Kristina Thum¹, Katja Kühlmeyer¹

¹ Institute for Ethics, History and Theory of Medicine, Ludwig Maximilian University of Munich

The marked shift in the doctor–patient relationship – from a traditionally paternalistic approach to a more deliberative one – goes hand in hand with the increasing personalisation of medical decisions. As a result, the question of the timing and appropriateness of such decisions is coming more sharply into focus. Sterilisation as a measure to fulfil the wishes of young women who do not wish to have children is a phenomenon that has received little research attention to date and which poses challenges for doctors.

Surgical severing or ligation of the fallopian tubes provides an extremely reliable form of contraception. Sterilisation is regarded as a permanent method of contraception, which requires a high degree of care in terms of patient education and decision-making. Accounts from those affected show that young women seeking sterilisation frequently encounter refusal. The concern is often raised that the procedure might be regretted at a later date. Consequently, some gynaecologists turn away women without children or those below a certain age across the board. On the one hand, this raises the question of the moral legitimacy of age limits. Furthermore, it is unclear whether such a refusal is consistent with the ethical obligations incumbent upon doctors.

The lecture therefore addresses the question: Is it ethically justified to refuse young women who wish to undergo sterilisation?

To this end, a discussion will take place, against the backdrop of principled ethics, on the circumstances under which sterilisation may be ethically justifiable. The obligations to do good and to do no harm will be examined, with a focus on both the hoped-for benefits of the treatment and its potential harms. We will then discuss the requirements for an autonomous decision regarding the procedure. Finally, we will address the perspective of justice with regard to the social costs and burdens involved.

In conclusion, we find that a blanket rejection of young women’s requests for sterilisation cannot be convincingly justified from an ethical point of view. Particularly with regard to the principles of doing good and respecting autonomy, it would seem, rather, that supporting a self-determined decision regarding sterilisation is the appropriate course of action. Finally, we examine whether the procedure may be withheld on the grounds of a decision based on conscience.