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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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50. Sterilization
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The medical practitioner treats, but nature heals.
~ Hippocrates
Sabotaged Sterility
Upholding Professional Obligations and Respect for Patient Autonomy in Sterilization Procedures
The sterile surgical room was filled with an eerie silence. The medical team was busy preparing for the sterilization procedure. Dr. Harris, a renowned gynecologist, was leading the surgery. She was known for her expertise in the field of sterilization and had performed hundreds of successful procedures.
As they were about to begin, Dr. Harris noticed that one of the instruments was missing. She asked the nurse to check if it was misplaced somewhere. The nurse went to the storage room but couldn’t find it. After a thorough search, they discovered that the instrument was deliberately hidden by someone.
Dr. Harris immediately alerted the hospital administration and informed them of the incident. The hospital authorities launched an investigation, and it was revealed that someone had tampered with the equipment. The investigation team suspected that it was a case of sabotage, and they started looking for clues.
The team discovered that one of the residents, Dr. Smith, had a history of opposing sterilization procedures. He had voiced his opinion against sterilization, citing religious reasons. He had even refused to assist Dr. Harris during one of her procedures.
The investigation team interrogated Dr. Smith, and he finally admitted to his crime. He had deliberately hidden the instrument to prevent Dr. Harris from performing the sterilization procedure. He believed that sterilization was against his religious beliefs and that he was protecting the patient’s right to have children.
The hospital authorities took swift action and suspended Dr. Smith from his duties. They also educated him on the importance of respecting patients’ autonomy and their right to make decisions about their own bodies. The incident also highlighted the need for healthcare providers to uphold their professional obligations, including providing patient-centered care and respecting patients’ informed consent.
The incident was a lesson for all medical students and healthcare providers about the importance of sterilization as a constitutional right and the obligation of healthcare providers to respect patients’ autonomy. The incident also underscored the need for healthcare providers to remain unbiased and provide patients with objective information and referrals to qualified practitioners when they cannot provide the requested service themselves.
In conclusion, the incident served as a reminder that medical practitioners must uphold their professional obligations and respect patients’ autonomy. Sterilization is a constitutional right that should be respected, and healthcare providers should provide unbiased information and referrals to patients who request sterilization. This approach promotes justice and acknowledges the importance of reproductive rights in public policy.
Abstract
The right to sterilization as a form of birth control has been determined as a fundamental constitutional right under the 14th Amendment’s due process clause. This means that all adults with decisional capacity have the autonomous right to request, access, and consent to sterilization without interference from others. The patient’s autonomy must be respected and practitioners have a professional obligation to provide patient-centered care that respects the patient’s informed consent that are in line patient’s reasonable goals, values, and priorities. If a practitioner declines to perform the sterilization procedure, they must provide unbiased information and a referral to a qualified practitioner. The concept of reproductive justice, which includes the right to legal sterilization, is an essential public policy and a response to past injustices of forced sterilization programs.
**
Think
[50:1] All adults with decisional capacity have the individual autonomous right to request, have access to, and consent to contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else. The patient’s autonomous right to choose to be sterilized as a form of contraception has been determined to be a fundamental constitutional right.
[50:2] The 14th amendment provides the due process clause from which several fundamental constitutional rights have been justified even though they are not explicitly listed in the Constitution, including the right to use contraception.
[50:3] Fourteenth Amendment Section 1:
… no state shall deprive any person of life, liberty, or property, without due process of law.
[50:4] Sterilization as a form of birth control is the intentional treatment of a patient to make that individual unable to reproduce, and methods used are surgical or non-surgical. Typically, sterilization for female patients is by tubal ligation, and for male patients by vasectomy. Long-acting reversible contraception (LARC) methods, such as intrauterine devices and implants, are available for female patients and are almost as effective as permanent sterilization.
[50:5] As of now sterilization is recognized as a constitutional right and considered to be both a negative right (obligation of others not to interfere) and a positive right (obligation of others to provide access).
[50:6]
[50:7] As a negative right, others have an obligation to not interfere with the patient’s individual right to get sterilized. That means the patient’s spouse, partner, parents, or anyone else does not have a legal right to interfere with the patient being sterilized.
[50:8] As a positive right, others have an obligation to provide the patient with access to sterilization referrals, information, and services. The American College of Practitioners (ACP) recognizes the patient’s positive right to sterilization when it explicitly states:
On abortion, sterilization, contraception, or other reproductive services … the physician [practitioner] has a duty to inform the patient about care options and alternatives or refer the patient for such information, so that the patient’s rights are not constrained.
[50:9] The prime directive of the medical profession is to maximize the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities.
Assess
Patient: 1) Autonomy
[50:10] Patient autonomy is one of the four cardinal principles of medical ethics. The patient has the right to provide informed consent that authorizes the medical practitioner to provide the medical standards of care. This autonomous right includes the right to be sterilized.
[50:11] As with all medical procedures, the practitioner must be assured that the patient understands, is acting voluntarily, and that it is coherent and logically consistent with the patient’s reasonable goals, values, and priorities. These conditions together comprise what is referred to as having decisional capacity.
[50:12] For an autonomous informed consent to be sterilized, the following necessary conditions must be met:
- 1. Patient understands what sterilization is, the purpose, how the procedure is performed, and the risks, and benefits.
- 2. Patient makes their choice for sterilization freely without any coercion (a credible threat) and without any manipulation (providing selective information to determine a particular decision).
- 3. Patient is able to provide logical reasons for sterilization that are coherent with the patient’s reasonable goals, values, and priorities for authorizing the procedure.
- 4. Patient chooses to authorize the practitioner to perform the procedure.
When these necessary conditions are met, then the patient has provided informed consent.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[50:13] Medical practitioners have a professional obligation of beneficence (do good) of providing patient-centered care that maximizes the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities. Usually, they will be in line with the practitioners, but not always. The practitioner has a professional duty to respect the patient’s autonomous informed consent, as long as the consent is for procedures that are within the medical standards of care and based on the principle of nonmaleficence (do no harm).
[50:14] Sterilization is a medical standard of care, so if the patient has decisional capacity, then the patient has the right to authorize the practitioner to provide the procedure.
[50:15] If the medical practitioner declines or cannot perform the requested procedure, then in a timely manner, without judgment, the practitioner needs to respectfully provide unbiased, objective information and a referral to a qualified medical professional willing to provide the requested sterilization procedure.
Public Policy: 4) Justice
[50:16] Reproductive justice as provided by legal sterilization is as essential a public policy as the prohibition of reproductive injustice such as coercive and forcible sterilization. In the 1970’s the era of paternalism “doctor knows best,” some obstetrician-gynecologist’s criterion for sterilization was to take the patient’s age multiplied by the number of their children, and then only if greater than 120 was sterilization considered permissible. Also, between 1909-1979 state and federally funded programs forcibly sterilized 60,000 females without their consent.
[50:17] In 1976, in response to these injustices, the U.S. Department of Health, Education, and Welfare (DHEW) developed protective Medicaid procedures that were in effect until April 30, 2022. Sterilization consent form (HHS-687)
[50:18] Medicaid regulations:
- 1. Prohibits the sterilization of patients younger than 21 years of age,
- 2. requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control, and
- 3. patients understand that they can refuse sterilization at any time and that the patient will not lose any health services or benefits provided by Federal funds if they decline sterilization.
[50:19] These Medicaid social policies had the consequence of increasing healthcare disparities. Tubal sterilization after childbirth is one of the most popular forms of contraception and is readily available to females with private insurance, but not for Medicaid beneficiaries unless the forms are filled out at least 30 days in advance, but not more than three months before giving birth. These requirements put Medicaid patients at a significant disadvantage for sterilization access compared to patients with private insurance.
[50:20] Health and Human Services, Consent For Sterilization states:
At least 30 days have passed between the date of the individual’s signature on this consent form and the date the sterilization was performed.
[50:21] Ethicists argue that it is unjust to allocate medical access based solely on the source of payment and that, therefore, Medicaid regulations that require a 30-day wait before sterilization are unjust and contribute to healthcare disparities based on wealth.
[50:22] Ethicists also recognize that decisional regret is always possible when making autonomous decisions and is frequently referred to as “dignity of risk.” The dignity of risk argues that consequentially the harm associated with institutional or government restriction of, say, patient autonomy is considered greater than the amount of harm associated with risk of regret. Both professionally and legally, as a matter of justice (be fair), practitioners and society have a professional, legal, and moral obligation to respect the patient’s rights and liberties to pursue and prevent pregnancy by sterilization.
Conclude
[50:23] Medical practitioners must respect the decision-making authority of the patient who, with decisional capacity, has provided informed consent decision to be sterilized. Although the level of evidence of such a decision may be higher than other less consequential decisions, once decisional capacity and informed consent has been unquestionably established, such decisions ought to be respected.
[50:24] In summary, sterilization is considered both a negative right (obligation of others not to interfere) and a positive right (obligation of others to provide access). Ethicists argue that Medicaid regulations requiring a 30-day wait before sterilization are unjust and contribute to healthcare disparities based on wealth. Medical practitioners must respect the decision-making authority of the patient who, with decisional capacity, has provided informed consent decision to be sterilized. This approach promotes justice and acknowledges the importance of reproductive rights in public policy.
**
Civil Rights
Obligation of others to Not Interfere
Negative Right
Obligation of others toProvide something
Positive Right
50. Review Questions
1. All adult persons with decisional capacity have the individual autonomous right to request, have access to contraception, and sterilization, independent of the judgment of the spouse, partner, parents, or anyone else.
2. The patient’s right to choose to be sterilized as a form of contraception is not a fundamental constitutional right.
3. As a positive right, others have an obligation to not interfere with the patient’s individual right to get sterilized.
4. As a negative right, others have an obligation to provide the patient with access to sterilization referrals, information, and services.
5. If the practitioner declines or cannot perform the requested procedure, then in a timely manner, without judgment, the practitioner needs to respectfully provide unbiased, objective information and a referral to a qualified medical professional willing to provide the requested sterilization procedure.
6. Medicaid prohibits the sterilization of patients younger than 21 years of age.
7. Before sterilization, Medicaid requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control.
8. Tubal sterilization after childbirth is one of the most popular forms of contraception and is readily available to females with private insurance, but not for Medicaid beneficiaries unless the forms are filled out at least 30 days in advance, but not more than three months, before giving birth.
9. Ethicists argue that it is unjust to allocate medical access based solely on the source of payment and that, therefore, Medicaid regulations that require a 30-day wait before sterilization are unjust and contribute to healthcare disparities based on wealth.
**
Wrong 😕
[50:1] All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to abortion, contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else. The patient’s autonomous right to choose to be sterilized as a form of contraception has been determined to be a fundamental constitutional right. Laws that encroach on a fundamental right must pass strict scrutiny to be constitutionally upheld.
CORRECT! 🙂
[50:1] All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to abortion, contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else. The patient’s autonomous right to choose to be sterilized as a form of contraception has been determined to be a fundamental constitutional right. Laws that encroach on a fundamental right must pass strict scrutiny to be constitutionally upheld.
Wrong 😕
[50:1] All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to abortion, contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else. The patient’s autonomous right to choose to be sterilized as a form of contraception has been determined to be a fundamental constitutional right. Laws that encroach on a fundamental right must pass strict scrutiny to be constitutionally upheld.
CORRECT! 🙂
[50:1] All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to abortion, contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else. The patient’s autonomous right to choose to be sterilized as a form of contraception has been determined to be a fundamental constitutional right. Laws that encroach on a fundamental right must pass strict scrutiny to be constitutionally upheld.
Wrong 😕
[50:7] As a negative right, others have an obligation to not interfere with the patient’s individual right to get sterilized. That means the patient’s spouse, partner, parents, or anyone else does not have a legal right to interfere with the patient getting sterilized.
CORRECT! 🙂
[50:7] As a negative right, others have an obligation to not interfere with the patient’s individual right to get sterilized. That means the patient’s spouse, partner, parents, or anyone else does not have a legal right to interfere with the patient getting sterilized.
CORRECT! 🙂
[50:8] As a positive right, others have an obligation to provide the patient with access to sterilization referrals, information, and services. The American College of Physicians (ACP) recognizes the patient’s positive right to sterilization when it explicitly states:
On abortion, sterilization, contraception, or other reproductive services … the practitioner has a duty to inform the patient about care options and alternatives or refer the patient for such information, so that the patient’s rights are not constrained.
Wrong 😕
[50:8] As a positive right, others have an obligation to provide the patient with access to sterilization referrals, information, and services. The American College of Physicians (ACP) recognizes the patient’s positive right to sterilization when it explicitly states:
On abortion, sterilization, contraception, or other reproductive services … the practitioner has a duty to inform the patient about care options and alternatives or refer the patient for such information, so that the patient’s rights are not constrained.
CORRECT! 🙂
[50:15] If the practitioner is a conscientious objector, then in a timely manner, without judgment, the practitioner needs to respectfully provide unbiased, objective information and a referral to a qualified medical professional willing to provide the requested sterilization procedure.
Wrong 😕
[50:15] If the practitioner is a conscientious objector, then in a timely manner, without judgment, the practitioner needs to respectfully provide unbiased, objective information and a referral to a qualified medical professional willing to provide the requested sterilization procedure.
Wrong 😕
[50:18] Medicaid regulations:
1. Prohibits the sterilization of patients younger than 21 years of age,
2. requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control,
3. patients understand that they can refuse sterilization at any time and that the patient will not lose any health services or benefits provided by Federal funds if they decline sterilization.
CORRECT! 🙂
[50:18] Medicaid regulations:
1. Prohibits the sterilization of patients younger than 21 years of age,
2. requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control,
3. patients understand that they can refuse sterilization at any time and that the patient will not lose any health services or benefits provided by Federal funds if they decline sterilization.
CORRECT! 🙂
[50:18] Medicaid regulations:
1. Prohibits the sterilization of patients younger than 21 years of age,
2. requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control,
3. patients understand that they can refuse sterilization at any time and that the patient will not lose any health services or benefits provided by Federal funds if they decline sterilization.
Wrong 😕
[50:18] Medicaid regulations:
1. Prohibits the sterilization of patients younger than 21 years of age,
2. requires a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control,
3. patients understand that they can refuse sterilization at any time and that the patient will not lose any health services or benefits provided by Federal funds if they decline sterilization.
Wrong 😕
[50:19] These Medicaid social policies had the consequence of increasing healthcare disparities. Tubal sterilization after childbirth is one of the most popular forms of contraception and is readily available to females with private insurance, but not for Medicaid beneficiaries unless the forms are filled out at least 30 days in advance, but not more than three months, before giving birth. These requirements put Medicaid patients at a significant disadvantage for sterilization access compared to patients with private insurance.
CORRECT! 🙂
[50:19] These Medicaid social policies had the consequence of increasing healthcare disparities. Tubal sterilization after childbirth is one of the most popular forms of contraception and is readily available to females with private insurance, but not for Medicaid beneficiaries unless the forms are filled out at least 30 days in advance, but not more than three months, before giving birth. These requirements put Medicaid patients at a significant disadvantage for sterilization access compared to patients with private insurance.
CORRECT! 🙂
[50:21] Ethicists argue that it is unjust to allocate medical access based solely on the source of payment and that, therefore, Medicaid regulations that require a 30-day wait before sterilization are unjust and contribute to healthcare disparities based on wealth.
Wrong 😕
[50:21] Ethicists argue that it is unjust to allocate medical access based solely on the source of payment and that, therefore, Medicaid regulations that require a 30-day wait before sterilization are unjust and contribute to healthcare disparities based on wealth.
50. Clinical Vignettes
1. Ms. Grace Smith is a 35-year-old accountant who is married and has two children. She is interested in permanent sterilization as a form of contraception and has consulted with her gynecologist, Dr. Jones, about this option. She has decisional capacity and has provided informed consent for the sterilization procedure. Dr. Jones, however, declines to perform the procedure due to personal religious beliefs that do not support sterilization. Ms. Smith asks for a referral to another qualified practitioner who can perform the procedure, but Dr. Jones refuses, stating that providing a referral would be going against her beliefs.
2. Mr. John Smith, a 35-year-old software engineer, presents to his primary care practitioner requesting a vasectomy. He is married and has two children, and he and his wife have decided that they do not want any more children. He understands the procedure, including the risks and benefits, and provides logical reasons for his decision. Which of the following best represents the ethical approach for the practitioner?
3. Ms. Maria Rivera, a 32-year-old elementary school teacher, and her husband, Mr. Jose Rivera, a 35-year-old engineer, present to their family practitioner requesting permanent sterilization. Ms. Rivera wishes to undergo a tubal ligation, but Mr. Rivera is strongly against the procedure, as he wants the option of having more children in the future. Ms. Rivera has decisional capacity and meets the necessary conditions for autonomous informed consent, as she understands the procedure, including the risks and benefits, and provides logical reasons for her decision. The practitioner provides counseling and education to the couple, but they are unable to reach a mutual decision. Which of the following best represents the ethical approach for the practitioner?
4. Ms. Sarah Jackson, a 25-year-old woman, has been married for five years and has two children. She works part-time at a grocery store and is covered by Medicaid. She wants to undergo a tubal ligation as a form of permanent sterilization. Ms. Jackson has decisional capacity and meets the necessary conditions for autonomous informed consent, as she understands the procedure, including the risks and benefits, and provides logical reasons for her decision. Which of the following is true regarding Medicaid's requirement for a 30-day waiting period before sterilization?
5. Ms. Gabriella Taylor is a 27-year-old woman who recently gave birth to her third child. She works part-time at a retail store and is enrolled in Medicaid. During her postpartum visit, Ms. Taylor expresses to her obstetrician that she is interested in getting a tubal ligation as a form of permanent birth control. However, her obstetrician informs her that she cannot schedule the procedure until 30 days after the visit, as required by Medicaid regulations. Ms. Taylor is frustrated because she knows that women with private insurance can get the procedure immediately after giving birth. Clinical Differential Diagnosis:
CORRECT! 🙂
Explanation: Dr. Emily Jones has a professional obligation to respect the patient's legal choices, even if it goes against her personal beliefs. As a medical practitioner, Dr. Jones has an obligation to provide unbiased information and a referral to a qualified practitioner who can perform the sterilization procedure. This is supported by the American College of Physicians, which recognizes the patient's positive right to sterilization and states that practitioners have a duty to inform the patient about care options and alternatives or refer the patient for such information. Refusing to provide a referral would be a violation of the patient's autonomy and a failure to provide patient-centered care. The other options are incorrect because Dr. Jones has a professional obligation to provide a referral, the patient's right to access sterilization does not require Dr. Jones to perform the procedure if it goes against her personal beliefs, and Dr. Jones has an obligation to provide a referral to a qualified practitioner, not just inform the patient about the procedure. [50:1, 50:8, 50:13, 50:15]
Wrong 😕
Explanation: Dr. Emily Jones has a professional obligation to respect the patient's legal choices, even if it goes against her personal beliefs. As a medical practitioner, Dr. Jones has an obligation to provide unbiased information and a referral to a qualified practitioner who can perform the sterilization procedure. This is supported by the American College of Physicians, which recognizes the patient's positive right to sterilization and states that practitioners have a duty to inform the patient about care options and alternatives or refer the patient for such information. Refusing to provide a referral would be a violation of the patient's autonomy and a failure to provide patient-centered care. The other options are incorrect because Dr. Jones has a professional obligation to provide a referral, the patient's right to access sterilization does not require Dr. Jones to perform the procedure if it goes against her personal beliefs, and Dr. Jones has an obligation to provide a referral to a qualified practitioner, not just inform the patient about the procedure. [50:1, 50:8, 50:13, 50:15]
CORRECT! 🙂
Explanation: The concept of autonomy is central to the ethical approach to sterilization. All adults with decisional capacity have the autonomous right to request, have access to, and consent to contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else [50:1]. Mr. Smith has provided logical reasons for his decision, and as long as he meets the necessary conditions for autonomous informed consent, his decision should be respected [50:12]. The practitioner has a professional obligation to provide patient-centered care that maximizes the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities [50:13]. Referring Mr. Smith to another practitioner willing to perform the procedure is the appropriate ethical approach if the practitioner cannot perform the requested procedure [50:15]. Providing biased information to discourage the procedure would violate the practitioner's professional obligation to respect the patient's autonomous informed consent [50:13]. Denying Mr. Smith's request based on his age and current number of children would infringe on his individual right to get sterilized [50:7].
Wrong 😕
Explanation: The concept of autonomy is central to the ethical approach to sterilization. All adults with decisional capacity have the autonomous right to request, have access to, and consent to contraception, and sterilization independently of the judgment of the spouse, partner, parents, or anyone else [50:1]. Mr. Smith has provided logical reasons for his decision, and as long as he meets the necessary conditions for autonomous informed consent, his decision should be respected [50:12]. The practitioner has a professional obligation to provide patient-centered care that maximizes the patient’s best interests as determined by the patient’s reasonable goals, values, and priorities [50:13]. Referring Mr. Smith to another practitioner willing to perform the procedure is the appropriate ethical approach if the practitioner cannot perform the requested procedure [50:15]. Providing biased information to discourage the procedure would violate the practitioner's professional obligation to respect the patient's autonomous informed consent [50:13]. Denying Mr. Smith's request based on his age and current number of children would infringe on his individual right to get sterilized [50:7].
Wrong 😕
Explanation: All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to contraception, and sterilization, independent of the judgment of the spouse, partner, parents, or anyone else [50:1]. Ms. Rivera has decisional capacity and meets the necessary conditions for autonomous informed consent, so her autonomous decision to be sterilized must be respected. The practitioner provides counseling and education to the couple, but they are unable to reach a mutual decision [50:9]. Respect for patient autonomy is central to the ethical approach to sterilization, and spousal objections do not provide a legal or ethical basis for refusing a patient's request for sterilization [50:1]. Providing biased information to discourage the procedure or denying Ms. Rivera's request would violate the practitioner's professional obligation to respect the patient's autonomous informed consent [50:13]. Therefore, the ethical approach in this scenario is for the practitioner to respect Ms. Rivera's autonomous right to provide informed consent for the procedure and perform the sterilization as requested, as long as she has decisional capacity and meets the necessary conditions for autonomous informed consent. The practitioner should continue to provide counseling and education to the couple to help them reach a mutual decision, but ultimately the decision to be sterilized is Ms. Rivera's autonomous right.
CORRECT! 🙂
Explanation: All adult persons with decisional capacity have the individual autonomous right to request, have access to, and consent to contraception, and sterilization, independent of the judgment of the spouse, partner, parents, or anyone else [50:1]. Ms. Rivera has decisional capacity and meets the necessary conditions for autonomous informed consent, so her autonomous decision to be sterilized must be respected. The practitioner provides counseling and education to the couple, but they are unable to reach a mutual decision [50:9]. Respect for patient autonomy is central to the ethical approach to sterilization, and spousal objections do not provide a legal or ethical basis for refusing a patient's request for sterilization [50:1]. Providing biased information to discourage the procedure or denying Ms. Rivera's request would violate the practitioner's professional obligation to respect the patient's autonomous informed consent [50:13]. Therefore, the ethical approach in this scenario is for the practitioner to respect Ms. Rivera's autonomous right to provide informed consent for the procedure and perform the sterilization as requested, as long as she has decisional capacity and meets the necessary conditions for autonomous informed consent. The practitioner should continue to provide counseling and education to the couple to help them reach a mutual decision, but ultimately the decision to be sterilized is Ms. Rivera's autonomous right.
CORRECT! 🙂
Explanation: Medicaid regulations require a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control before sterilization can be performed [50:18]. The waiting period must be strictly enforced, regardless of the patient's circumstances. The waiting period is intended to provide patients with adequate time to consider their decision and explore alternative forms of contraception. Ms. Jackson, being a Medicaid patient, is subject to this waiting period and must wait for 30 days after receiving counseling on alternative forms of contraception before undergoing the tubal ligation. The practitioner cannot waive the waiting period, even if Ms. Jackson is a low-income patient. The waiting period can only be waived in the case of a medical emergency or if the patient has a medical condition that necessitates sterilization. In this scenario, the waiting period must be enforced, and Ms. Jackson cannot undergo the procedure until 30 days have passed after counseling on alternative forms of contraception. The practitioner should provide counseling and education to Ms. Jackson on alternative forms of contraception during this waiting period to help her make an informed decision.
Wrong 😕
Explanation: Medicaid regulations require a 30-day waiting period after the practitioner counsels the patient of other non-permanent and effective methods of birth control before sterilization can be performed [50:18]. The waiting period must be strictly enforced, regardless of the patient's circumstances. The waiting period is intended to provide patients with adequate time to consider their decision and explore alternative forms of contraception. Ms. Jackson, being a Medicaid patient, is subject to this waiting period and must wait for 30 days after receiving counseling on alternative forms of contraception before undergoing the tubal ligation. The practitioner cannot waive the waiting period, even if Ms. Jackson is a low-income patient. The waiting period can only be waived in the case of a medical emergency or if the patient has a medical condition that necessitates sterilization. In this scenario, the waiting period must be enforced, and Ms. Jackson cannot undergo the procedure until 30 days have passed after counseling on alternative forms of contraception. The practitioner should provide counseling and education to Ms. Jackson on alternative forms of contraception during this waiting period to help her make an informed decision.
CORRECT! 🙂
Explanation: According to the ethical principles of patient autonomy, beneficence, and justice [50:1-23], Ms. Taylor has the right to be sterilized as a form of birth control, as long as she has decisional capacity and provides informed consent. Medicaid regulations requiring a 30-day waiting period before sterilization after childbirth may be considered unjust and biased, as women with private insurance can receive the procedure immediately after giving birth [50:19-22]. The obstetrician should provide Ms. Taylor with unbiased information on all available contraceptive options and refer her to a qualified practitioner if necessary [50:8-9, 50:15]. The 30-day waiting period required by Medicaid is an administrative requirement that does not affect Ms. Taylor's decisional capacity or her right to informed consent [50:18].
Wrong 😕
Explanation: According to the ethical principles of patient autonomy, beneficence, and justice [50:1-23], Ms. Taylor has the right to be sterilized as a form of birth control, as long as she has decisional capacity and provides informed consent. Medicaid regulations requiring a 30-day waiting period before sterilization after childbirth may be considered unjust and biased, as women with private insurance can receive the procedure immediately after giving birth [50:19-22]. The obstetrician should provide Ms. Taylor with unbiased information on all available contraceptive options and refer her to a qualified practitioner if necessary [50:8-9, 50:15]. The 30-day waiting period required by Medicaid is an administrative requirement that does not affect Ms. Taylor's decisional capacity or her right to informed consent [50:18].
**
50. Reflection Vignettes
1. Dr. Samantha Green, a 35-year-old gynecologist, is approached by an adult patient with private insurance who is seeking permanent sterilization. The patient has decisional capacity and is fully informed of the permanency of the procedure, as well as the availability and effectiveness of long-acting reversible contraception (LARC) methods. Despite being informed of the LARC options, the patient declines and insists on the permanent sterilization procedure immediately. As a practitioner, Dr. Green must ensure that the patient's decision is voluntary and informed, and that the patient fully understands the permanence of the procedure. Dr. Green should discuss the patient's decision-making process, explore the reasons for wanting sterilization, and ensure that the patient is not under any undue pressure to undergo the procedure. Dr. Green should also provide the patient with thorough preoperative counseling, discuss the risks and benefits of the procedure, and obtain the patient's informed consent.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Ms. Sarah Miller, a 30-year-old patient on Medicaid, with decisional capacity, provides informed consent for getting sterilized. Despite being informed about the permanency of the procedure and being offered long-acting reversible contraception (LARC) methods that are equally safe and effective, Ms. Miller declines LARC options and immediately requests a permanent sterilization procedure. Although all adults with decisional capacity have the autonomous right to request, access, and consent to sterilization without interference from others, Medicaid regulations prohibit the sterilization of patients younger than 21 years of age and require a 30-day waiting period after the practitioner counsels the patient on other non-permanent and effective methods of birth control. Ms. Miller, being an adult with decisional capacity, has the right to authorize the practitioner to provide the procedure, but as a Medicaid patient, she must wait 30 days. Practitioners must respectfully provide unbiased information and a referral to a qualified practitioner willing to provide the requested sterilization procedure if they decline or cannot perform the requested procedure. The concept of reproductive justice, including the right to legal sterilization, is an essential public policy and a response to past injustices of forced sterilization programs.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
50c*
An adult patient with decisional capacity comes into the medical practitioner’s office and requests sterilization. After the practitioner explains all the various options, including no sterilization, along with all the risks, benefits, and consequences of each option, the patient decides to get permanently sterilized. The patient’s spouse calls in distress and pleads with the practitioner not to perform the procedure as the spouse wishes to have biological children and believes that their spouse will one day regret the decision to get sterilized. What should the practitioner do?
- A. Convince the patient that they are too young to make such a decision.
- B. Refuse to perform the procedure until the spouse or partner can come to a mutual agreement.
- C. Perform the procedure.
- D. Inform the spouse that they will need to get a court order.
- E. Inform the patient that they must get a psychological evaluation before the sterilization procedure can be performed.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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