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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
50c*. Sterilization
[C50:1]
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?
[C50:2]
- 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.
**
TAC: Think - Assess - Conclude
I. Think: What is the question?
[C50:3] Does a patient have full authority, independent of anyone else, to decide to get sterilized?
II. Assess: Specify & Balance the four principles of bioethics
Patient: 1) Autonomy - Informed Consent
[C50:4] All adults with decisional capacity have the right to determine what is done to their bodies. Contraception and sterilization procedures are all well within the bodily rights of the patient regardless of any objections from the spouse, partner, or anyone else.
[C50:5]
Practitioner: 2) Beneficence & 3) Nonmaleficence
[C50:6] Professional beneficence (do good) and professional nonmaleficence (do no harm) must be determined by the patient’s: goals, values, and priorities, not by someone else’s goals, values, and priorities. If an adult patient with decisional capacity has reasons to believe that not having children will maximize their best interests, then, nobody else has the legal or moral authority to demand that they have children.
Public Policy: 4) Justice
[C50:7] All persons have the civil right to do with their bodies as they see fit. The civil right is a negative right, meaning that others have the social obligation of not interfering with such determinations. If it were a positive right then others would have an obligation to provide such determinations, which does not seem to be the case in this scenario.
[C50:8]
[C50:9] Justice seems to point towards the obligation of others to not interfere with the patient choosing to get sterilized.
After specifying each principle, all four principles support the patient’s right to decide to be sterilized.
[C50:10]
III. Conclude: Nationally or Professionally True Answer
[C50:11] A patient has a fundamental right to use contraception and be sterilized without the consent of a spouse or partner.
Answer Options: [C50:12]
(Choice A) Convince the patient that they are too young to make such a decision.
(Choice B) Refuse to perform the procedure until the patient’s spouse or partner can come to a mutual agreement.
(Choice D) Inform the spouse that they will need to get a court order.
(Choice E) Inform the patient that they must get a psychological evaluation before the sterilization procedure can be performed.
A,B,D,E are wrong because an adult patient with decisional capacity has the right to authorize legitimate medical treatment options.
(Choice C) Perform the procedure.
C is correct. The patient has a fundamental right to use contraception and be sterilized without the consent of a spouse or partner.
***
Informed Consent
patient demonstrates knowledge about their diagnosis or condition
Understands diagnosis or condition
Understands Treatment options
patient demonstrates knowledge of the various treatment options, including no treatment
Understands Purpose of each treatment option
patient demonstrates knowledge of the purpose of the various treatment options
Assess Benefits and Risks of each treatment option, including no treatment
patient can weigh and balance the benefits and risks of the various treatment options, including no treatment, using the patient’s own goals, values, and priorities
Present Logical Reasons for the authorization of a treatment option
patient can provide logical reasons for their treatment or no treatment authorization that are in line with the patient’s reasonable goals, values, and priorities
Provide Authorization for treatment option
patient can communicate the authorization for treatment option
Civil Rights
Obligation of others to Not Interfere
Negative Right
Obligation of others to Provide something
Positive Right
Assessment
Sterilization
Principles
Perform
Do Not Perform
X
Autonomy
X
X
X
Beneficence
Nonmaleficence
Justice
