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Medical Justice

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Risk Management

Spousal Consent for Vasectomy

04/09/18 9:21 AM

I recently came across an informed consent form for a vasectomy. (Not mine. I was doing research.) The consent form included the expected items; risks, options, benefits, and so on.

There was a signature line for the patient.

There was a signature line for a witness.

Just below was a paragraph of additional text and a signature line for the spouse.

I am the wife of ___________________________________. I understand that my husband has asked the physician to perform a bilateral vasectomy procedure on him. I have read the consent which my husband has signed and realize the procedure will not take effect for some time after it is performed, but thereafter it will be very unlikely that my husband will be able to cause me to become pregnant. I have no objection to this procedure and agree that I will not assert any claim against the physician on the basis of the procedure performed and that I release him from any and all liability arising out of or relating to the procedure.

While husbands and wives share many secrets with one another, what happens if the husband does not want to share THIS secret?

In this case, the consequences of the vasectomy may very well impact the spouse’s reasonable expectations.

Still, medical ethics weighs heavily in terms of patient autonomy – to decide what medical procedures the patient wants and does not want performed.

While a husband should discuss major life issues with a spouse, what if he wants to shut his wife out of the decision-making process? Would such an informed consent imply that the spouse has veto power over the procedure?

I can find no state law which mandates spousal approval for a vasectomy.

Further, if a physician forces a spouse to disclose medical details with his wife, this could trigger a HIPAA problem. In this light, the physician would not have disclosed any protected health information. But, the patient might argue he was coerced by the physician against his will to do so; particularly if he was led to believe he had no option.

My personal opinion is that successful relationships are based on honesty. And, if a spouse is affirmatively choosing to become infertile, he should inform. But, it should be patient’s choice.

Perhaps the better middle ground is to suggest to the patient that he should discuss the consequences of the procedure with his spouse. Then document he was encouraged to do so.

By the way, this discussion is not sex-specific. It’s easy to imagine an analogous consent form being presented to a woman and her husband for tubal ligation. Or to a woman and her same sex spouse, again for tubal ligation.

What do you think? Let us know in the comments below.

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Posted by Medical Justice | in Risk Management | 12 Comments »

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Michael M Rosenblatt, DPM
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Michael M Rosenblatt, DPM

While this discussion concerns itself primarily with physician and therefore HIPAA liability, there are other greater societal changes raging around this issue. (For disclosure this does not affect me, as I am still married for 50 years to the same spouse) I don’t know if physicians are familiar with the “MGTOW” movement, (Men Going Their Own Way) spreading rapidly around men in all social and financial classes. An addendum in a consent from a wife would run severely counter to husbands or male partners, thinking or planning to go MGTOW. There is not enough time or space to explain this… Read more »

EasyE
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EasyE

“Suggest to the patient that he should discuss the consequences of the procedure with his spouse. Then document he was encouraged to do so.” = best practice. I suspect the urologist with dual consent may have seen a case of spousal litigation from unexpected pregnancy. The verbiage in this consent is unnecessarily strong, but frankly, I don’t fault the doctor. It may be an unenforceable document, but it can serve as a deterrent to frivolous litigation. Does a physician have a right to refuse to perform an elective procedure if he or she is uncomfortable that the spouse is unaware?… Read more »

Henry A Unger
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Henry A Unger

I am a retired board certified urologists. With every vasectomy I preformed, I required the spouse to be present at the consultation. I inform7 the patient that the law does not require her consent and she would not be giving it. I wanted her present in the discussion so that she was aware. . If this was not acceptable to the patient, I politely asked him to find another individual to do the deed. I did not want to get involved in drama. This is a family decision and all partipants need to be aware, not necessarily giving their consent.

Elizabeth
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Elizabeth

So you think it’s ok to violate hippa?

Kim
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Kim

That doesn’t violate hipaa (you didn’t even get that right).

Roy Vahldieck
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Roy Vahldieck

Its not a family affair if the guy wants it done,it gets done just as a woman has autonomy to get a tubal ligation. You are an idiot!!

Jasmine
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Jasmine

Then its not your decision if your wife wants her tubes tied right? Oh you didn’t know your wife needed your permission to get her tubes tied be at a certain age and have kids already? Its not okay for a Dr to want your wife’s consent but its okay for you to not want hers?

Kwinsor
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Kwinsor

I have dealt with this issue, among many others including divorce from a medical spouse, medical malpractice, legal malpractice, licensure board action, PHP abuse. Agree that society, through decline and decay, and abuse of husbands by the court system if they are good providers, good fathers etc, makes marriage and fatherhood a frightfully risky proposition as outlined in the book below. Recommend men get vasectomy before they even get married, and only after marriage is stable, wife working etc., then get it reversed. Worth the risk and money, especially when you are looking at 50% divorce rate.Brutal outlook, I know… Read more »

Joe Horton
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Joe Horton

Agree with Unger above: if you insist that the spouse–if there is a spouse at the time–give consent before you operate, you as a surgeon are within your rights to refuse unless that’s done. There are certainly other surgeons who won’t require it and the patient is free to seek one of them. I don’t think that it should be a requirement, but that’s just me. A loosely parallel situation was my refusal, because of much higher complication rates, to treat elective aneurysm patients who smoked until and unless they 1) stopped smoking for at least a month before I… Read more »

john
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john

Virginia Medicaid requires consent be obtained and then a 30 day period prior to procedure- I always have the spouse witness the signature. Once I did have a pt get it done w/o spousal knowledge and he also failed to get f-u semen analysis and I am told, in that small community, that he cheated on his wife and I was uncomfortable having abetted a possible home break-up, which led to my current double signing.

retiredmd
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retiredmd

The reason that we are having this discussion at all unfortunately is the legal system run wild. We can discuss the issues of trust and relationships, but with a divorce rate at or near 50% have we educated the people in society as to what a commitment to marriage actually means from a young age. Obviously not. Do people get married too early in today’s society? Of course. But we also live in a culture where we expect instant gratification at the click of a mouse. So if the spouse doesn’t meet that instant gratification it is time to throw… Read more »

EasyE
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EasyE

I was at a birthday party Saturday, and I discussed this consent with a friend who is a urologist, and does not recommend discussing vasectomy with spouse. AUA guidlines mandate a post-vasectomy semen analysis. I guess if the patient is shooting blanks a month after vasectomy, the spouse should have no recourse against the surgeon since there should be no chance (doubt 0%) of an unwanted pregnancy. Wives may want to know if they suspect infidelity, but that may result in an unsuspected STI (Formerly STD). Thank you.