Paternalism and the right to choose

[skygazer]

Most of the time when people speak of the right to choose, they're talking about abortion. A recent development in my own life has led me to ponder the fact that there's more to it than that or at least that there are other facets to it that often aren't realized.

My daughter recently had an abnormal pap. It was re-done and again came back as abnormal, showing pre-cancerous cells. She will be having a biopsy to determine at what stage those cells are - if they prove to be at a late (and therefore dangerous) stage, she would prefer to undergo a hysterectomy rather than less radical treatment that does not have the same success rate at eradicating the cancer. This is all speculative at this stage, of course, since she doesn't know the extent of it but in talking about it, we touched on the paternalistic attitudes in women's medicine.

My daughter is 24. She's engaged to be married and has no children. She doesn't want biological children and has already decided that if she decides to be a parent, she wants to adopt. However, it's likely that her doctor will try to dissuade her from having the surgery, pushing instead for other options that will leave her capable of having children. I ran into the same thing when I asked to get my tubes tied after her birth. I was 22 and had two kids - they refused. Said they "didn't do that" until a woman was at least 25 because she "might change her mind."

At the time I accepted it and it led to the birth of my son later on. Now, I love my son and have no regrets about having him but the truth is, his conception led to a lot of difficulties for me, not least marriage to his father who was a jerk (and yes, I was using birth control when I got pregnant with him).

The bottom line here is that there is a paternalistic attitude in medicine that goes beyond abortion - it touches on several aspects of women's health care, most of which are connected to childbirth in some way and work on the assumption that a woman is not smart enough to make up her own mind about what she does with her own body. I'm not aware of any atmosphere of this sort pertaining to medicine involving men and it really irks me.

Discuss.

[Solly Mack]

1. Best of luck to your daughter!!!! Well wishes coming her way!

And you're 100% correct - "choice" is about much more than abortion.

[Matariki]

2. I had my tubes tied when I was 21. No children either.

I've since heard that was unusual, but I was very adamant.

[Caoimhe]

3. Good luck to your daughter!

She sounds very mature for her age. Yes, medicine is very paternalistic when it comes to women's health. My sister in law had her second boy in a military hospital and they refused to give her a tubaligation. She didn't want any more children. My brother ended up getting a vasectomy a couple of years later after leaving the service. Sadly, this happens every day. As patients, we are treated like children. Especially women. It's disgusting. I hope your daughter is okay and the precancer cells are just that. I've heard of many young women having precancer cells and having them burned off, then going on to have several children. But that is her choice, not her doctors.

My aunt was pregnant in the late 60's and got very sick. She went to a male physician who told her it was all in her mind. (her mother in law was his nurse, talk about uncomfortable) He refused to run any tests. She went back to him again, same answer. As the weeks went on she was sicker than a dog and her skin began to turn a pale yellow. When she was finally rushed to the ER with hemorraging and crippling pain, it was discovered that her fetus was dead, she was almost dead and it should have been taken over a month before, when it died. It was poisoning her body. She was never able to have children after that and has had a long life of horrible pain and menstrual problems because of it. This male doctor didn't listen to her, to him she was a young, dumb girl in her first pregnancy and didn't know what she was talking about. So sad, I know this story isn't an isolated circumstance.

For that reason I won't go to a male OB/GYN. I know maybe it's not fair to stereotype based on a few instances in the past, but I wouldn't take my car to a mechanic who'd never owned a car, either.

I will be sending good thoughts to your daughter and her fiance! Best wishes.

[noonwitch]

4. I agree in principle, but not necessarily with the reasoning this time

My sister has had abnormal paps in the past. They caught them early and did an outpatient procedure to remove the abnormal cells. It's been at least 6 years and has had normal paps (and 2 babies) since. Some doctors are conservative about surgery, and try the least invasive procedure first. A hysterectomy is a major procedure that has a lot of implications regarding hormones, and there are the anesthesia risks that any operation entails to consider.

Also, her insurance will only cover a hysterectomy if the doctor states it's the best treatment for her condition, not because she doesn't want to have kids.

[Bunny]

5. I'm thinking the same thing as you are.

While I would never presume that a 24 yr. old woman doesn't know her own mind, the fact is that some people do change their minds about having children. And a hysterectomy, unlike a tubal ligation, is irreversible. 24 is a young age to make such a life-altering decision.

Also, as you pointed out, insurance may very well deny coverage for a hysterectomy if that is not the most appropriate first treatment for the condition.

Of course, none of that negates the paternalism that exists in women's medicine. In my case, I was in my forties and desperate for a hysterectomy, as the bleeding would go on for 21-25 days each month. My former ob/gyn was very conservative about surgery, and told me that I would just have to learn to live with it. :grr: I wanted to tell him to try dripping blood out of his asshole for 3/4 of every month, for two years running, and then tell me about "learning to live with it"! Fucker. Anyway, I finally gave up on him and doctor-shopped around until I found one who would do my hysterectomy. Best medical decision I ever made!

BTW, skygazer, sending good thoughts to your daughter. :hug:

[skygazer]

6. People change their minds about a lot of things

But they are their minds to do with as they please and if they have later regrets, they are their own regrets. Why should not an adult, whether 24 or 57, make up their own mind on their life, whether it has to do with having children or with some other decision? Human beings are not an endangered species, after all. There is no special need for all of us to procreate and she feels strongly about that as well as about the positive aspects of adoption. I have no reason to suppose that she is simply making a knee-jerk response to this and it is certainly not her health care provider's place to presume that either.

As stated in the OP, she is reserving a final decision on this for when she knows the stage the cancerous cells have reached. I was only using her as an example because it's a recent development, not because she is firm in her decision to have a hysterectomy (she only mentioned that as a possible option if the situation warrants it). My point remains the same - it is neither the doctor's place, or yours, or mine, to dictate to an adult woman what she can or cannot do with her own body.

And thanks for the good thoughts. I do appreciate them. :hug:

[oldcoot]

7. Women are "suppose" to want children

I agree with you. I feel that requiring a waiting period for women before they are allowed to get an abortion or requiring them to get counseling before an abortion is paternalism. I think that part of the problem is that doctors and others believe that women are suppose to want to be mothers no matter what. They cannot imagine any woman willingly giving up "the joys" of motherhood. I suspect the pharmacists who refuse to provide women with birth control pills and other contraception are influenced by similar attitudes.

Interestingly enough, women are apparently "smart enough" to decide whether or not they need to get other forms of surgery such as plastic surgery. We do not see politicians arguing that women need a waiting period before getting their breasts enlarged or getting nose jobs and like all procedures, plastic surgery does carry some risks.

I hope everything goes well for your daughter and that she gets the medical care that she needs.