Careful, or you’ll regret not reproducing.

For once, I’m not talking about the anti-choice movement. American Sexuality magazine has a piece describing one young woman’s travails in finding a doctor willing to perform a tubal ligation on her. She’s in her early 20s, and absolutely, positively, 100% certain she never wants children. Never.
Seems perfectly logical to me that she’d want her tubes tied. After all, birth control is expensive. And can be a nuisance. If you know you won’t want kids, why wait another 10 years to have this surgery? Maybe because doctors are refusing to perform it on her:

“[Planned Parenthood of Boston**] said it was much too permanent and weren’t going to give it to me, plus my insurance wasn’t going to cover it,� recalls Green. What’s more, according to Green, “It was all and only about my age.� She was twenty-two at the time.
Green’s experience is not that unusual. Though no actual laws have ever been put into place, most OBGYNs refuse to provide women under thirty with permanent forms of contraception. Dr. Daniel Wiener, assistant professor of obstetrics and gynecology at McGill University in Montreal, is one such doctor.
With thirty plus years of medical practice, Dr. Wiener finds no good reason for putting otherwise healthy patients in surgery: for one, there are anesthetic risks involved. Plus, tubal ligations are considered elective surgeries (assuming the patient can use other, less invasive forms of birth control). More pressing, still, is the fear that a patient may one day change her mind. Sound familiar?

Yes, actually it does. The last time I heard the “we must protect women from their future selves” argument, it was being proffered by Justice Anthony Kennedy.
Over at Broadsheet, Tracy Clark-Flory says, “It’s an issue of reproductive choice and freedom, to be sure. But making medical and ethical judgments like whether to tie a woman’s tubes (or whether someone is prepared for a sex change) is a doctor’s right and, arguably, an essential part of the job description.” Um, what? 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.
It’s not hard to believe the stigma that the woman in the article says she faced in pursuing the surgery. After all, I’ve seen this story about the increasing demands of 20-somethings for tubal ligations (or vasectomies) crop up a few times in the past year. The simple fact is our society still has a hard time accepting that some people just aren’t interested in spawning.
So what should doctors do when faced with a patient in her 20s who requests a tubal ligation? I think Justice Ginsburg’s advice in the wake of Gonzales v. Carhart applies to this situation quite nicely: inform women of their options, the attendant risks, and the likely outcomes. Then let them make the decision for themselves.