Social Question

Facade's avatar

Is this the norm? (Doctor-patient question)

Asked by Facade (22884points) March 1st, 2011

As some of you may know, my boyfriend and I don’t want to have children. Because of this, we’ve agreed that “he” should get a vasectomy. He went to the doctor yesterday to discuss some things, and one of the things discussed was setting up for a vasectomy. The doctor told him he wouldn’t perform the procedure because he is so young (my boyfriend is 28), and also because there are other, less permanent options for us a couple (which is true, but obviously we don’t want those options).

Do y’all think we’ll come into this type of roadblock with most physicians?

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70 Answers

JilltheTooth's avatar

Unfortunately, very often physicians have their own agenda about reproductive issues, and your boyfriend will probably have to “shop” to find one that will respect his wishes. I don’t think the majority feel that way, but I would suggest getting recommendations from, say, your local Planned Parenthood or other like-minded group.

Facade's avatar

@JilltheTooth So we could contact planned parenthood, and they’d give us recommendations on which physicians would be likely to perform the procedure?

SpatzieLover's avatar

@Facade Yes. In many locales, there are Docs “known” for doing vacs.

KatawaGrey's avatar

@Facade: Here is a link to find a Planned Parenthood center that could help you. Personally, I think it is ridiculous that a doctor would withhold treatment just because he disagrees with your boyfriend’s decision.

Facade's avatar

@KatawaGrey I think it’s fucking ridiculous. I was pissed when he came home and told me that. Thanks for the link.

syz's avatar

Yep. I had to have an ectopic rupture and nearly die before my ob-gyn would agree to a tubal ligation (that I had been asking for nearly 10 years). “You’re too young, you may change your mind” is a common refrain – I’ve known I didn’t want to have kids since I was 16. I’m now 47 and I’ve never regretted it.

Facade's avatar

Wow… =(

iamthemob's avatar

Realize that this may be equally about balancing your interests and his as well. If there are less permanent solutions, etc., he may be unwilling to deal with suggesting and going through with something more radical as medical experience often shows that one’s desires, especially about family planning, are different ten years down the road from what they may be now.

And this is especially true when a decision is made as a couple – the doctor may be concerned that in fact one party is influencing the other to a degree – and if the two end the relationship, the party having the procedure may deeply regret it.

Knowing that, doctors may often find themselves subject to liability claims from patients who were not counseled properly with that in mind…and they may just refuse to get into the whole mess as a CYA kind of thing.

Facade's avatar

@iamthemob I’m not sure I understand what you’re saying, but he is the one who brought up getting a vasectomy initially, and this was almost three years ago. Neither my nor his feelings have changed about it.
Do you think it would help anything if we were both present when he presents the idea of getting a vasectomy to physicians? Maybe it will show that it is indeed a mutual decision.

SpatzieLover's avatar

@Facade It might help for you both to be present. It would definitely help if the doc understood this isn’t a short term idea or a short term relationship.

Possibly the idea of a male under 30 coming in alone asking for this made the doc think “young guy wants to have lots of sex w/out condom”...I’m just guessing here.

Facade's avatar

@SpatzieLover You have a good point. Maybe if the doctor can see that we’re both clean (no STDs), have been together for a while, plan on getting married, etc., it’ll help?

SpatzieLover's avatar

@Facade That does factor in, yes. When a doc sees a young, unmarried male come in asking for this it’s a bit of a red flag. I’d go back to this doc hand in hand, or seek one out that does this procedure frequently in your area.

iamthemob's avatar

@Facade – I’m saying that he would of course be remiss in presenting you with all of your options. However, whether or not he will (1) recommend an option, or (2) be the one responsible for enacting it are not only based on what may be what he would do in that situation, but also needs to take into account current forces outside the patient being part of the decision, as well as how someone of one age will feel ten years down the line – even twenty.

So, he may both be taking the whole patient into consideration, as well as covering his own ass regarding liability (e.g., what if you two break up? And now he wants kids? And now he has to get a reversal? And what if it doesn’t work? He could have to deal with a lawsuit).

Facade's avatar

@iamthemob That’s true, but there are risks with everyone. I think him performing the procedure now is much better than an unwanted pregnancy later.

SpatzieLover's avatar

and to further what @iamthemob, he may want to cover his ass by saying, “You are young and want to have sex without having kids, but this operation won’t take STDs out of the equation”...especially since he went w/out you.

Facade's avatar

@SpatzieLover So we should definitely go together? I didn’t go last time because that wasn’t the sole purpose of the appointment.

iamthemob's avatar

@Facade – True, but the operation is a definite, while pregnancy a potentiality…and it might be better for you, but not for him (e.g., if something goes wrong or you change your mind.)

If you could get the doctor to give you all his concerns, if possible, you may be able to figure out where the decision is coming from – and decide for yourselves better what the best option is.

SpatzieLover's avatar

@Facade I would go. You don’t have to. However, it may speed the process along. Most of the married men that I know that have had it done, had their wives their for the appointment and for the procedure. (they were a bit nervous)

Supacase's avatar

The doctors I am familiar with will only do a tubal ligation if you are 35 or have 2 kids. I would assume they have similar rules regarding vasectomies. Not that this information helps you, but it does answer the question that your situation is not uncommon.

Facade's avatar

@iamthemob What do you mean “decide for yourselves better what the best option is”? We’ve decided.
@SpatzieLover I’m perfectly fine with going. I’ll have to nudge my boyfriend a bit though.
@Supacase That seems ridiculous to me. Not having a child when you wanted one is a lot less damaging than having one when you didn’t want any. I don’t get it.

gasman's avatar

Yes, you’ll likely run into resistance from the US medical profession to have a sterilization procedure at a young age—male or female. The doctor, however, is not usually pressing a political agenda as implied by some messages above. It’s a more an ethical question and the “prime directive” of do no harm. In this case, one must factor in how commonly adults have a change of heart before the end of their reproductive years.

The GYN who eventually did my wife’s tubal questioned her decision at the time—she was 26 & we were married w/ 3 kids.

The most benign view is that it’s a safety flag. Like when you’re about to delete a big computer file and the message pops up: “Are you sure?”

To refuse to perform the procedure is also the physician’s prerogative. Whether s/he must make a referral to another provider may be subject to state law. But it sounds like the question is ethics, not legality.

It boils down to the old yin-yang of paternalism versus autonomy—two very strong cultural traditions. It’s your body, but ‘the doctor knows best.’ It totally depends on the situation & the personalities of all parties involved. Maybe s/he “picked up a vibe” (it might be non-verbal) of hesitation or uncertainty or unrealistic expectation of reversibility.

…Not to be too defensive of the medial profession—many competent doctors can be total jerks.

JilltheTooth's avatar

Personally I think it’s grossly inappropriate for the doctor to go beyond recommending alternatives and refusing outright. This man asking for the procedure is not 19, he’s 28 years old, able to legally enter into a contract, etc. etc. If he signs a waiver to the effect that he understands the potential consequences, the doctor’s ass is covered. And, with all due respect to the relationship, he should not have to produce an amenable long-term partner. I tend to be as outraged by a doctor refusing to perform a vac on a fully compos mentis adult male as I am about a doctor refusing a tubal or an abortion to a fully compos mentis adult female.
This bothers me a lot because I had to fight against just such well-meaning control in order to even pursue the idea of @KatawaGrey . <steam escaping from ears>

SpatzieLover's avatar

@JilltheTooth Their oath is “Do no harm”. It’s up to each individual’s morals/ethics to decide what this means to him/her. It is a procedure and some will be leery of doing any procedure that is irreversible.

JilltheTooth's avatar

I get that, but the concept of “harm” seems to be very fluid, here, and that’s what bothers me. Cosmetic surgery for vanity’s sake does more physical harm, in most cases, but it’s done frequently. I know that vacs and tubals are not always reversable, but they frequently are, and the techniques for performing them for the possibility of reversal have been explored and found effective in recent years. I also think it’s the height of hubris to presume to know what virtual strangers will want in 10 years.

Facade's avatar

@JilltheTooth My thoughts exactly! Would they rather people have kids then say, “You know what? This little monster is cramping my style,” and become bad parents?
It’s so frustrating.

iamthemob's avatar

@JilltheTooth – Isn’t it the same hubris, though, to presume to know what you yourself will want ten years down the road – particularly when it comes to family decisions – and particularly in your twenties?

@Facade – I’m not attempting to say “You don’t know what’s good for you” so don’t take it as that – I’m just remiss myself to endorse permanent decisions made by anyone in their 20s or 30s about anything – we change so much in those decades, it’s hard to believe.

Supacase's avatar

The bottom line is that no matter how you feel about it, the doctor cannot be forced to do a procedure he does not want to. I have no problem with that part of it – they deserve to make choices for themselves just as the patient does. You will likely need to find another physician.

SpatzieLover's avatar

@JilltheTooth These aren’t cosmetic surgeons doing this, though..that’s the thing.

In my 20’s, I was certain I wanted zero children and that if I ever changed my mind I’d adopt. I’m now in my 30’s and have one son. I cannot imagine my life w/out him.

I am not saying this to change your mind @Facade…Not One Bit. I am mentioning it because docs see this all of the time. The Dr may just be thinking one of you will change your mind. Some Drs perform this procedure only after a patient has asked for it a certain number of times (the 2nd or 3rd visit, he/she may say yes…some have made personal decisions not to perform this on under 30yr olds-etc).

If you and he want this done promptly, go by the way of Planned Parenthood, as stated above. They will assist you in finding a Dr that will not have this obstacle for you.

Facade's avatar

@iamthemob I know people change. But in our case, we’ve based our decision on logic, not emotions. (To us) it isn’t logical to have children when we want to live with as little obligations as possible. Children can be wonderful, but they are expensive, messy, exhausting, etc. We’ve decided we don’t want that. Having a cat is enough responsibility and obligation =)

@Supacase Agreed.

iamthemob's avatar

@Facade – I totally understand. The problem with basing decisions about family on logic and not emotions is that, to be honest, it’s not really possible. Not recognizing that there’s always an emotional element to family choice is doing yourself a disservice, I believe.

And remember – emotions tend to build up and shift over time in a way that logic, frankly, does not.

Dr_Dredd's avatar

I agree with much of what has already been said, but there’s another factor, too. Does your doctor belong to a Catholic hospital or health care system? If so, he/she may be forbidden from referring/discussing/performing sterilization procedures.

I don’t agree with this, BTW.

Facade's avatar

@iamthemob I recognize it. I just know that children don’t fit into our desired lifestyle of doing what we want, when we want. If that sounds selfish, it’s because it is and we are =). I don’t think I’ll ever desire to be responsible for another life. There’s too much involved. Babies are adorable, and it’s great to see kids grow up, but I’m 100% sure I don’t want my own. If I get a craving to be around kids or take care of kids, I know plenty of people with babies and my boyfriend is an uncle. What I’m saying is that completely removing our ability to have kids wouldn’t hurt us, even if we changed our minds (which is extremely unlikely)
@Dr_Dredd I don’t know, but I doubt it.

I’d also like to point out that if we had a child, we’d be great parents to it, but again, no thank you.

SpatzieLover's avatar

@Facade We have plenty of family/friends kids to cuddle or hang out with, too. W/out a kid, we’d be able to spoil them with our time a bit more ;) You & you BF have made the decision that is best for both of you.
Now you need to go make that call and find a Dr that agrees w/that decision. Please update us when you can.

JilltheTooth's avatar

@iamthemob : Yes, the hubris is as great, but it’s my hubris, related to my life. If @Facade‘s boyfriend changes his mind ten years down the line, then he’s the one that takes responsibility for it, not the doctor. If he has made an informed decision at 28, and later regrets it, so be it. And, as I said, it’s only potentially permanent, not definitely. It may be reversible. I don’t like the idea of moving away from the concept of owning your decisions.
I recognize the doctor’s right to perform or not a procedure, but to claim that he won’t because he thinks an adult might regret it a decade later smacks a bit too much of inappropriate paternalism. If his reasons are religious, or something akin, fine.

Facade's avatar

@SpatzieLover I definitely will. I’m waiting on him to come home at the moment…
@JilltheTooth GA

iamthemob's avatar

@Facade – This advice is the best in the end: “Now you need to go make that call and find a Dr that agrees w/that decision.” The doctor’s choice cannot be allowed to interfere with your own.

@JilltheTooth – True – but how often do people really take responsibility for their own decisions and not try, at least initially, to blame someone else? ;) I blame you for making me sound like a pessimist. ;)

JilltheTooth's avatar

Nerf bat cocked and ready, here. ;-)

JilltheTooth's avatar

Oh, and @Facade, GQ! I got my aerobic activity with this Q today; heart rate’s up, respiration up, all those things without having to run a mile! Thanks!

Facade's avatar

You’re welcome! =)

Seaofclouds's avatar

It took me a year to convince my GYN to do a tubal ligation on me. He finally agreed after a year of me continuously bringing it up when I saw him. At that point, I guess he finally felt like I was serious about wanting it. I can understand a doctor wanting to be sure their patient is 100% sure about what they are doing, especially with things that are mostly permanent (I say mostly because there are reversals possible now, but they aren’t always effective). I had my tubal ligation done in October of 2007 when I was 26 years old (with one child and not in a long-term relationship). I ended up getting it reversed in May 2010 and now we’re expecting a baby in June… funny how things work out. I’ll forever be thankful that my reversal was successful and would probably feel really badly if it wasn’t. I wouldn’t have held it against the doctor that did the ligation though, just myself for going through with it.

@Facade I’d recommend that your boyfriend simply not give up at this point and maybe consider it that the doctor was being cautious in case your boyfriend wasn’t 100% sure or aware of what the consequences were. I understand that the two of you have thoroughly discussed it and he’s aware of it, but the doctor really doesn’t know that. Before switching doctors, I’d suggest making another appointment strictly to discuss the vasectomy and go from there. I’d suggest going with your boyfriend to the appointment because some doctors want to know that both people in the relationship are okay with the decision. If the doctor continues with his “I don’t really want to do it attitude”, you can either ask him exactly what it would take to convince him to do the procedure or to recommend you to someone else that will do it. Some doctors are just more willing than others to do procedures on their patients.

Facade's avatar

@Seaofclouds I’m very happy you were able to have a second child!
If we had the money to pay his $50 co-pays each time, we’d probably go that route, but we don’t. I’m going to bring this up to him when he gets home, but we’ll probably contact Planned Parenthood for info on which doctors have no qualms with performing the procedure.

Seaofclouds's avatar

@Facade Good luck to the both of you. Maybe in the process of calling around, he could try to call his doctor and see if he could just ask him over the phone if there’s any way he would change his mind about doing it. Either way, I hope you guys find someone willing to work with what you want!

Facade's avatar

Knowing him, he’d see calling the doctor about changing his mind as begging. Men. But I’ll ask!

perspicacious's avatar

Yes, you may. It is certainly a physician’s right to not perform it. It’s the same thing as a doctor refusing to tie a 20 year old woman’s tubes.

MilkyWay's avatar

Man, some doctors can be total dickheads! what the hell? They’re supposed to help you with your physical issues, and I don’t think your boyfriend is too young to get it done anyway…

casheroo's avatar

My ex had that procedure done, I believe he was 23 or 24 at the time. He went to his PCP who referred him, but he had to have a psychologist evaluate him first! They want to make absolutely sure you are positive, and he did that and then they scheduled the procedure.

I’d look for another doctor. also, what do you guys think of the Essure? I’ve heard it’s even better than sterilization!

Facade's avatar

@casheroo I completely forgot about the Essure. Didn’t you tell me about that before? He and I have discussed that, and we decided that he would still get the vasectomy, and that I could do the Essure in the future if I wanted to.

cak's avatar

In my first marriage my ex forged my name (I was out of town) on a form for a vasectomy. After I found out about it, and read the document it was more of a “cya” document for the doctor. It was to keep things like what my ex was doing from happening. Didn’t completely work, though. He still had one without my knowledge.

It’s more normal now that say 20 years ago.

KatawaGrey's avatar

The way I see it, your boyfriend is an adult. If he changes his mind in the future, then he has to live with his mistake. There are also plenty of ways to have children if you two do decide to have kids in the future. You also make an excellent point that a person who doesn’t want kids and accidentally has one is much worse off than someone who wants a kid and doesn’t have one or has to work a little harder to have one. People make bigger mistakes that effect them worse than what your boyfriend is doing. Also, something my mom and I were talking about earlier is how many people are established in their careers and have children by the time they’re 28. Knowing that you do not want children by that age doesn’t seem that different to me.

I’ve seen both you and your boyfriend, @Facade and I think you’re doing a great disservice to the human race by not breeding. ;)

Facade's avatar

@KatawaGrey Well-said! Flattery will get you everywhere :P

KatawaGrey's avatar

@Facade: Another point I forgot to mention is that deciding whether or not to have a child based on logic rather than emotions is such an amazing way to go about things. If more people did that, overpopulation wouldn’t be such a problem and there would be many fewer unwanted pregnancies and children.

On a side note, does insurance cover this kind of procedure? I personally think it should seeing as a 500 dollar vasectomy is certainly less expensive and less burdensome than an unwanted child.

Facade's avatar

@KatawaGrey Yep, I believe it will only cost him $100. He says that it’d be $800 without insurance!

cazzie's avatar

Doctors are often left second guessing patients when it comes to their care. They are the ones who can be sued or held professionally responsible if something goes wrong, and in this case, your boyfriend could change his mind later and say he felt pressured into the decision and hold the doctor responsible for not using the standard industry practice procedures that are approved by the medical ethics board.

You are both so young. So much can happen. You could get hit by a bus tomorrow. He could meet a new lady in a few years time and decide he wants a family and then he goes back to that doctor and asks for a reversal.

I’ve known men who had their family in their 20’s… got divorced in their 40’s and then met the woman of their dreams in their 50’s who was 20 years younger than them and were desperate for a child of their own, but he had had the snip in his 30’s and went through hell and high water to get a reversal.

28 is so very, very young and there are other options. You should visit a family planning specialist together.

JilltheTooth's avatar

@cazzie : But, as has been said before, this man is an adult. If he gives his informed consent the doctor is not liable for regrets @Facade‘s boyfriend may have later. We are part of a society that is constantly lamenting the assignation of blame and the lack of recognizing personal responsibility for our actions, yet so many posters here seem to support the idea of someone else (the doctor) making choices for this adult man. If he changes his mind later, and can’t have children with the other options (and there are a number of them) available, then he just gets to man the hell up and deal. At 28, many men already have families, I wonder how many of those men it was suggested to that they wait because they might regret it later? Or they might divorce? Or they might suffer a financial reversal and have difficulty supporting those children?
If he’s not impaired in some way that would indicate he should not make such decisions, I see no reason why he should not make such decisions. 28 is far enough away from childhood to be respected for his adulthood and ability to behave responsibly.

Facade's avatar

@cazzie, @JilltheTooth is absolutely right. As I said in my original post, we don’t want to use condoms or birth control or any of that, and we have decided to something more permanent. If we change our minds after the fact, tough shit. Really. We both want to do this now to lessen the likelihood of any “accidents.”

iamthemob's avatar

In all honesty, though, realize that vasectomies are not always successful – if you’re really concerned about making certain that you don’t have kids, you really should continue to regularly use birth control in other forms.

cazzie's avatar

Adults make poor choices that doctors are held liable for all the time.

JilltheTooth's avatar

Then maybe it’s the doctor’s responsibility to have a comprehensive Informed Consent contract in place to minimize such issues. I find your implication that this is a “poor choice” to be rather presumptuous, unless, of course, you are well acquainted with @Facade and her boyfriend, and have inside knowledge of the situation. In which case, please accept my apology.

KatawaGrey's avatar

@cazzie: But that doesn’t mean that’s how it should be. If @Facade and her boyfriend are the kind of people to blame doctor ten years down the line, then neither of them are really fit to be parents. What few dealings I’ve had with @Facade indicate to me that she is the opposite.

cazzie's avatar

I’m just saying in general, people. I don’t know them. Trying to see this from both sides. I’m also sure the they will find a doctor who will perform the procedure. I’m sure the doctor who said no is seeing his age and the fact they aren’t married and have no children yet. They are all ‘red flags’ from an ethics board point of view.

Dr_Dredd's avatar

@JilltheTooth A crafty plaintiff’s attorney can convince a jury that a doctor is liable for anything, including regrets about a procedure that someone gave consent for. That’s true regardless of what informed consent “contract” was used.

Facade's avatar

I’m not going to sue anyone…
@cazzie I’m sure you’d be annoyed if I called the choice to have children to be poor, so let’s leave that alone.
Why is there so much pressure to procreate?

cazzie's avatar

I am not arguing that you are making the wrong choice by not having children. I never said that. at all…. ever.

edit… and I kind of take offence at you putting words in my mouth.

Facade's avatar

@cazzie It was the implication…

cazzie's avatar

the implication of…. saying some doctors feel this way?? Saying…. see a family planning specialist??? who could find you the doctor you’re looking for??? or show you a solution you may not have considered yet? geez…. I don’t know how you got I was dissing you for not wanting kids. I’m not. Why the heck would I do that? I’m just trying to get you to see that doctors are trained to not always look at what the patient is saying. They are trained to look at facts. Fact one. You are not in a married relationship. (not a judgement on my part, but the law and industry). Two: He’s 28 and lastly… there are other options that are as effective and less permanent.

Keep looking for a doctor who will do this for you. You’ll find one. Just be prepared to come across ‘automatons’ who have been trained by the system.

I wish you a long and happy life with your boyfriend and I’m NOT judging your personal decisions.

Facade's avatar

OK, thanks.

Dr_Dredd's avatar

@Facade Oh, good. :-)

casheroo's avatar

@Facade It’s only 800 without insurance?! Dang, my husband has no excuse now! lol

Facade's avatar

@casheroo That’s what his doctor told him, so of course, prices may vary.

LuckyGuy's avatar

Hey @Facade
Now that 3+ years have passed can you tell us how it all worked out?
Did he get the vasectomy?
Are you still with him?
Any regrets at all?
Of course it is none of our business, but either way, your answers might be helpful for the next person down the line. Thanks.

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