Matt Zeitlin

This is an issue I’ve had, uhh, very little interaction with – 20 something women getting tubal ligations (ie – getting their tubes tied). Not to surprisingly, many doctors refuse to perform the surgery on women who are under 30. Not too surprisingly, Ann at feministing takes offense:

Is it a medical professional’s job to “protect” women from their own decisions? Is it a pharmacist’s right to make medical and ethical judgments like whether to dispense contraception? If you’re a doctor who’s happy to provide tubal ligations to older women, it seems totally out of sync to deny them to younger women who are equally certain they’ll never want to reproduce.

I am very sympathetic to women’s medical and reproductive autonomy being highly valued, but I’m torn on this issue. Surely Ann would admit that there’s a difference between the type of medicinal paternalism being practiced in the case of Laura Green, the 25 year old graduate student who has been uniformly turned down for tubal ligation, and in the case of procuring an abortion or getting the morning after pill. For starters, getting morning after or an abortion are both time sensitive in a way tubal ligation isn’t. Moreover, tubal ligation also has permanence that abortions and birth control do not.

For feminist activists, it makes sense to immediately blanch at any question of a woman’s reproductive autonomy or her standing to receive certain medical treatment – especially on the Justice Kennedy esque grounds of “we must protect women from their future selves.” There is however a stark difference between abortions and tubal ligation – while the only likely future negative consequence of abortion is some sort of emotional pain (the risks of such are serially overstated by anti-choice groups), tubal ligation makes it impossible for a woman to have her own children if she changes her mind. And yes, while birth control can be inconvenient, it seems prudent for doctors to at least make sure women don’t rush into such a decision. Additionally, there are the standard risks with come any surgery.

And yes, that justification seems awfully paternalistic, but I’d argue that everyone under 30 could use some soft paternalism, and permanent decisions of this nature ought to be extensively thought through, and then thought through some more. Doctors also have extensive personal and collective wisdom on this issue, so when there’s a near unanimous position- even among those doctors who work at organizations that provide abortions – against doing this surgery for women under 30, I feel that there should be stronger arguments against it than claims of agency, especially considering tubal ligation’s elective nature.

I feel it’s well within a doctor’s purview to counsel against elective, dramatically life changing surgery at such a young age. Does this conclusion seemingly rely on common stereotypes of young women being “fickle” and emotionally and intellectually immature? Maybe it does, but just saying that doctors are acting in a possibly stereotypical manner is not a reason to say that the decision of thousands of OB/GYNs is prima facie wrong, just a reason to question it.