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.


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