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Lord's justice.


Now that all the IUDs are off the market I am relieved. I can easily say no to patients who request the devices, instead of having them sign waivers of responsibility if they insist on them. In 1977 the F.D.A. produced a new set of warnings for doctors to distribute to patients before IUD insertions. I often wondered how anyone who read those booklets could then use the device. I certainly never would. But why couldn't I just say no to patients before? Perhaps, while the devices were on the market, I believed that if they were so bad the F.D.A. would step in. After reading the books about the Dalkon Shield I will never again make so foolish an assumption.

One crucial issue of health care emerges from all this: physician vs. patient autonomy. Does a doctor have the right, or responsibility, to refuse a procedure or treatment which she or he thinks is wrong even if it is approved by government regulatory agencies and is in general use? I have learned from the IUD saga that physicians should make autonomous decisions in such circumstances.

Of course, the argument is generally made that once the patient is given a full explanation of risks and benefits she can make her own decision. The doctor thus becomes the passive purveyor of medical technology. If there is an unfortunate outcome, the malpractice attorneys step in and claim that neither the drug company nor the doctor was negligent. That is how the free market economy of medicine works in our country. That is also the reason why patients have to pay me an additional $40,000 a year that I turn over to an insurance company for distribution among injured people and their lawyers. Wouldn't it be better to take steps to prevent such injuries? In the case of IUDs, the result of all the litigation is good--the devices are gone.

The more difficult questions remain: Why did so many women have to be injured before the devices were eliminated? And how can we avoid another such tragedy? In answer to the first question, let me ask another: If the IUD were a male method of contraception, would it have been on the market for almost fifteen years? Of course not. Male reproductive organs are not to be tampered with in such a dangerous fashion. In appraising contraceptive methods, the side effects that women suffer are routinely underestimated and those that men suffer, overplayed. Witness the near hysteria about the presence of antisperm antibodies which develop after vasectomy, compared with the routine acceptance of the risks of general anesthesia and operative problems connected with female sterilization.

Avoiding such problems will continue to be difficult. But while we're waiting for the "ideal" contraceptive (presumably a female method), let's recognize that we have a very good method already on the market. It's safe and second only to the pill in effectiveness. It also provides significant protection against sexually transmitted diseases. Its drawback is that it's a male method. Isn't it about time to promote condoms and ask men to accept a greater share of the contraceptive burden?

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Author:Cooke, Cynthia W.
Publication:The Nation
Article Type:Book Review
Date:Mar 29, 1986
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