Ship of Fools: UK judge sanctions sterilisation "in his best interests".

Thread: UK judge sanctions sterilisation "in his best interests". Board: Oblivion / Ship of Fools.

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Posted by luvanddaisies (# 5761) on :

BBC News article here .

In summary, a judge has sanctioned the sterilisation of a man in the Midlands who has learning difficulties. He and his partner (who also has learning difficulties) already have a child, which had a profound effect on them and their families, and apparently do not want another one, although he can't be relied on to use contraception. Is is suggested that having another child could cause him psychological harm.

Apparently this is the first time a request like this has been granted. It seems to have been thought about carefully, with the GP, the man's parents, the local authority looking after his care, but it still seems, well, uncomfortably reminiscent of the
Eugenics in the USA ,Nazi Germany and other countries .
Is that just squeamishness and paranoia, or is it right to be wary of this decision?

Posted by Marvin the Martian (# 4360) on :

Everybody concerned (including the man himself) wanted it to happen, but because it has been decreed that he is unable to consent to the surgery they needed a judge to consent on his behalf.

Where's the problem?

Posted by Drifting Star (# 12799) on :

What Marvin said. I was a bit puzzled about the need for it to go before a judge, since everyone, including the man himself, is in favour, but I suppose if it is subject to such scrutiny it is better to be overly cautious.

The alternative - constant observation of his 'long-standing, loving relationship with his girlfriend' to ensure he uses contraception - seems to me to be a gross infringement of his right to as normal a life as possible.

Posted by luvanddaisies (# 5761) on :

I don't know if there even is a problem, that was part of the reason for the post.

If he's not capable of consenting, is it right that non-essential surgery is sanctioned for him? Is is non-essential? I don't know.
It seems pretty unusual, given that it's the first case where the judge has agreed, and there must be a reason for that unusualness.

Posted by luvanddaisies (# 5761) on :

ETA - I think including the links to Wiki articles on eugenics may have made my OP lean more towards an "aaagh - arm-waving" sort of post than it was meant to be. It was more intended to be just a question of what people thought, not loaded towards a reaction of panic and opening floodgates. My bad - it's unclear.

oops - hit quote not edit. Ah well.

[ 16. August 2013, 13:17: Message edited by: luvanddaisies ]

Posted by L'organist (# 17338) on :

Just your squeamishness, luvanddaisies.

A medic friend is tearing their hair out over a similar situation: THREE children, all with profound learning difficulties, all at special school, none likely to be capable of independent living.

Mum doesn't know where the babies come from, or why, and is incapable of looking after them or herself.

Dad (roughly like an 11-12 year old) has worked and can run a home, more-or-less, with support. He was made to give up work when the first baby arrived and hasn't been able to work since.

Condoms have been tried but he is forgetful - plus the wife thinks they are balloons and blows them up for the kids to play with...!

Dad would like a vasectomy but has been told by Social Services that his wife "must consent" - even though her mental capacity is that of a 4-5 year old...so he is unable to work, the family is entirely dependent on the state and, while they have the same social worker, they are likely to have more children [Mad]

Posted by luvanddaisies (# 5761) on :

quote:
Originally posted by L'organist:
Just your squeamishness, luvanddaisies.

Like I said above, I'm not saying I think it's wrong or that there's necessarily a problem - although the links I put in the OP may have made it come across that way. In other words, I communicated badly - especially in the sentence where I said it seems uncomfortably reminiscent of... My bad writing.
I'm just wondering.

Maybe a better question to have asked would be why this one case? Why is this man the one when in cases like the one you talk about there sounds like there would be grounds for similar but there hasn't been. Not that I'm saying it's an easy decision for anyone involved, or that it should not be a rare thing.

[ 16. August 2013, 13:30: Message edited by: luvanddaisies ]

Posted by orfeo (# 13878) on :

Court authorisation of sterilisation is a requirement in Australia for children. There is some controversy about it within disability rights circles for much the same reasons you mention, the reminiscence of eugenics in the past - or at least, there was some controversy when I was working in the relevant area circa 2006-7.

The leading case on the topic does have a very careful discussion about capacity to consent, and why a court should be involved rather than it being left to parents. I'm not sure whether it's come up here with an adult, but I suspect much the same principles would apply with an adult who lacks capacity to consent and has some kind of guardian. Indeed, I think many of the States here have placed the decision-making process with their guardianship tribunals because they feel that's the most suitable body to make the necessary kind of judgements.

[EDIT: It's probably worth mentioning that the 'best interests' of the child is the fundamental test here as well.]

I can completely understand why some people look at the past history of sterilisation - I read some absolutely horrible stories when I was working in this area - and conclude that the best policy is to say no sterilisations, ever, the risks of injustice are too great. But personally I think there will be a small number of cases where sterilisation really is the better option because of the person's distress over being non-sterile. It should be a pretty rare case, though, and any rise in the numbers of approvals always needs to be examined with great care.

[ 16. August 2013, 13:50: Message edited by: orfeo ]

Posted by SvitlanaV2 (# 16967) on :

quote:
Originally posted by L'organist:

Dad would like a vasectomy but has been told by Social Services that his wife "must consent" - even though her mental capacity is that of a 4-5 year old...so he is unable to work, the family is entirely dependent on the state and, while they have the same social worker, they are likely to have more children

Does a married man have to get his wife's consent before he has a vasectomy? I'm very surprised to hear that. It's also surprising that the problems this particular couple were likely to face weren't considered when they first got married.

[ 16. August 2013, 14:00: Message edited by: SvitlanaV2 ]

Posted by L'organist (# 17338) on :

Considered by whom?

Her parents couldn't wait for her to be married, he was mad keen, she wanted to wear a pretty dress, the social worker thought it was "sweet" and the registrar asked no questions...

Posted by SvitlanaV2 (# 16967) on :

Considered by the people around them who were supposed to be the responsible adults. I'm not saying that they shouldn't have got married, but isn't marriage about more than looking sweet in a pretty dress? Life after the nice wedding was bound to be very challenging for them, but it doesn't sound as if anyone had given this any thought at all.

Posted by Adeodatus (# 4992) on :

quote:
Originally posted by L'organist:
... and the registrar asked no questions...

Generally incorrect. If the Registrar has any grounds to doubt that either party has the mental capacity to understand the nature of the marriage vows, they have to make enquiries. I don't know the nature of the enquiries, or the grounds for doubt, but I've known it happen on several occasions.

Posted by North East Quine (# 13049) on :

Originally posted by luvanddaisies:

quote:
Maybe a better question to have asked would be why this one case? Why is this man the one when in cases like the one you talk about there sounds like there would be grounds for similar but there hasn't been.

I'd guess that what is different about this case is that both families are helping facilitate a long-term relationship, in which a vasectomy for the man is the easier option. In previous cases avoiding pregnancy was seen as more of an issue for the woman. Therefore the focus was on female sterilisation.

I think this is good news, as it suggests that long term relationships involving people with a learning disability are being taken seriously.

Posted by Jade Constable (# 17175) on :

quote:
Originally posted by North East Quine:
Originally posted by luvanddaisies:

quote:
Maybe a better question to have asked would be why this one case? Why is this man the one when in cases like the one you talk about there sounds like there would be grounds for similar but there hasn't been.
I'd guess that what is different about this case is that both families are helping facilitate a long-term relationship, in which a vasectomy for the man is the easier option. In previous cases avoiding pregnancy was seen as more of an issue for the woman. Therefore the focus was on female sterilisation.

I think this is good news, as it suggests that long term relationships involving people with a learning disability are being taken seriously.

Agreed with this, and with Orfeo's post. L'Organist, what a terrible situation for the couple you mentioned.

Posted by Heavenly Anarchist (# 13313) on :

quote:
Originally posted by Jade Constable:

quote:
Originally posted by North East Quine:
Originally posted by luvanddaisies:

quote:
Maybe a better question to have asked would be why this one case? Why is this man the one when in cases like the one you talk about there sounds like there would be grounds for similar but there hasn't been.
I'd guess that what is different about this case is that both families are helping facilitate a long-term relationship, in which a vasectomy for the man is the easier option. In previous cases avoiding pregnancy was seen as more of an issue for the woman. Therefore the focus was on female sterilisation.

I think this is good news, as it suggests that long term relationships involving people with a learning disability are being taken seriously.
Agreed with this, and with Orfeo's post.

I also agree. I was just listening to radio 4 where a charity was welcoming this decision saying that they would rather such a decision was made in a court of law than privately without due consideration as might have happened in the past. As mentioned, the man did want the operation himself but was legally unable to consent therefore it was put to the court to consider.

Posted by PaulBC (# 13712) on :

If this person is not capable of consent then a judging allowing this procedure is the right way to go.
As to sterelizing the handicapped . Hold the phone that is BAD procedure and the state should not do it. It has happened here in Canada as recently as the 1950's
in the USA about the same time line . And yes it is the slippery slope to the unthinkable , just look at Germany 1933-45.
However if a person asks for a procedure and can not give consent then a judge in consultation with medical professionals should be able to sign off on the procedure.
That is helping & supporting the person seeking help.

Posted by Gee D (# 13815) on :

quote:
Originally posted by L'organist:
Considered by whom?

Her parents couldn't wait for her to be married, he was mad keen, she wanted to wear a pretty dress, the social worker thought it was "sweet" and the registrar asked no questions...

From what you say, neither of them could form a proper intention to be married and there would be a decent argument that they were not in fact married.

The elder sister of one of Dlet's mates - they live a short walk from here - is very, very severely retarded. She cannot speak, but rather squeaks and grunts, and cannot care for herself. Her periods terrified her and made her uncontrollable for days. She lacked any ability to understand what was happening. Her parents made an application to the Family Court and she had a radical hysterectomy. The application involved appointment of a separate representative for Sarah, presentation of detailed reports from several experts, and the formality of a court hearing. It's the same sort of procedure - although to the Family Court rather than to the Supreme Court - followed when Jehovah's Witnesses refuse permission for blood transfusions for their children.

OK, it does smack a bit of eugenics, but does anyone have any other suggestions?

[ 16. August 2013, 22:04: Message edited by: Gee D ]

Posted by Jade Constable (# 17175) on :

quote:
Originally posted by Gee D:

quote:
Originally posted by L'organist:
Considered by whom?

Her parents couldn't wait for her to be married, he was mad keen, she wanted to wear a pretty dress, the social worker thought it was "sweet" and the registrar asked no questions...
From what you say, neither of them could form a proper intention to be married and there would be a decent argument that they were not in fact married.

The elder sister of one of Dlet's mates - they live a short walk from here - is very, very severely retarded. She cannot speak, but rather squeaks and grunts, and cannot care for herself. Her periods terrified her and made her uncontrollable for days. She lacked any ability to understand what was happening. Her parents made an application to the Family Court and she had a radical hysterectomy. The application involved appointment of a separate representative for Sarah, presentation of detailed reports from several experts, and the formality of a court hearing. It's the same sort of procedure - although to the Family Court rather than to the Supreme Court - followed when Jehovah's Witnesses refuse permission for blood transfusions for their children.

OK, it does smack a bit of eugenics, but does anyone have any other suggestions?

I've heard of similar cases to that and indeed was thinking about that when I saw this thread. I think cases where it's obvious that a person cannot cope with a normal bodily function like periods and will never be able to do so, that can become a form of consent. I think a hysterectomy to relieve suffering (since a period doesn't just involve pain, without wishing to be too graphic!) when that person could never consent to sex and pregnancy anyway, is not like eugenics in the least. After all, intellectually normal (not sure of the right term?) women have hysterectomies to end their periods too, without it being to do with preventing pregnancy.

Posted by Golden Key (# 1468) on :

Forced hysterectomies are just as problematic as sterilizations. There's a long history of them.

I wonder if anyone considered that the hysterectomy would put the young woman into immediate menopause? That's no walk in the park, either, and she's probably unable to manage helpful medications on her own. And I suspect trying to make her take them would be a nightmare.

Posted by Gee D (# 13815) on :

quote:
Originally posted by Golden Key:
Forced hysterectomies are just as problematic as sterilizations. There's a long history of them.

I wonder if anyone considered that the hysterectomy would put the young woman into immediate menopause? That's no walk in the park, either, and she's probably unable to manage helpful medications on her own. And I suspect trying to make her take them would be a nightmare.

All of that was carefully looked at as a part of getting court approval. Sarah could not manage any form of medication on her own. She has some sort of implant, renewable annually, for HRT.

Posted by Moo (# 107) on :

quote:
Originally posted by Gee D:
The elder sister of one of Dlet's mates - they live a short walk from here - is very, very severely retarded. She cannot speak, but rather squeaks and grunts, and cannot care for herself. Her periods terrified her and made her uncontrollable for days. She lacked any ability to understand what was happening.

I heard a similar story about a severely retarded girl in an institution who was approaching the age of puberty. She panicked at the sight of blood, and the staff at the institution was afraid she would have to be heavily sedated during the time of her monthly period. They applied to the court for permission to perform some sort of surgery; I'm not sure what. The permission was denied.

Would the hormonal effects of the proposed surgery be worse than being almost knocked out cold for several days every month?

Moo

Posted by Soror Magna (# 9881) on :

Obviously we don't know the whole medical story behind any of these cases, but it seems like they didn't consider other methods of birth control. Implants and drugs like Depo-Provera not only prevent pregnancy, but they also stop menstruation.

(And before everyone freaks out about having no periods, remember that in the good old days, most women got their periods between pregnancies.)

ETA: Sorry, I just noticed Gee D's mention of implanted HRT. Which, again, though, makes me wonder why implanted birth control wasn't used instead.

[ 17. August 2013, 13:24: Message edited by: Soror Magna ]

Posted by Heavenly Anarchist (# 13313) on :

I guess in the original case stated sterilisation was preferred as the man himself is stated as wanting this, though obviously we cannot know his understanding of the choices available (but presumably the judge did consider the options).

[ 17. August 2013, 17:07: Message edited by: Heavenly Anarchist ]

Posted by wheelie racer (# 13854) on :

The issue here is that of capacity to consent to surgery. In England and Wales, there is a very good piece of legistlation called the Mental Capacity Act which I am assuming from my knowledge of the law and what I have read so far about this case is the basis behind the need for a court decision to be made over surgery.

The Act is underpinned by five key principles:

A presumption of capacity: every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise.
The right for individuals to be supported to make their own decisions: people must be given all appropriate help before anyone concludes that they cannot make their own decisions.
That individuals must retain the right to make what might be seen as eccentric or unwise decisions.
Best interests: anything done for or on behalf of people without capacity must be in their best interests.
Least restrictive intervention: anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.
Assessment of mental capacity is specific for each individual decision at any particular time. People are considered to lack capacity if they have an impairment that causes them to be unable to make a specific decision. The person should be able to understand, retain and weigh the information provided and communicate their decision.

From my reading of this case, it is clear that the man concerned wanted surgery and the issue lay in the fact that it was felt that he did not have the capacity to consent.

The law has specific questions that need to be asked To test if the person has capacity:
Does the person have an impairment of the mind or brain, or a disturbance of mental function?
If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?

To have capacity to make a decision, someone must be able to:
Understand the information relevant to the decision.
Retain the information.
Use that information as part of the process of making the decision.
Communicate his/her decision either by talking, signing, or any other means.

The purpose of the Mental capacity Act and the judges decision in my reading seems to be a means of safeguarding this man, as opposed to oppression from the courts and social services etc

Posted by wheelie racer (# 13854) on :

The idea of what consitutes "best interests" within the law is also specific and also defines clearly ho best interests decision should be made.

The law clearly states that everything that is done for or on behalf of a person who lacks capacity must be in that person's best interests.

The Act provides a checklist of factors that decision-makers must work through in deciding what is in a person's best interests.

(1)A person can put his/her wishes and feelings into a written statement if they so wish, which the person making the determination must consider.

(2)Carers and family members have a right to be consulted.

(3)All decisions must be made in the best interest of that person:

(4)Involve the person who lacks capacity.

(5)Be aware of the person's wishes and feelings.

(6) Consult with others who are involved in the care of the person.

(7)Do not make assumptions based solely on the person's age, appearance, condition or behaviour.

(8)Consider whether the person is likely to regain capacity to make the decision in the future.

Posted by Belle Ringer (# 13379) on :

quote:
Originally posted by wheelie racer:
The law clearly states that everything that is done for or on behalf of a person who lacks capacity must be in that person's best interests.

I think this is the difference between humane law and eugenics.

The humane law's focus is on the good of the individual in their own present and ongoing life. Eugenics dis-values the individual, focusing instead on the supposed good of "society" or "the human race."

Posted by scuffleball (# 16480) on :

quote:
Originally posted by L'organist:
was made

By whom?

Posted by orfeo (# 13878) on :

quote:
Originally posted by Soror Magna:
Obviously we don't know the whole medical story behind any of these cases, but it seems like they didn't consider other methods of birth control. Implants and drugs like Depo-Provera not only prevent pregnancy, but they also stop menstruation.

(And before everyone freaks out about having no periods, remember that in the good old days, most women got their periods between pregnancies.)

ETA: Sorry, I just noticed Gee D's mention of implanted HRT. Which, again, though, makes me wonder why implanted birth control wasn't used instead.

I remember this coming up when I was working on this stuff. There's a good argument, at least, that the number of sterilisations should drop as viable alternatives are available. I think this MAY in fact have been what the stats here were showing, but I can't be certain 6 years later.

Posted by Leorning Cniht (# 17564) on :

quote:
Originally posted by Soror Magna:
Obviously we don't know the whole medical story behind any of these cases, but it seems like they didn't consider other methods of birth control. Implants and drugs like Depo-Provera not only prevent pregnancy, but they also stop menstruation.

Here's my thinking. Assume we have a person who has such profound mental retardation that he or she will never come close to being competent to care for a child.

That person having a child is a really really bad outcome, both for the person and the child, so it should be prevented. The involvement of the courts is necessary as the person isn't competent to give consent, and the issue is of sufficient magnitude that just a parent or other guardian's say-so probably isn't enough.

Then the question is what method of avoiding pregnancy is most appropriate. For a man, a vasectomy is low risk, pretty failsafe, and has no side-effects, so should be pretty much the automatic choice.

For a woman, there are plenty of options on the table - from long-term implanted contraceptives through tubal ligations to complete hysterectomies. As others have commented, a hysterectomy is only worth considering if there are other reasons apart from avoiding pregnancy, given the side effects, but as the person's mental condition is not going to chance, there is no argument for preferring a temporary solution over a permanent one.

The eugenics argument is, IMO, nonsense. There is no slippery slope. If the person understands that he/she needs a permanent contraceptive solution and asks for it, that's great, but this should not prevent a person's guardian for applying for such a solution if they don't understand it (see L'organist's post for an example of the misery that you get otherwise.)

Posted by Gee D (# 13815) on :

What Leorning Cniht has said. None of us knows just what was considered or not, but given that there were several detailed reports presented by the parents and on behalf of Sarah, it would be surprising if the experts did not evaluate the whole range of options available 6 years or so ago. Those reports in turn were considered by a judge, with the separate representative having the opportunity to draw attention to the plusses and minuses of each.

Posted by L'organist (# 17338) on :

Do all those who deplore the idea of the severely impaired being given a hysterectomy have experience of helping such a person to cope with menstruation?

A dear friend had to help her daughter in just such a way for over 20 years - the daughter, with the capacity of a 4 year old - (a) didn't understand what was going on, however many times anyone tried to explain it, (b) never got to gripe with dealing with sanitary towels, etc, (c) tried to fight off anyone trying to change her sanitary protection and (d) could be relied upon to remove such items at the first opportunity, wherever she was, and hurl them from her.

So tubal ligation is not an option...

Posted by Curiosity killed ... (# 11770) on :

However some of the implanted or injected contraceptives could be a solution, as they normally suppress menstruation.

Posted by Ian Batten (# 17784) on :

quote:
Originally posted by SvitlanaV2:

quote:
Originally posted by L'organist:

Dad would like a vasectomy but has been told by Social Services that his wife "must consent" - even though her mental capacity is that of a 4-5 year old...so he is unable to work, the family is entirely dependent on the state and, while they have the same social worker, they are likely to have more children
Does a married man have to get his wife's consent before he has a vasectomy? I'm very surprised to hear that. It's also surprising that the problems this particular couple were likely to face weren't considered when they first got married.

No, they don't. However, bizarrely, when I had mine on the NHS about fifteen years ago the initial paper work insisted that I should arrive for "counselling" with my wife. I instead arrived with my strop on, pointed out that last I checked they weren't demanding husbands consent to their wives' contraceptive choices and that it was absolutely outrageous. They were extremely defensive, and made all sorts of arguments which led me to suspect a great deal of sauce was being poured on the goose which wasn't being given to the gander. Men demanding vasectomies so as not to have more children were apparently cheating their wives out of their "right" to have children, but not vice versa.

When it came to it, the real NHS paperwork made no mention of spousal consent (quite properly), and I simply told the person doing the "counselling" that they could either sign off on the interview or I would make a formal complaint to the health authority (as it was in those days) and my MP. They folded like a wet newspaper, and in fact a few years later a friend of mine showed me the paperwork from the same clinic which had changed quite radically, and had an issue date on it about a month after my experience.

I do, however, know several people who have had private vasectomies (and in each case, had a really bad time of it with infections) precisely because they felt harassed and judged by the female staff who were the gatekeepers for the NHS procedure.

Posted by the famous rachel (# 1258) on :

quote:
Originally posted by Curiosity killed ...:
However some of the implanted or injected contraceptives could be a solution, as they normally suppress menstruation.

For both the injected, and more particularly the implanted contraceptives, they might have the effect you refer to, or they might cause persistent and/or irregular bleeding which is very difficult to manage. About a quarter of women who receive one of the common contraceptive implants have had them removed within a year of receiving them ( source). I've looked up the details (sorry - you need access to a subscription only journal) and well over half of those women had "excess bleeding". The figures for injections are a lot better, I believe, but you do then have to live with three-monthly (somewhat painful) injections, which may cause other problems for someone with a learning disability... This doesn't strike me as necessarily an easy or obvious solution.

Best wishes,

Rachel.

[ 19. August 2013, 11:06: Message edited by: the famous rachel ]

Posted by Doublethink (# 1984) on :

quote:
Originally posted by Ian Batten:

quote:
Originally posted by SvitlanaV2:

quote:
Originally posted by L'organist:

Dad would like a vasectomy but has been told by Social Services that his wife "must consent" - even though her mental capacity is that of a 4-5 year old...so he is unable to work, the family is entirely dependent on the state and, while they have the same social worker, they are likely to have more children
Does a married man have to get his wife's consent before he has a vasectomy? I'm very surprised to hear that. It's also surprising that the problems this particular couple were likely to face weren't considered when they first got married.
No, they don't. However, bizarrely, when I had mine on the NHS about fifteen years ago the initial paper work insisted that I should arrive for "counselling" with my wife. I instead arrived with my strop on, pointed out that last I checked they weren't demanding husbands consent to their wives' contraceptive choices and that it was absolutely outrageous. They were extremely defensive, and made all sorts of arguments which led me to suspect a great deal of sauce was being poured on the goose which wasn't being given to the gander. Men demanding vasectomies so as not to have more children were apparently cheating their wives out of their "right" to have children, but not vice versa.

When it came to it, the real NHS paperwork made no mention of spousal consent (quite properly), and I simply told the person doing the "counselling" that they could either sign off on the interview or I would make a formal complaint to the health authority (as it was in those days) and my MP. They folded like a wet newspaper, and in fact a few years later a friend of mine showed me the paperwork from the same clinic which had changed quite radically, and had an issue date on it about a month after my experience.

I do, however, know several people who have had private vasectomies (and in each case, had a really bad time of it with infections) precisely because they felt harassed and judged by the female staff who were the gatekeepers for the NHS procedure.

A woman with no children under the age of thirty who requests a sterilisation also faces increased scrutiny. They are essentially worried that people will act in haste and repent at leisure.

Posted by Zacchaeus (# 14454) on :

Indeed - a relative of mine with several young children already, was turned down for sterilsation because she was under 30..

Posted by birdie (# 2173) on :

quote:
Originally posted by Ian Batten:

No, they don't. However, bizarrely, when I had mine on the NHS about fifteen years ago the initial paper work insisted that I should arrive for "counselling" with my wife. I instead arrived with my strop on, pointed out that last I checked they weren't demanding husbands consent to their wives' contraceptive choices and that it was absolutely outrageous. They were extremely defensive, and made all sorts of arguments which led me to suspect a great deal of sauce was being poured on the goose which wasn't being given to the gander. Men demanding vasectomies so as not to have more children were apparently cheating their wives out of their "right" to have children, but not vice versa.

When it came to it, the real NHS paperwork made no mention of spousal consent (quite properly), and I simply told the person doing the "counselling" that they could either sign off on the interview or I would make a formal complaint to the health authority (as it was in those days) and my MP. They folded like a wet newspaper, and in fact a few years later a friend of mine showed me the paperwork from the same clinic which had changed quite radically, and had an issue date on it about a month after my experience.

I do, however, know several people who have had private vasectomies (and in each case, had a really bad time of it with infections) precisely because they felt harassed and judged by the female staff who were the gatekeepers for the NHS procedure.

On the other hand, someone I know went for an initial consultation with an NHS consultant recently regarding a vasectomy, and was told by the consultant that many men who had vasectomies were subsequently left by their wives, who went on to have more children with another man, and that women should be getting sterilised, not men.

Moral: there are people with very strange opinions all over the place.

Posted by Ian Batten (# 17784) on :

quote:
Originally posted by Doublethink:
A woman with no children under the age of thirty who requests a sterilisation also faces increased scrutiny. They are essentially worried that people will act in haste and repent at leisure.

I was, however, nearly forty and had two children.

Posted by Panda (# 2951) on :

Under 40 is not very old for a vasectomy - they will have met many people that age, and with children, who want to have it reversed, because they've changed their mind about more children. In some cases, sadly, one of their own has died and they don't want the surviving child to be on their own, or they're in a new relationship and the new partner - perhaps younger, perhaps with no kids yet - wants children with him.

I'm reasonably sure I don't want any more children but I don't think I'd want my husband going down that road, when there are other options available.

Posted by Ian Batten (# 17784) on :

quote:
Originally posted by Panda:
Under 40 is not very old for a vasectomy - they will have met many people that age, and with children, who want to have it reversed, because they've changed their mind about more children. In some cases, sadly, one of their own has died and they don't want the surviving child to be on their own, or they're in a new relationship and the new partner - perhaps younger, perhaps with no kids yet - wants children with him.

I'm reasonably sure I don't want any more children but I don't think I'd want my husband going down that road, when there are other options available.

By which logic, of course, no man should ever be able to receive a vasectomy: it's hardly unknown for men in their fifties or sixties or seventies to leave their wives for younger women, after all.

And just as men don't get to sign off on their wives' contraceptive arrangements, neither should women on their men's. It's a marriage, not a power of attorney.

But this is all a case of "only the poor people". Private clinics will perform vasectomies pretty much on demand, for a small price. It's only the NHS that wants to impose a moral standard.

Posted by anoesis (# 14189) on :

quote:
Originally posted by the famous rachel:

quote:
Originally posted by Curiosity killed ...:
However some of the implanted or injected contraceptives could be a solution, as they normally suppress menstruation.
For both the injected, and more particularly the implanted contraceptives, they might have the effect you refer to, or they might cause persistent and/or irregular bleeding which is very difficult to manage. About a quarter of women who receive one of the common contraceptive implants have had them removed within a year of receiving them ( source). I've looked up the details (sorry - you need access to a subscription only journal) and well over half of those women had "excess bleeding". The figures for injections are a lot better, I believe, but you do then have to live with three-monthly (somewhat painful) injections, which may cause other problems for someone with a learning disability... This doesn't strike me as necessarily an easy or obvious solution.

Best wishes,

Rachel.

Posted by Gee D (# 13815) on :

quote:
Originally posted by anoesis:

Just seconding what has been said above, from personal experience. I do seem to have stopped bleeding, a year and a half after having an implant, but for the first five months, I bled every. single. day. Then stopped for a week. Then started again for another month. Then it sort of tailed off in unpredictable fashion from there. I suspect the doctors in GeeD's post had had a good hard think about what they were doing and it really was the best thing, in that particular situation, because at least the outcomes are predictable.

Yes. What I was really commenting on was Soror Magna's comment that "it seems like they didn't consider other methods of birth control". We don't know what was considered or not, but given that (a) several specialists provided reports, and that there was a separate representative for Sarah to act as a devil's advocate, and also obtaining reports; (b) that these reports and submissions were considered in a formal setting by a judge, who gave a formal judgment; and (c) this happened a half dozen or so years ago; it is most likely that the pros and cons of a very wide range of choices were considered. This was not just a question of birth control. There were questions of hygiene, fear of blood/bleeding, pain management and so forth to take into account as well.

And judges don't jump to conclusions. My lunch companions at table a few years ago included a couple of judges who from time to time heard cases of medical procedures concerning children and those unable properly to make decisions for themselves. They both said that they found these some of the most difficult cases with which they dealt and that the agonised about their decisions, - even the comparatively straight-forward ones involving blood transfusions and other medical procedures for children of JWs.

Posted by Doublethink (# 1984) on :

quote:
Originally posted by Ian Batten:

quote:
Originally posted by Doublethink:
A woman with no children under the age of thirty who requests a sterilisation also faces increased scrutiny. They are essentially worried that people will act in haste and repent at leisure.
I was, however, nearly forty and had two children.

The NHS will do it, if they are sure you are sure. Sounds like the local policy was badly drafted, but suggesting someone takes time to reflect before making permenant life altering changes to their body doesn't seem so heinous.

You may have thought carefully about the whole thing first, but I assure you many people do not.

Posted by Pearl B4 Swine (# 11451) on :

Doublethink posted this a few days ago:

A woman with no children under the age of thirty who requests a sterilisation also faces increased scrutiny.

I should think that a woman with children over the age of 30 should be able to get whatever she wants. [Biased]

Seriously, I was just over 30 when my 2nd (and last) was born, and faced opposition to being sterilized. I requested the procedure be done while I was still on the table, right after delivery. My gyno finally gave in and agreed to do it, but I had to sign a paper agreeing not to sue or hold him responsible for denying me more babies. I saw marriage wreckage looming ever closer, and was abolutely sure I wouldn't change my mind.

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