Dutch doctor challenges informed consent regulations

Xavier Symons
12 Jul 2014
Reproduced with Permission

A new article in the Journal of Medical Ethics suggests that medical authorities lessen informed consent requirements for perinatal sterilization. Dr. Douwe Verkuyl of Refaja Hospital, the Netherlands, argues that tubal occlusion (TO) should be offered to women after a traumatic birth, even if they haven't previously been consulted during pregnancy.

Under current International Federation of Gynaecology and Obstetrics (FIGO) regulations doctors can provide a TO at the time of birth provided the patient has been consulted during pregnancy. If there has been no early consultation doctors are prohibited from performing the procedure.

FIGO is concerned that vulnerable women will rashly chose sterilization at the time of birth and later regret it.

Dr. Verkuyl questions the 'vulnerability' of women at the time of birth. He claims that there is no empirical evidence to support the belief that regret is higher in cases of 'belated consultation' perinatal TO. The risk, he asserts, is "possible but unproven".

Verkuyl argues that, in developing countries, the benefits of perinatal TO for a women's health outweigh the possible drawbacks:

"Doctors should always consider whether the costs of not offering the TO option are likely to outweigh the possible but unproven additional risk of TO regret after belated, as compared with early, TO counselling."

Verkuyl asserts that in developing countries alternative contraceptive methods are often hard to come by and perinatal TO might be the only contraceptive option. It may be the only means of preventing "unsettling" and "dangerous" future pregnancies.

Many see Verkuyl's new article as a worrying challenge to informed consent regulations. It flies in the face of prudent advice found in FIGO guidelines : "Even if a future pregnancy may endanger a woman's life or health, she will not become pregnant immediately, and therefore must be given the time and support she needs to consider her choice."