Paternalistic Patriarchal Surgeons And A Philosopher's Choice To Have No Children

A philosopher was faced with the choice between a vitally necessary surgery and giving up the chance to have children. This was an easy choice for her to make, but a hard one for the surgeons to accept:

 I assured the surgeons, my partner and I weren’t planning on having kids. Naively, I thought this extra bit of information would settle the matter. As it turned out, it had surprisingly little impact on the (male) surgeons. You think that now, they told me. But if you lose your ability to have children, it’s permanent – and you may regret it later. Sure, I thought, of course I may regret it. But then, having kids is also permanent – and I might regret that too. I couldn’t see how my potential regret should factor into this decision, especially given that people are statistically more likely to regret child-having than non-child-having. (Turns out I would also end up with very good reason to regret a surgery delayed by medical hand-wringing about my childlessness. But this was the sort of potential regret that didn’t matter in this context, as it was only indirectly connected to lack of babies.)

My case – which is medically unusual and complicated – ended up being taken for discussion to the surgical board of the medical school which runs the teaching hospital where I’m treated. The decision they handed down still shocks me, every time I can bear to think about it. The director of the surgical team advised tactics to delay the operation as long as possible, so that I could “try to complete my family”. That my family could already be complete was not, apparently, something they considered.

It was never obvious what exactly they wanted from me, when they advised that I “try to complete my family”. My condition – especially given what was happening at the time – made it unlikely that my body could sustain a pregnancy beyond the first trimester. And if I could manage to carry a pregnancy to term, it would be very dangerous for me, and would likely cause me permanent harm. It seemed that I was being told to undergo a series of frustrating miscarriages in pursuit of a dangerous pregnancy I didn’t want. When I asked my primary care physician why this was happening, she sighed, rolled her eyes, and said “They want to be able to say that they told you to try.”

The expectation throughout seemed to be that I should try, that I should pursue biological reproduction regardless of the harm or danger. That’s what the brave woman would do. If it worked, I would have the moral victory of motherhood against the odds. If it didn’t, I would have the moral reassurance that at least I’d tried. And if it ended up killing me – well, I would die in the noble pursuit of motherhood, surrounded by understanding women, like Julia Roberts in Steel Magnolias.

What followed were a series of increasingly frustrating conversations with (male) surgeons. One responded to my claim that I didn’t want children by patiently explaining: “You shouldn’t say that. You never know about these things. Children are a wonderful blessing.” I have a hard time imagining how a doctor could think that’s an appropriate thing to say to any adult woman. But that a doctor could think it’s an appropriate thing to say to an adult woman for whom pregnancy would be a serious risk defies belief.

Another surgeon, when faced with a similar declaration from me, reacted quite differently. He smiled, as though he suddenly understood something sad and profound, and then said: “Ah, I see. Is it that you’re afraid your child would have [your condition]?” This wasn’t the first time I’d heard something to this effect. In fact, it sometimes felt like the only way to avoid the doctors’ rampant paternalism was to embrace their equally rampant ableism. My condition is genetic – autosomal dominant – so my biological children would have a 50% chance of inheriting it. But this was never a part of my decision not to have children. Insofar as I wanted children, I would’ve been delighted to have children with my condition. It’s just that I didn’t want children, disabled or non-disabled.


Whenever I would point out to my doctors that I could have children without having my biological children, they would look at me like I’d just sprouted a second head.

Find out how things turned out for her in the end.

And then her saddening struggles after that.

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About Daniel Fincke

Dr. Daniel Fincke  has his PhD in philosophy from Fordham University and spent 11 years teaching in college classrooms. He wrote his dissertation on Ethics and the philosophy of Friedrich Nietzsche. On Camels With Hammers, the careful philosophy blog he writes for a popular audience, Dan argues for atheism and develops a humanistic ethical theory he calls “Empowerment Ethics”. Dan also teaches affordable, non-matriculated, video-conferencing philosophy classes on ethics, Nietzsche, historical philosophy, and philosophy for atheists that anyone around the world can sign up for. (You can learn more about Dan’s online classes here.) Dan is an APPA  (American Philosophical Practitioners Association) certified philosophical counselor who offers philosophical advice services to help people work through the philosophical aspects of their practical problems or to work out their views on philosophical issues. (You can read examples of Dan’s advice here.) Through his blogging, his online teaching, and his philosophical advice services each, Dan specializes in helping people who have recently left a religious tradition work out their constructive answers to questions of ethics, metaphysics, the meaning of life, etc. as part of their process of radical worldview change.

  • James Sweet

    Weird. I had some sympathy for the doctors early on — reminding a patient that a decision they are making has irrevocable consequences, and that they might change their mind at some later date*, I think that’s entirely appropriate. Trying to convince the patient that their current outlook is wrong, however, is completely out of bounds.

    In short: “Are you absolutely certain? While you don’t want children now, you may change your mind in the future” is acceptable and probably even advisable, as long as it doesn’t go overboard. “But children are great! You really should have some” is completely out of line.

    * Although the line about how having children is also irrevocable and something many regret, that’s a clever and effective rebuttal to that line of argumentation, I suppose…

    • Brandon

      Even the, “Are you absolutely certain? While you don’t want children now, you may change your mind in the future” strikes me as odd and unnecessary. In seems like something that someone would express only if they hadn’t stopped to think for a moment – does anyone really believe that someone who says “I don’t want kids” hasn’t considered the possibility that they’ll change their mind later? Seriously, how completely oblivious to reality would someone have to be to say, “I don’t want kids” without having considered what their life might be like later?

  • Illuminata, Genie in the Beer Bottle

    One would like to think that female physicians are less unbelievably sexist and paternalistic, but IME, they can be worse.

    • Camels With Hammers

      Really? In the rest of the piece I quoted, she paints a picture of numerous women in health care (from surgeons to nurses) being instantly understanding.

      What has your experience been like?

    • Happiestsadist

      I know I got disapproval fro the nurse who was preparing for my tubal ligation. (Bit late, don’t you think?)

    • papango

      I had to have a chunk of my reproductive system removed last year and I was really surprised by how well the doctors assimilated the fact that I don’t want children into my care. I’ve had ‘you’ll change your mind’ and ‘of course you do, don’t be silly’ since I was a teenager, so I was expecting the same sort of thing. But they just made a note of it and moved on to what I would need to know about hormones and early menopause should a full hysterectomy be required (they didn’t know before they unzipped me how much would need to come out and what I’d be left with). They spent more time discussion my decision to let a ob/gyn medical student do a full pelvic examine while I was unconscious. (“You’ll be out of it and he’ll have his hand up your skirt, that ought to be a real nostalgia trip for you.” “Shut up, mum”).

  • sqlrob

    A woman (or a man. I had to go through several doctors to get my vasectomy) is told that not having children is a life changing decision, and you have to be at least X years old to make it

    But having children isn’t???? Somehow, maintaining the status quo is lifechanging, but changing it isn’t???? o_O

  • Mara

    I’m so not shocked. After a horrible and terrifying first pregnancy, I said I didn’t want to get pregnant again. Everyone (including my husband) thought I was crazy. Everybody needs to have more than one child! I would be miserable without another child! My family couldn’t be complete with one child.

    After years of pressure, I got pregnant again. And nearly died in the process. Nobody seems to care all that much about that part, because hey, at least we have two kids!

    I feel terrible for this poor woman. It must have been a terrible experience dealing with this. I would have started screaming at them.

  • drlake

    Sounds like malpractice to me.

  • Cathryn

    What troubles me most about this is the implication that the doctors know better what this woman wants than she does herself! This is incredibly patronizing! We aren’t talking about a teenager, here, but a 27 year-old woman!

    Further… what, exactly, do the doctors think is so horrible about the notion of adoption if she would change her mind later on? No wonder there are so many children who never get adopted…

  • carovee

    First, hi, I’m new to this blog.

    I had some sympathy for the doctors early on — reminding a patient that a decision they are making has irrevocable consequences, and that they might change their mind at some later date

    That might make some sense if she were electing to get her tubes tied or something but the text makes it sound more like her choices were cake or death and the doctors were encouraging her to choose death. For doctors of all people to push her to do something quite dangerous for her health certainly does sound like malpractice.

    • RW Ahrens

      …and worse, this was at a teaching hospital! Just think of how many future doctors are being indoctrinated with that attitude!

  • Granny Weatherwax

    As an adoptee, I also liked what she had to say about prejudice against adoption and blindness to the appearance of real families. I continue to see a lot of hysteria about having “one’s own” children and a concurrent dismissal of adoption as a sort of sad consolation prize for those who have failed at the magical wonders of motherhood. Adoption comes across as the equivalent of picking a puppy out of a cardboard box next to the dumpster, behind the pet store where the “real” purebred dogs come from. Why isn’t parenthood all about loving a child–any child, especially one in need of a caring, stable, permanent home–rather than focused on perpetuating one’s own probably not very valuable DNA? In the early 70s I was excluded from a special family photo because I wasn’t a “real” grandchild; I’d hoped attitudes would have changed in 40 years, but I don’t see much sign of it.

  • savoy47

    I think she has some blame for having to have a more invasive, riskier procedure than would otherwise have been needed.

    She should have told her male doctors; I’ve been informed about all the risk and this here is my decision. She should have asked outright; are you refusing to operate? If they answered yes then go to another doctor right away.

    I understand that this story is about the attitude of the male doctors and I agree that they were out of line but sometimes you to need to hit a jackass with a 2 x 4 to let them know you are serious.

    • Mara

      From my personal experience, when enough people tell you enough times that you won’t be complete without a child (or another child, in my case), you start to wonder if you’re the one who’s crazy.

      It also sounds like she did try multiple doctors and they all did the same thing until she finally found a woman.

  • Makoto

    When I started my treatment for testicular cancer (single orchiectomy, additional surgeries, chemo) the doctors told me that I should consider having some sperm banked in case I ever wanted kids, because by the end of everything they did, I’ve got about a 2 – 5% chance of doing so. They gave me the info, and after reading it I decided not to, since the place they advised only guaranteed the sperm for a few years, it would’ve cost thousands of dollars (which I was spending on surgeries and such), and I knew I wouldn’t be in a place in life to father a child within the given timeframe anyway.

    The response? “You sure? Well, okay.” They never offered to delay any part of my treatment, it was more like “if you want to do this, here’s the info, get it done before Friday because you’re in the OR on Saturday”. I find it so frustrating that this woman had to be talked down to like she was, while my doctors gave me the info and let me do my own thing.

  • oldebabe

    When my then husband and I decided not to have children, no one cared… (1957) and when I subsequently did not want to have children, no one cared either, or at least never said anything. And that’s the way it should be. Suffice to say, I never regretted that decision. Some people don’t.

    This story is a very bad example of our medical system (and perhaps a reversion to `the doctor knows best’ syndrome?) and those docs need to be re-educated.

  • had3

    My wife and I are also a childless couple w/no regrets. However, you state that people are statistically more likely to regret childbearing than regret not having children. Do you have a source for this fact? My quick perusal yielded a NewsDay survey to the contrary and a debunking of the Ann Lander’s article that appeared to support the position. (see: So, while I agree with your position and would like your facts to be true, I can’t seem to find anything that actually supports it.

  • DonZilla

    Dear Granny @ #8:

    “I continue to see a lot of hysteria about having ‘one’s own’ children . . .”

    Because most people want to perpetuate themselves into the future, through kids. How many parents have you met that weren’t more than a teeny tiny bit disappointed when their kids didn’t turn out to be exact clones of themselves?

    (And they say people who don’t have kids are selfish. Go figure.)

  • DuWayne

    I flat out wasn’t allowed to get a vasectomy when I was in my early twenties. Mind you, I was engaged in rather severe substance abuse, was essentially homeless – had been for most of my adult life, was jobless and I was a total slut (though also a condom nazi – still, shit happens).

    Don’t get me wrong, I love my boys and I am glad they are about. But to be perfectly honest, they haven’t had particularly wonderful lives to date. They are doing better and better, but that is in spite of their parents (and due to a lot of damage control on my part). I still get fucking pissed about the whole vasectomy denial. And it is made the worst because when I went and actually got one, the nurse at Planned Parenthood was required to interrogate me as to my absolute desire *not* to have more children.

  • Art

    It sounds like it the doctor’s attitude was approaching malpractice. On the other hand malpractice certainly played a part. Doctors, with a considerable amount of help from lawyers and court cases, have learned that jurors in malpractice cases are romantics.

    Consider that you are a lawyer specializing in defending doctors from malpractice charges.

    Case one is one where a woman claims a operation which would remove any chance of her having children was delayed and this caused her hardship and risked her life. She claims pain, and mental anguish.

    Case two is one where a woman sues because she claims she was rushed into having an operation, which she will claim was unnecessary, and has been deprived of having children. She has a breakdown in front of the jury and her lawyer lays it on thick with a ‘won’t someone think about the unborn child’ speech.

    Yes, in this case, patriarchal attitudes were likely involved but so was a the relative difficulty in defending against a malpractice case.

  • ‘Tis Himself, OM

    When I got my vasectomy at age 31 the urologist said “Are you sure, because while a vasectomy is easy, splicing a cut vas is intensive microsurgery.”

    I told him “yes, I’m sure” and got it done three days later.

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