Hacker News Reader

Comment by amanaplanacanal | Hacker News Reader

Most doctors refuse to perform sterilization procedures on young people, at least until after they have had children. After all, what if they change their minds?

My girlfriend couldn’t get hers done until she was over 30.

View on HN

This is a topic near and dear to my heart, because unwanted children leads to enormous suffering (which I have seen up close as a volunteer Guardian ad Litem, a legal advocate for children in the system). A recent thread on the topic of unwanted children at scale [1].

So I bought and operate a domain which points to the r/childfree subreddit wiki list of doctors [2] who will provide permanent birth control to people who want it without onerous conditions such as partner approval, being over 30, or having at least two or three kids first. I run marketing campaigns on socials with this digital property. Next steps are building a site to act as a "store locator" app for this data. My partner and I also contribute in r/sterilization for those seeking permanent birth control, helping folks navigate insurance (bisalps in the US are free under most insurance situations, and vasectomies are covered at 100% in 10 states) and logistics.

High level, we should collectively be robustly supporting parents who want to be parents, but we must aggressively assist though who would rather not. 40% of US domestic pregnancies every year are unintended [3]. ~600k children are in the foster care system [4], very roughly half of which are adoptable but are never adopted. It costs ~$310k to raise a child from 0-18 in the US [5], and this does not include daycare or college costs.

[1] https://news.ycombinator.com/item?id=40053774

[2] https://www.reddit.com/r/childfree/wiki/doctors

[3] https://www.guttmacher.org/fact-sheet/unintended-pregnancy-u...

[4] https://usafacts.org/articles/how-many-kids-are-in-foster-ca...

[5] https://www.brookings.edu/wp-content/uploads/2022/08/Brookin...

Bandaid solutions to societal ills probably just prolong the suffering.

On the contrary, this is a pipeline problem. If you get to the root of the problem by avoiding unwanted children, the effort to paper over the suffering in the future is never needed. Society ain't changing on any meaningful timeline (based on all available evidence), "the purpose of the system is what it does," so attack the root cause in earnest.

It is a choice to not actively solve for the suffering, so find an inexpensive point of leverage to attempt to solve for it. Folks seeking this healthcare are being marginalized by the system at great cost realized as externalities, and therefore require empowerment (with strong positive second order effects). Like vaccinations, prevention is far cheaper than the alternatives.

Tangentially, it's kind of wild to think that the global population boom, billions of people, over the last ~100 years was because of women not being empowered [1], broadly speaking. Because as soon as women are empowered [2], educated, and have robust access to contraceptives, boom, fertility rate plummets off a cliff. Turns out, society (economic pyramid schemes leading to pearl clutching about rapidly declining populations) and men [3] [4] want more children than women do. Ergo, we must empower the human, because all available evidence demonstrates the system is built and operated to subjugate rather than empower (from a first principles systems analysis).

[1] https://ourworldindata.org/fertility-rate#what-explains-the-...

[2] https://news.ycombinator.com/item?id=40982392 (citations)

[3] https://www.cbc.ca/news/canada/women-children-study-1.711984...

[4] https://www.theguardian.com/world/2019/may/20/paid-paternity...

A society that doesn't support having children won't lead anywhere worth going.

I'm pretty sure that given the support they needed, and a society that didn't program them all the way to want other things in life more; the numbers would look very different.

And that IS the long term problem.

Which is not at all an excuse for not solving other problems, I don't feel it has to be one or the other.

Society very much has, and is, changing; drastically, exponentially. And in an increasingly destructive direction for quite a while now.

And it will have to change into something more constructive, humane, rational; if it wants to survive at all.

Indeed, society can fix the system if it so chooses. Otherwise, it must make peace with rational actors making rational decisions in an irrational and dysfunctional system. In my small acts, I am gifting agency and freedom. Society is free to make a better offer (I wish it would), but we know it won't.

Prof Scott Galloway asks, "Do we love our children? [1]" I can prove that we don't, beyond a shadow of a doubt. It is clear as day.

[1] https://www.ted.com/talks/scott_galloway_how_the_us_is_destr...

Then it will be replaced by something more suitable, like many times before.

Once you drift too far away from basic human needs and the truth, something will happen, and we're more or less there if you ask me.

I'm curious how you would prove it? The biggest indictment of humanity to me is our destruction of the biosphere for future generations (and at the rate we're going, a few current generations as well).

Is it that or something else?

I can enumerate the long list of policy that treats youth as a resource to extract from vs supporting and enabling their success. Is that what you had in mind for this?

No need to enumerate the list; I can imagine rather a lot of it, and it probably isn't limited to youth, but they're usually the least able to deal with those who would extract from them.

But I still think the largest indictment of humanity is our failure to care for our home. Buckminster Fuller gave us the idea of "Starship Earth"; that we are all the crew of a spaceship that winds through the galaxy and we must all cooperate to maintain it for those that come after. It seems almost certain now that we will not make it.

I think it would be cool to know your main digital property or some other way to connect - so folk who want to help could reach out.

I got mine done at 37, after having two kids, and they still asked me if I was sure.

I can see why you'd be hesitant to do it on a 22-year-old. If you asked me at 22, I'd probably say I don't want kids. But I completely changed my mind as I approached 30.'

Also, vasectomies are less reversible than people think.

Why not adopt? There are plenty of kids already who need a parent or two.

I already have two kids.

Pretty sure adoption is very difficult nowadays. Also people do change their minds about having their biologically own kids.

It's difficult and expensive, and my wife and I have no issues conceiving. Why make it even more competitive for people who can't conceive?

Why question a human’s innate desire to raise their own off-spring like we’ve evolved to do for millions of years?

So often people chime in with the “just adopt” and while I agree in a perfect world, that’s exactly what would happen, but in reality it goes against a very fundamental part or human nature to opt to raise someone else’s child instead of your own. It just completely misses the human element of why people are so naturally driven have kids and families to begin with.

Because sometimes we need to question "fundamental parts of human nature"

Plenty of people raise other people’s kids without ever knowing. They didn’t love them less.

Yes, but usually they believe it is their own kid

the reality is, most kids you can adopt are severely messed up, due to drug use of parents or poor eating/nutrition of parents.

i guess you are downvoted because it sounds like you say that drug use or poor eating are the main reasons for children to end up in adoption. i don't think that's true, there are many other possible reasons. that said, whatever the reasons are, i fear few children come out unaffected by whatever trauma they experienced which lead to an adoption, with the only exception of children being adopted right at birth.

This decision really needs to be removed from the hands of doctors, as long as there is no physical risk to the patient.

You think doctors should be forced to perform procedures they don’t want to perform?

At the very least the doctor should be required to refer the patient to a different doctor who is capable of performing it. This question is kind of similar to "Should pharmacists be able to deny birth control (or other medicine like vaccines) to people because of the pharmacist's personal religious belief?"

Except it’s not a question of the doctor’s personal religious belief or preference, but rather a question of professional judgment.

It is technically possible for a physician to prescribe methamphetamine or fentanyl. Many adults in the United States want to consume methamphetamine or fentanyl. (Sometimes both at the same time!) But it is very hard to find a physician who will write those prescriptions purely on the basis of “the patient asked for it”. Like it or not, some degree of paternalism is an inherent part of the practice of medicine.

The current version of the Hippocratic Oath says this:

""" I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism. """

Which does not include "except those I don't feel like doing".

The Declaration of Geneva states the following:

""" THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration; I WILL RESPECT the autonomy and dignity of my patient; """

Which I read to similarly state that a doctor's own preferences as to the procedures is necessarily secondary.

This amounts to saying doctors should be forced to perform procedures they believe are not in the best interests of their patients, go against conscience, or expose them to significant litigation risk.

All surgical sterilization procedures come with physical risk, and many other birth control does as well.

Or we still have physicians with the mindset of "What does your husband say?"

And then more and more schools, not less and less, are teaching abstinence-only sex ed.

And politicians pushing it. Including Lauren Boebert, 4th generation teen mom, who has a son who got his girlfriend pregnant at a ... questionable ... age. And Sarah Palin, who works with her daughter while her daughter has had two kids out of marriage.

(To be clear, my perspective on sex ed and morality is not saying there's issue with sex and children out of marriage, quite the opposite. But you have people who are being held up as rolemodels doing ... not what they preach.)

Curious if the doctors are actually just proxies for insurance providers in this case?

Reply on news.ycombinator.com