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Comment by Jiro | Hacker News Reader

"To control my body" is an absurd political spin on "because they expect me to regret it". Can she imagine that a doctor might actually think "I don't want to perform an irreversible, life-alterring operation on someone who has a good chance of regretting it"?

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Doctors seem to have little hesitation regarding other life-altering modifications like sticking silicone balls in your chest, carving your face up because you don't like the outline of your nose, or slicing pieces off your kid's genitals.

I think sterilization is both more life-altering than your examples, and also that doctors, on par, absolutely have some amount of "hesitation" (i.e. making sure they really want it) regarding plastic surgery.

I would argue that anything up to and including assisted suicide performed with informed consent deserves less hesitation than performing arbitrary surgeries on unwilling and unconsenting children. Being willing to do that but not sterilize someone just makes you a hypocrite.

I'm not sure this argument really works, because it's different doctors in both cases. There are lots of doctors who would be unwilling to do what you reference, but they're selected out of that area of practice. The difference here is simply that this selection effect isn't present here because this procedure is a minority of the field

Are you talking about male circumcision? It's hardly a blip on the radar of invasive procedures with no lasting side effects except some minor benefits.

Cutting off an infant's outer ears or doing electrolysis on their armpit hair follicles or burning them with a hot iron also have no long lasting side effects but we don't allow those because of course we don't. Cutting off a male prepuce has just as much effect as cutting off a female prepuce. Can you imagine a doctor agreeing to removing a baby girl's clitoral hood? As someone who did have long-lasting effects from circumcision, I would delight in finding the son of a bitch that did it to me and seeing how he likes having pieces removed. You don't need a spreadsheet to know that causing agony to children is a bad thing.

> I would delight in finding the son of a bitch that did it to me and seeing how he likes having pieces removed

That's understandable, but I'm curious - do you feel the same about your parents, who presumably scheduled the circumcision?

Somewhat, but my parents didn't have to listen to the screaming. He did, and kept going.

You act like you remember it. Most parents are present for the operation. And at least modernly, they use injected local anistetic.

If that's the case why not wait until the recipient is an adult and can give consent?

When my son was born (in the US) the woman who did these procedures was very aggressive and persistent about having it done immediately. When I said that he could choose when he was an adult she replied, "But in that case he will say no" which seemed like a very odd position use to try to justify the mutilation.

Because it is way more of a big deal after infancy and especially after puberty. More nerve endings and more connections are made at that point. Not to mention just more skin to be removed.

A blip on the radar? I find completely insane about this response. How could we consider this even somewhat acceptable is insane. Mutilate a baby because "it looks better to me or that's how it looks usually". No, sorry, it completely unreasonable.

Adult deciding for themselves are totally fine. Children? No, that should be disallowed by law.

To elaborate the risk vs benefits[2], circumcision can reduce the risk of UTI in males by 10x. Not 10%, but 10x[1]. It also significantly reduces the risk of STI's particularly HIV. And as you said, there are no lasting negative side-effects (though a very small risk of complications).

[1]https://health.choc.org/circumcision-and-urinary-tract-infec... [2]https://www.center4research.org/circumcision-health-benefits...

Those are good reasons for you to get circumcised. They are not good reasons to do it to someone who cannot consent. You should also consider that statistics regarding complications only count complications that required medical intervention. Nobody goes around asking men "does anything bother you about your penis?" and noting down what annoyances could've been caused by circumcision. There are a lot of men who don't know that not everyone is bothered by loose underwear rubbing on them or that getting your frenulum licked is supposed to feel really nice.

I am sympathetic to the consent argument (I don't know that I would have my boys circumcised). However risk significantly increases with age, so that is something to consider.

> They are not good reasons to do it to someone who cannot consent.

Should we stop giving kids the polio and MMR vaccines until they can consent?

This really shouldn't be downvoted. If one is going to pull the "children cannot consent" card, one should be consistent. If it's not actually about consent and actually about something else, let's not pretend it's about consent.

Obviously the implication is that it's "obvious" that the benefits of vaccines outweigh the cons of ignoring consent, but that just prompts the questions: Is this true, and what amount of benefit is necessary to avoid consent in children? Explicit reasoning should laid out.

The vaccine is not taking away part of the pleasures of the child once they become adult, so the choice is between "bad" (vaccine pain) or "more bad" (sick).

The circumcision is between "fine and pleasure with some risks" and "very painful, loss of pleasure in some areas, annoying underwear rubbing, body mutilation, some reduced risks".

Finally, the reason why the vaccine is done without consent is because you can get killed (or kill accidentally due to lack of herd immunity) if you don't do it.

No one is affected by someone going through circumcision or not.

The majority of the world is not circumcised. The majority of the world is not dealing with an STI epidemic; some areas are, and only with some STIs. The US has a very high circumcision rate and a very high STI rate for what the proponents of circumcision would like you to believe. The two are only correlated due to a third variable. Circumcision simply isn't a good replacement in any circumstance for sexual hygiene. Don't mutilate children to control for the root variable.

Males are born with foreskin for a reason. Much like one is not born prozac-deficient, the majority of males are not born with some evolutionary "excess".

They're different doctors! Surgeons are a subset of doctors, and plastic surgeons are the ones who decided to chase money over glory

I have compared with a friend that wanted to get her tubes tied, and the doctor insisted she might change her mind, should wait a few years, and wanted her to speak to her partner about it.

I asked for a vasectomy, and the doctor scheduled it 2 days later. It really is a double standard

From my understanding vasectomies are much easier to reverse than the female equivalent that might account for some of it.

And on top of the reversibility, vasectomy is a much simpler out-patient procedure compared to tubal ligation (which means lower risk of complications). There is not a double standard here, just medical reality.

My vasectomy doc made it very clear that vasectomies are not always reversible and you should absolutely not count on them being reversible if you anticipate changing your mind.

Then why are all the refusal statements we're hearing about "regret" instead of risk?

Because the biggest consideration is the reversibility as GP said. If you have Tubal Ligation your odds of getting it successfully reversed is 1%[1]. It is effectively a permanent decision.

[1]https://www.fertstert.org/article/S0015-0282(15)00292-7/pdf

On the other hand, she is asking for a form of birth control. Given that abortion is banned in many parts of the US, it's easy to see why she views the denial of birth control as an attempt to control her body.

Why does the doctor get to decide whether another person may regret it or not? That isn't a medical decision.

The common wisdom is that they're afraid of being sued. For example, imagine someone with Bipolar disorder in the midst of a manic episode scheduling and performing a tubal ligation. Then later on, they accuse the doctor of malpractice for not identifying them as being in a state of compromised decision making capacity and denying their request.

It's really simple to say, that the patient asked for it and that the doctor acted as expected, but it doesn't prevent the lawsuit from being filed. If it's especially egregious, it might be dismissed with prejudice, but there's always a chance that it goes further than that.

I think you're right. Though a solution to this problem seems simple. Just like we ought to have timeouts from the moment you want to buy a firearm to the moment you can have it in your possession, we could have a procedure "fill out this form and sign in, have a consultation with your doctor, and if you come back 3 months later with the same request, after you sign one more form, you can have the procedure".

This is how vasectomy works in France. You have to wait four months and confirm your choice after that.

Because the doctor is performing the operation, and people are always responsible for their own actions. "They told me they wouldn't ever regret it and I foolishly believed them" isn't an excuse for avoiding responsibility.

Is the doctor responsible in the case of unwanted pregnancy after the refused sterilization?

If the doctor lied about performing the procedure, then presumably yes.

That's the inversion of your prescription, not what anyone else is proposing. Nobody is telling anyone they will not regret an elective medical procedure. That's something you need to figure out. Stop being disingenuous.

Ok devil’s advocate. Let’s say the doctor knows for a fact, magically, that they will want to have kids in 5 years. Is it ethical to do the procedure?

Let's say that magically devil's advocates don't exist. What argument do you want to make?

Deciding one wants kids later in life after thinking they would not is fairly common. Sterilizing young people means a great number of expected people who will be unable to conceive despite wanting to later on. The statistical expected utility of doing the operation may well be negative. Especially if abortion care is readily available (the fact that it is not is a key point here).

People getting sterilized because they’re afraid of lack of birth control rights and abortions is tragic.

People make choices and then change their priorities or at least their minds about a great many things especially as they get older. Many of these choices have higher regret rates than sterilization. Yet, it seems that sterilization has a special status that gives license for people to make decisions about others. Why is this? As a bodily autonomy absolutist it's hard to understand a willingness to accept someone else's authority over my body.

And why should one operationalization of utility be chosen out of the multitudes of conceivable[1] operationalizations?

1. yes, intentional. yw

Like what? (Has higher regret rates)

The first one that popped up is breast reconstruction after mastectomy, 47% of the sample at at least some regret[1]. Tubal ligation regret maxes at 20.3%[2]. While tubal ligation regret deminishes as age at the time of the procedure increases, my point is that it is still well below that of breast reconstruction. People seem to have no worries about reconstruction regret and large worries over people's sterilization regret. The paradox is hypocritical. There must be another factor at play.

Prostate surgery has comparable regret rates(1 in 5)[3] to sterilization. Again, society seems to be perfectly ok with letting folks make decisions about prostate surgeries. Female sterilization in particular seems to be a lightning rod for public discourse.

1. https://www.tandfonline.com/doi/abs/10.1080/1476832060112489...

2. https://pubmed.ncbi.nlm.nih.gov/10362150/

3. https://archive.nytimes.com/well.blogs.nytimes.com/2008/08/2...

Breast reconstruction is reversible, minus some possible loss of nerves from the original tissue source.

Why did you not address prostate surgery and do you have reversal rates on breast reconstruction surgery?

I don’t know much about prostate surgery. I presume it’s largely for people who have cancer. All I really know is that prostate cancer is very common among older men and is typically non lethal and probably should be done less? They should probably communicate the effects of prostate removal more than they do. Unnecessary surgeries done on underinformed patients is a different but serious problem.

The reversal rates are irrelevant. The fact is that it can be reversed whereas sterilization cannot, and frankly has much larger consequences than some body image issues. We don’t have a lot of studies on regret rates for young childless women because few young childless women get sterilized.

This poses a catch-22: young women are denied the care they request because there is not enough data on the care they request. Surely, the nature of the circular logic must confound you as well. Functionally it's the same as simply denying care.

Is it your understanding that tubal ligation cannot, under any circumstance, be reversed? If not so, then reversal rates are in fact important to this discussion.

Reversal is fair. I assume it’s permanent.

> This poses a catch-22: young women are denied the care they request because there is not enough data on the care they request. Surely, the nature of the circular logic must confound you as well. Functionally it's the same as simply denying care.

Lack of evidence of no harm is a hard sell against priors that assume harm.

It feels too close to being asked to prove a negative. Why not simply have an uninformative prior rather than a strong harm prior? Based on the discussion we've hard so far, it sounds like your prior is conditioned in some way, and to find the means by which it is is precisely why I'm digging[1].

1. at this point probably pestering

Since your premise is impossible (the doctor does not know this for a fact and cannot), the question isn't relevant. In any case, adoption is an option.

And herewith The Laplace's doctor is born, bound to plague medical ethics for centuries to come.

If we're going to allow magic in this scenario, I suggest that the woman magically give herself a tubal ligation and skip the patronizing medical professionals altogether.

Or if we're going to skip things, let's start with hypotheticals that will never happen.

Age matters. If someone wanted me to tattoo a snake on their forehead I would be taking account their age.

Sure, some doctors have a preference not to do it, but their stake in the situation is pretty low compared to the patient. Why do we let the doctors preference mean that the procedure becomes unavailable?

Imagine if mail carriers could refuse to deliver to houses with the mailbox up stairs. Yes, its fair that they don't like it but the cost of that is people lose a vital service. In that case the mail carriers have to accept their job might include some elements they don't like.

Some mail carriers do refuse to deliver at certain address for reasons that other carriers wouldn't refuse to deliver for.

If only they applied the same logic to males then it would make sense. They don't. Men can get sterilized in the blink of an eye, while women are forced to "have time to think a out it" and such.

Last I checked 26 was 8 years more than 18.

Doctors are not supposed to harm patients even if the patient is above the age of 18. If the patient is likely to regret the operation, doing the operation is causing harm.

You can't have an abortion - you had sex deal with the consequences of your choice, even if it means your death from complications in pregnancy.

You can't have your tubes tied - there might be consequences to your choice so you shouldn't have to deal with those.

What's different here? Oh right, nothing if the goal is forcing birth.

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