Given the history of forced sterilization in California, I think it's clear that at least some doctors do not hold themselves to a high ethical standard at all, but in fact, a quite low one. Pressuring an inmate or even offering if they are in labor a tubual ligation is now illegal as a result of that history:

"Since then, it's been illegal to pressure anyone to be sterilized or ask for consent during labor or childbirth."

Moreover, it has been documented in the article that at least some of the "approval" was given while patients were under sedation, which cannot be taken as approval in any ethical way, given the nature of the procedure. That is basically enough for an unethical doctor to cover his or her ass, but it is not appropriate for a journalist to refer to that as approval.

At any rate, it's good that you're asking why this is going on in this century. Just a shame you seem to be concern trolling about a very valid headline instead of addressing the issue at hand.