THE SAFE, CERTAIN BIRTH-CONTROL METHOD THAT DOCTORS WON’T TALK ABOUT

ARNOLD BRUNER August 12 1961

THE SAFE, CERTAIN BIRTH-CONTROL METHOD THAT DOCTORS WON’T TALK ABOUT

ARNOLD BRUNER August 12 1961

THE SAFE, CERTAIN BIRTH-CONTROL METHOD THAT DOCTORS WON’T TALK ABOUT

BY ARNOLD BRUNER

THOUSANDS OF MARRIED couples in Canada could be rid of an ever-present cause of anxiety and worry if the Canadian medical profession would let them in on one of its best-kept secrets: a method of birth control that is simple, safe anil everlasting for people who decide. for one reason or another, that they already have enough children.

1 he method is a minor operation for men, called vasectomy. It can be performed in a doctor's office in fifteen or twenty minutes, using the same type of "freezing” anaesthetic a dentist employs for pulling a tooth, but with rather less pain. Vasectomy cuts off the flow of sperm—the male fertilizing agent—but has no other physical effect on the man's sexual system.

This year an estimated 200 men will have the operation done in Canada, with the help of the Parents' Information Bureau, a private organization in Kitchener, Ont., devoted to giving advice about birth control. I he bureau has arranged 1,335 vasectomies in C anada during the past several years. An unknown number of Canadians (but probably more than get it done m this country) will go to the United States for sterilization. A lew may even get their own doctors to operate, or at least to refer them to another doctor willing to do so.

A simple inexpensive operation will make a man sterile with no other ill effects. Six doctors in four cities will sterilize as many as two hundred men in this way in Canada this year. The rest of the medical profession will continue to decree on no clear legal ground, that vasectomy is an illegal operation

THE CASE OF DR ZED

But it is extremely unlikely that an average Canadian who decides that vasectomy is the answer to his family’s birth-control problems could find a doctor in his community willing to perform the operation. 1 here are strong medical, legal and religious differences of opinion about vasectomy. Canadian doctors have been led In the Canadian Medical Association and the ('anadian Medical Protective Association, which gives legal advice to doctors, to believe that sterilization, except as a medical necessity, is illegal. The doctors have been warned that they may be sued, or prosecuted for criminal assault, if they perform such an operation for other reasons.

Blit sterilization is nowhere mentioned in the Criminal ('ode. No Canadian doctor has ever been prosecuted for performing such an operation, and some legal experts say a vasectomy with the patient’s consent can be just as legal and far more justifiable than a nose-lift by a plastic surgeon. Nevertheless, here is what happened to a Toronto doctor who, because he prefers to be anonymous at the present time, will be described here as Dr. Zed.

Dr. Zed is a handsome, athletic father of three children. He became interested in vasectomy u'hen the birth of his second child resulted in a serious operation on his wife. She asked at that time to be sterilized herself, but was refused. When the third child was born, her previous condition was aggravated, resulting in another more serious operation from which she barely recovered.

After that frightening episode. Dr. Zed approached a doctor friend and asked him to perform a vasectomy. The friend was sympathetic, but told Dr. Zed: "If your wife died after you were sterilized and you married again, your second wife could sue you.”

Dr. Zed was stunned by this refusal. One night some time later he slipped out of his home and went to his darkened office. He had reached a decision: if another doctor wouldn’t perform the operation on him, he would operate on himself.

He turned on the lights, and sterilized some instruments and towels. He sat in a chair, injected himself with a local anaesthetic, and began the tricky job of surgery. "In theory, it’s a simple operation." he told a visitor recently. “I knew my anatomy, knew precisely the number of layers of skin 1 had to cut through. But I became anxious when the layers of tissue kept sliding back and forth and I didn't know quite where I was. 1 dropped the sterile towels on the floor. I got tl>ftiu¿h all right, but for

a long time I worriej those towels. Luckily When Dr. Zed got tired and feeling the dj lion, he told his wife Dr. Zed achieved tw self”: Freedom from t just one contraceptive other serious illness anc wife: and the initial ex vasectomy.

Before his self-surgerv^^H surgical birth control h with the Parents’ Inform time A. R. Kaufman, a turer who founded the be

ection from pened." night, pale, the operaid myself.” 'doing himworry that mean anth for his erforming

nterest in in touch At that manufac) to provide birth-control help for family men he was forced to lay off because of the depression, had asked Dr. Zed to perform vasectomies on cases the bureau would refer to him.

He refused because he lacked experience in the technique of vasectomy. But now. with his hard-won experience, he accepted when asked again. The first person he operated on was another doctor.

THE RIGHT TO STOP HAVING CHILDREN

Since then Dr. Zed has probably performed more vasectomies than any other Canadian doctor. He handles applicants to the bureau from Ontario. Quebec and the Maritime provinces, and performs two vasectomies a week on the average, with a waiting list of a dozen. He spaces these operations because he does not want sterilization surgery to crowd out his fairly active general practice.

Since nearly all his cases are referred by the Kitchener organization, they have usually been thoroughly screened. Still, whenever possible, he tries to get both the man and his wife into his office. He is particularly alert for cases in which one spouse is putting pressure on the other in favor of sterilization. If he senses the possibility of future unhappiness, he tells the couple to go home and think it over. He is particularly cautious with Roman Catholics, who may be acting on an impulse they could regret later. He sets no limit on the number of children a couple should have. He believes it is everyone's right to stop having children when he or she wants to.

Dr. Zed is one of only six doctors in Canada willing to co-operate with the bureau in performing vasectomies. Of the others, three are in Vancouver, one in Edmonton and one in Kitchener. Another 20 doctors will go so far as to refer enquiring patients to the Parents’ Information Bureau. Dr. Zed makes no secret of the fact that he performs the operation that medical officialdom in Canada describes as illegal. Some of his colleagues sympathize, others are opposed, even angry—but none has done anything about it yet.

The Kitchener bureau helps with the cost of vasectomies in deserving cases. Dr. Zed. for example, charges $50 to people who can afford it. If he gets less than $25 the bureau will send him an "honorarium” CONTINUED ON PAGE 50

THE SAFE, CERTAIN BIRTH CONTROL METHOD

“Vasectomy is wrong, in law and ethics”

of $25 — if he asks for it. Some patients have paid Dr. Zed as little as $10 (doctors in the U. S. charge from $75 to $150).

Advocates of vasectomy believe that the status of voluntary sterilization will be clarified only when a doctor is charged with some breach of law after performing one. Dr. Zed, for personal reasons not related to his medical practice, is not yet ready to lay his reputation and career on the line in a test case. But he expects to be prosecuted some day, and it is possible that his name will go down in medico-legal history as the defendant in what w'ill probably be called "the Great Sterilization Case."

The official medical position, according to Dr. Arthur Kelly, general secretary of the CM A. is; “The only medical reason for sterilization is danger to life or health of the patient.” (This means that if future pregnancy or childbirth would endanger a woman’s life or health, then the operation must be perfonned not on the husband but the wife. Female sterilization is a far more complex and serious operation than vasectomy).

Dr. T. L. Fisher, of Ottawa, secretary of the Canadian Medical Protective Association, which undertakes the defense of doctors charged with medical offenses, says Canadian doctors are advised to refuse to sterilize without a reason. "And the only reason," he adds, "is preservation of life. Everything else is an excuse. A doctor has no right to deprive a person of a bodily function, including a sex function. Consent doesn't make any différence. A person hits no right to say, ‘For reasons of my own 1 want to lose a foot.’ Sterilization for economic reasons is wrong, morally, ethically and in law.”

Some legal and medico-legal authorities do not agree with the medical officials. John Desmond Morton, professor of criminal law at Toronto’s Osgoode Hall law' school, says: "A surgical operation is not a criminal offense and sterilization is not an assault; in a criminal action the consent of the patient would be a perfect defense, and if necessary the doctor could go to court to collect his fee.”

Glanville Williams, a British legal authority, lecturing at Columbia University declared that "human beings are usually the best judges of their own interest, and if they consent to ‘damage’ by surgery there is no reason why the law should protect them further.”

Then he raised the significant point that a number of other forms of "social surgery” even less related to the preservation of life than is vasectomy are accepted by doctors as a matter of course—face lifting, ritual circumcision, skin grafting, and the removal of healthy teeth to improve the appearance of an overcrowded jaw.

There appear to be no court decisions on sterilization in Canada, Britain or the United States, with the exception of a ruling by the supreme court of Minnesota that there was nothing against public policy in a husband being sterilized for the sake of his wife’s health. Many doctors in the United States (an estimated 900 U. S. doctors perform voluntary vasectomies) interpret “medical necessity.” which sanctions the operation, as including physical and mental health and "well being.” Some Canadian insurance companies which issue medical and surgical policies apparently do not agree with the medical officials. In Ontario they pay for voluntary vasectomies on policy-holders at the rate of $50 set by the Ontario Medical Association (for "medically necessary” sterilizations). "Possibly,” said an official of the Parents’ Information Bureau, "the insurance companies take the realistic view that it’s cheaper to pay $50 once than to risk several $85 claims for childbirth.”

The churches, too, take a varying view of "surgical birth control.” The Roman Catholic church is firmly opposed.

For Jews, says Rabbi David Monson, of Toronto, "sterilization for birth control purposes would be going too far.”

The majority of Protestant churches accept birth control in principle, although

few have dealt with sterilization specifically. However last year the General Council of the United Church, meeting in Edmonton, accepted a report by its commission on Christian marriage and divorce which approved of sterilization in the case of a man who may want to marry when suffering from a hereditary defect. Voluntary sterilization is also permitted in the case of a woman whose mental and physical health may be endangered by another pregnancy, if both husband and wife agree and the step is recommended by a doctor.

It is perhaps not surprising that Canadian doctors prefer to stay silent and inactive in the sterilization controversy. One result is that many Canadians who feel they have an urgent need for surgical birth control believe they can obtain it only by "bootlegging” it in from the U. S. One such case is a Toronto man who will be referred to as George Smith.

"I woke up early one Saturday morning.” Smith says, "and was about to go back to sleep when 1 remembered it was an important day. I had an appointment that afternoon to be sterilized.

"I'd thought about it long and hard after reading about vasectomy. We had practiced birth control conscientiously after the first two children w<ere born, but we had two more just the same. The sacrifices we had to make just weren't fair to us, or to the kids—and we wanted to start planning for the future.

"When the fourth baby was born my wife had an extremely difficult time and the state of her nerves had me worried. We figured we had at least twenty years left in which the chances of having more children were better than good. She asked her doctor to tie her tubes right then and there. He was sympathetic, and wanted to do it. but after consulting with some other doctors he told us it couldn't be done. After that, my wife was always tense and worried—she went through her days like a person trapped in quicksand.

“I decided to ask my own doctor about vasectomy. 1 had considered the possibility of remarrying for one reason or another and wanting more children, and the possibility of having my family wiped out in a disaster. But the chance of those things happening was remote compared with what was happening at the moment, and was likely to go on happening.

"The doctor said he'd never had a request like that before, but he thought it could be done without any trouble. The next time 1 saw him he said he had been mistaken. The operation, or any operation on a healthy person, he said, would be considered in law as an ‘assault’, even if 1 consented to it. But he gave me the

name of a doctor in the States who wouiîr* do the operation.

"1 called the American doctor, he agreed, and a few days later I received two forms to sign, one for me and one for my wife, saying that we consented to the operation and that we understood it would leave me permanently sterile.

“In spite of my intellectual approach to the whole thing, there is something disturbing about getting something done to yourself that you can't get undone, and the first time 1 saw the American doctor,

I backed down. He said it was a good idea to talk it over first, and 1 returned home, still fertile, to think it over.

“Couple of weeks later, on a Saturday,

I drove down to New York state for the real thing. The doctor injected a freezing drug and the area was completely without feeling within a few seconds. He made a small incision —1 couldn’t feel it — and pulled the tube out where he could get at it.

"That was the most uncomfortable part. The pulling gives you a momentary sick feeling. He told me he was cutting one inch of the tube out and putting a stitch in each of the cut ends. 1 watched him sew me up. then he w'ent to work on the other side—cut. pull, cut. sew—the whole thing was over in about 15 minutes.

"He told me that after a while, the ends of the tubes move closer again, and sometimes an incredible thing happens. The little holes in the centre, which are so small you can hardly see them, find each other and grow' together. When that happens—in about one case out of a hundred —the operation fails. 1 remembered that the consent form I signed said he didn't guarantee the operation.

"He advised me to get a sperm count every six weeks for six months. He said if the tubes haven't grown together six months after the operation, I could be sure it had succeeded. His fee was $100.

"The next day there was some uncomfortable swelling and 1 was worried about some hard lumps that formed just under the incisions. On Monday. I went to see a specialist in my own city. He didn’t mind looking after me after the operation, but he said he was making no record of my visit.

“He told me the lumps had formed through accumulation of secretion. But after a few' days, with the help of some warm baths, the body would soon absorb them and the lumps would go away. They did. I lost one day of work.

“But one thing really had me worried. 1 wondered if I'd ever be the same again —1 mean sexually. I had read that the operation has no effect whatever on a man's sex drive and that the only thing that changed was his ability to father children. My worries proved needless.

“Married life now is even more satisfying and pleasant than it's ever been, probably because my wife and 1 know we're off the hook of constant parenthood forever.'’

That is George Smith's story, and he seems happy with his vasectomy. Possibly in the long run he may suffer a twinge of regret at the very permanence of his sterility—although that factor had already been taken into account when he made his decision. However, now that vasectomy is being slowly accepted—despite the attitude of Canadian medical officialdom — research will undoubtedly lead to improved techniques and even make vasectomy a "reversible” operation. Already doctors at Mount Sinai Hospital in New York City are experimenting in that direction. They are hoping to use clips to shut off the tubes, a technique which may allow the patient to decide to become fertile again if circumstances should make it desirable, it