological children and not being able to have them.

quote:
Considering that sterilization is a choice, and birth control is adequate, it shouldn't be covered by health care plans. Birth control should, however, but that is a different topic.

I can't say i even believe birth control should even be covered. Sex is not a requirement of everyday living. Food, water, shelter, clothing ... now those you will need for safety and health issues. You do not need sex/intercourse. But you're right ... that is better left alone right now.


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lemming
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I guess I should 'step up to the plate,' as I started all this.

At 18, you can make this decision for yourself - but good luck finding a doctor to perform the surgery for you. But it is, of course, the doctor's prerogative to accept or refuse a patient for surgery.

But the problem, I think, comes with WHERE we choose to put the line here. Is 21 okay? 25? Should there be a waiting period? Well, a month? 6 months? a year? And who's to say?

I don't think that sterilization can be covered if we don't cover contraception - which many medical plans don't. But it must be said that sterilization, while very expensive, does negate the need for other expensive things like pregnancy, contraception, and - heck - childcare.

There are reasons for sterilization other than convenience - not that convenience is a bad reason, though. I am certain I don't ever want children - as is my partner - and I've been sure of that ever since I could speak. Being on hormonal contraceptives for the rest of my fertile period does not strike me as the best possible thing for my health, and condoms alone are not good enough for me. Or should I simply be abstinent?

Anyway, that's how I feel on the issue, but I am *really* interested in hearing how other young people feel, because I don't get to talk about this in a safe open forum.

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Laurel Lemming
Scarleteen Advocate

"Maypole/The ties that bind you will unwind/To free me one day/And everything decays..." - XTC, "The Wheel and the Maypole"


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logic_grrl
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quote:
and people may change their minds and decide they want biological children.

Equally, some people who have biological children may change their minds and decide they don't want them.

The point is that choosing to have a biological child is also a major decision, and one which is liable to last, if not forever, at least for the next 18-20 years. And it too takes away the option of changing your mind later.

And unlike sterilization, it affects at least one other human being.

I don't see why you see sterilization as somehow more serious and irrevocable.


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Dzuunmod
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quote:
Originally posted by lemming:
At 18, you can make this decision for yourself - but good luck finding a doctor to perform the surgery for you. But it is, of course, the doctor's prerogative to accept or refuse a patient for surgery.

But the problem, I think, comes with WHERE we choose to put the line here. Is 21 okay? 25? Should there be a waiting period? Well, a month? 6 months? a year? And who's to say?


Both of these points apply equally to other things that we've previously discussed on the boards. Who's to say that 14, or 16, or 21 is when people should be allowed to have sex? No age is going to please (or be right for) everyone, but I think we'd all agree that there has to be a minimum age for both of these things. There's just no way around it, but to pick an age almost out of the air for this stuff.

The other thing that you raise in an indirect way here, lem, is the question of whether doctors should be allowed to refuse treatment to someone in this instance. If we're saying that they should, then we're also saying that doctors should be able to refuse to perform abortions.

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"And when I'm gone, she'll never leave me. No, no she'll never, be untrue. And buddy if you do not believe me, you don't believe the sky is blue."
-Joel Plaskett, Down at the Khyber


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KittenGoddess
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quote:
Originally posted by Dzuunmod:
The other thing that you raise in an indirect way here, lem, is the question of whether doctors should be allowed to refuse treatment to someone in this instance. If we're saying that they should, then we're also saying that doctors should be able to refuse to perform abortions.

To the best of my knowledge, doctors are able to refuse to perform abortions. I don't see a problem at all with a doctor refusing to perform a sterilization if they do not feel comfortable doing it on the individual requesting the procedure. I also don't see a problem with doctors who are uncomfortable performing abortions to be required to perform them. Those procedures are (at least to some extent) elective procedures. They are not matters of life and death. Now if a doctor is refusing to provide care to you when you're having a heart attack...well that's a different issue. It's quite likely that not treating a heart attack will kill you.

Doctors are humans too and I hardly think it's fair to say that they must preform a procedure that they are uncomfortable with in the situation. As a patient, you have the right to refuse any treatment that you are not comfortable with for any reason (ei. physical, religious, moral, emotional, etc.), shouldn't that same right be extended to physicians at least in the case of elective treatments? I'm not saying that you shouldn't be able to obtain such procedures at that age (I'm not sure I have an opinion about that)...I'm just saying that it seems reasonable for a doctor to say that they are not comfortable preforming the procedure for you for any reason and instruct/refer you to another physician.

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KittenGoddess
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[This message has been edited by KittenGoddess (edited 01-21-2003).]


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Gumdrop Girl
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I'm with KittenGoddess on this one and so is the medical community. When a doctor chooses his/her school for training, what he/she wants to practice is definitely a factor. For example, several US medical colleges have religious affiliations. Schools like Georgetown (Jesuit Catholic), Loma Linda (Seventh Day Adventist) and Albert Einstein (Jewish) do not offer training for abortion services. If a doctor wants to perform abortions in his/her professional practice, these are schools he/she should NOT apply to. That is the physician's choice and it is perfectly ethical to make.

Likewise, if I was Michael Jackson's plastic surgeon, I would have refused Jacko service about three nose jobs ago. Yes, it is MJ's nose and he can do with it as he pleases, but it is permissible for the surgeon to not want to be an accomplice in a feat that he finds objectionable (if not potentially dangerous).

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According to the experts, I am some species of badass.


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LilBlueSmurf
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First I must apologize to twiceagainyesterday ... I didn't realize it wasn't you that started this in another thread, and that you weren't really asking anyones opinion.

I also tend to believe sterilization can affect more than one person as well. Obviously it's not going to be unborn children, but it could be your partner. My partner considered having a vasectomy for a while ... and i'd be absolutely devastated, had that been his choice. And sure, it's not my body, and what he does w/ his reproductive bits are his business, but ... I'd really like to have biological children w/ the man i'm in love w/.

And maybe it isn't more serious ... But part of what we do here is preventing people from making what-could-be mistakes w/ their bodies. We advise people to use contraception (or abstain) if they don't want children, at this point in their lives. I don't see how advising people to give some serious thought to an equally serious situation is so bad.

I'm merely expressing my concern for such a serious operation that is so irreversible ... And i can advise against it. But that's all i can do. I'm not (at least not intentionally, tha'ts for sure) passing judgement, here. Every person has the right to do w/ their bodies as they wish. You can bet i'd be screaming the loudest of them all if someone told me i couldnt' do something w/ my own body ... ! I just dont' really feel altering your body surgically is the way to go ...

That is just my opinion tho. I don't hold anything against those who choose to. For a while I didn't want children either ... Had that continued, i may have chosen it too.


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Heather
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Just a quick addition -- I don't want to intrude because it's interesting to listen.

But some of why there will be age issues with surgeries like this is because development does have bearing. To my understanding, you do NOT want to perform any sort of sterilization on someone who is not through with puberty because it can be whole-body detrimental; hormonally, physilogically.

That's without even going into discussing the issues of what a doctors role is in terms of being a person who performs services or a person who heals...

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Heather Corinna
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logic_grrl
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quote:
And maybe it isn't more serious ... But part of what we do here is preventing people from making what-could-be mistakes w/ their bodies. We advise people to use contraception (or abstain) if they don't want children, at this point in their lives. I don't see how advising people to give some serious thought to an equally serious situation is so bad.

I totally agree, and I don't think that anyone is saying that sterilization isn't a very serious decision which requires very serious thought.


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UKgirl
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quote:
Originally posted by LilBlueSmurf:
I also tend to believe sterilization can affect more than one person as well. Obviously it's not going to be unborn children, but it could be your partner. My partner considered having a vasectomy for a while ... and i'd be absolutely devastated, had that been his choice. And sure, it's not my body, and what he does w/ his reproductive bits are his business, but ... I'd really like to have biological children w/ the man i'm in love w/.

I'm not sure this is a very fair argument. It his his body, and his choice not to have children. To me this seems rather similar to the idea of "father's rights" in abortion, which I persoanally do not think is ok. Our bodies, our choices, and that goes for men too.


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logic_grrl
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And as a further point, if someone does finally decide that they absolutely do not want to have biological children ever, then getting them to have children they don't really want just in order to keep a partner happy is not necessarily going to be a great idea - either for them or for the children in question.
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Heather
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Just for some more info, I poked around on the web this morning for some articles on vasectomy, in case anyone wants them.

http://webmd.lycos.com/content/article/12/1685_52231?

http://www.plannedparenthood.org/BIRTH-CONTROL/allaboutvas.htm

http://www.nichd.nih.gov/publications/pubs/vasect.htm

I want to add here that if, as women, it is important to you to have a male partner who wants to father and co-parent children, that isn't something that is a default.

In other words, just because a man is physically ABLE to create children doesn't mean he wants to, or that if he doesn't want to, he'll change his mind (or should!). What his body is capable of really is secondary to what he wants. So, if having biological children is important to you, you discuss it with potential partners, you ask if it's important to them, if it's what they want, etc., in the same way you'd talk about any other kind of compatibility.

I also want to poke in with something else: I think it's really important to recognize that not everyone "naturally" wants children, or feels biological children are more important than non-biological children. And having or not having children can be a very big deal, but it need not be a life-breaker if it can't or doesn't happen.

Personally? I want kids at some point. But it doesn't mattter to me in the slightest if they're biological or not. I felt that way at 15, I still feel that way now. In my mind, the only real difference is which will be available to me when the time comes that I'm ready to parent, ready practically (I'm 33, if I'm not ready in the next ten years, I'm not comfy with bearing children), ready financially (both adoption and childbearing cost big bucks, but if money remains an issue, foster parenting is workable), and so forth.

I think it's also worth bearing in mind that opting OUT of parenting or childbearing is no more serious (and I'd say less so) than opting INTO it. And yet, we're usually supportive of people who make the decision to opt INTO parenting in just a couple months time.

(Just one more side note: I know a handful of "vasectomy babies," children who were conceived with men who were sexually active shortly after the procedure. So, just an FYI for those considering: it doesn't always work the first time.)

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Heather Corinna
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My epitaph should read: "She worked herself into this ground."
-- Kay Bailey Hutchinson


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Dzuunmod
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It's one thing to say that in the U.S., doctors should be able to pick and choose which clients they want to have, or which services they want to provide. When you're on the public dime, however, and when abortions or sterilizations are covered entirely (in many cases in Canada) or partially by medicare, you don't work for yourself. You're at the service of the public, and you do whatever is in your job description.

Or, at least, you should.

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"And when I'm gone, she'll never leave me. No, no she'll never, be untrue. And buddy if you do not believe me, you don't believe the sky is blue."
-Joel Plaskett, Down at the Khyber

[This message has been edited by Dzuunmod (edited 01-22-2003).]


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Alabaster
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I think it is very important to consider the relative maturity and perspect your average 18 year old may have. When I was 18 I swore off children for the rest of my life. I held to that belief until I was 20, when I decided that perhaps one day I will want children, though definatly not now. Some may try to argue that they positivly know what they want from the rest of their life when they are 18, but I think in general terms thats a bunch of boloney. I was a computer science major for two years and am now in college to be an english teacher. I have friends, aquaintances, and enimies who have changed what the path of their life will be numerous times, and there are many more who still are unsure what that path will be.

I suppose I see the whole situation as being very much like when the parent refuses to let the teen have an unlimited curfew. Sure, I may want that limited curfew, may beg and plead and feel deep down in my soul that it is a good and just thing, but my parents, with their years of wisdom, can pretty quickly determine that such a situation could turn bad quickly. Then again it might not, but protecting their offspring from unessary trouble or pain, or bad/hasty decisions is a parents primary goal. So it is with society when our 18 year olds procalim their adulthood, allthogh they are not signifigantly more capeable of making decisions when they are 18 then when they are 17 years and 364 days old. Personally, I would approve of a law that is going to prevent me from making a hasty decision, or one that I very well may come to regret in 10 years.

Ideally, sterilization would require a 2 year waiting period, and that period would not be able to be started until the 21st birthday. In that period counceling would be requires, as well as consultations with physicans in order to make sure the patient knows exactly how chancy a reveral could be.

I know if I were a doctor, I would not conduct myself any other way.


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Bobolink
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I may have to take issue with Dzuunmod here. I'm not sure how health care is paid for in Québec but in Ontario, it is on a fee for service basis. The doctor is not an employee of the government. The government pays for services rendered. If a doctor does not perform an abortion, he doesn't get paid for performing one. It really isn't in an Ontario doctor's job description.

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We can't solve problems by using the same kind of thinking we used when we created them.

- Albert Einstein

[This message has been edited by Bobolink (edited 01-22-2003).]


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