Benn and Lupton come down on the side of the patient, though not gently: While the authors write that later regret “should not be a factor in a doctor’s decision about whether sterilization is in the patient’s best interest,” they also offer no balm for the patient’s future emotional distress. If a young woman’s resoluteness is as valid as an older woman’s regret, the doctor’s hands are clean.
Dr. Denise Jamieson, a practicing physician and chief of the Women’s Health and Fertility Branch at the Centers for Disease Control, is also supportive of a patient’s right to choose, though she notes that the statistics don’t lie. “As a clinician, I know that regret is so common. Patients come in heart-broken because the situation has changed, and now they desperately want a child. It makes you feel bad as their physician,” she said.
However, Jamieson sees her role first and foremost as an educator and adviser, not as the decider. “Ultimately, it is the patient who makes the decision. It’s not my role to guess what they will feel in the future.”
But, as our reader reports demonstrate, Jamieson and the ACOG may be out of touch with what’s actually going on in the examination room.
In a 2010 survey of American gynecologists, researchers found that doctors responded to hypothetical patients’ requests differently depending on age, number of children, and spousal agreement. For a 26-year-old with one child and a disagreeing husband, almost 70 percent of physicians were “somewhat or very likely to discourage her.” Predictably, older imaginary women with more children and accordant husbands were far less controversial.
Interestingly, the gender of the physician had no measurable effect on his or her opinion, suggesting that paternalistic sexism is not at play (that is, unless you count the fact that there are no wait-time restrictions on vasectomies). And moreover, the vast majority of OBGYNs (91 percent) said they would eventually provide the service if the patient insisted (7 percent would refer and only 2 percent would refuse). As the study notes, though, “self reports may differ from clinical practices.”
During our conversation, Jamieson stated very directly that, when it comes down to it, “Doctors should offer medically appropriate care.” I was relieved—finally, a straightforward answer! But as it turns out, it’s not that simple.