Hacker News Reader

Comment by oneoff786 | Hacker News Reader

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?

View on HN

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.

Reply on news.ycombinator.com