Over my career I have provided a range of human services. Usually I tried to let the process be driven by my clients, figuring they probably knew what they needed more than I did. But from time to time, I would get asked to do something that I was pretty sure, based on professional experience, would turn out to be a Bad Idea. I would actively try and dissuade. And once or twice, I refused (though I did make it clear to the client they could get the service elsewhere).

I do believe that a Dr. has a positive duty to share her/his experience and understanding, to dissuade a patient from a course they feel is wrong. I also do believe that a Dr. has the right to refuse to perform invasive surgery when they feel that it is a bad idea and alternatives are possible, so long as the patient has other choices available, both in terms of birth control and other providers of medical services.

If a Dr has a bunch of experience that suggests that early 20s is too young to be sterilized, s/he may well be wrong, but I do not see how s/he is under any obligation to participate in something that s/he believes to be ill-considered. Thankfully, we aren't yet in a situation where your choices are confined to a single Dr.; you do have choices, and as long as you do, so does the Dr.

(And yes, I feel the same way about pharmacists dispensing Plan B; even though I believe them to be deeply wrong, if there are other alternatives, I do not see why society should compel them to act against their beliefs.)

Incidentally, not only is the success rate for tubal ligation reversal NOT 100% (and the success rate is strongly influenced by a bunch of factors, including length of time since the ligation, so that claiming this or that percentage in the case of an individual patient considering ligation is meaningless), it is also expensive and complicated surgery, with a higher risk factor than the original ligation. It isn't like flicking a light-switch.

My own life experience would suggest that the Drs are right. Even if most women in their 20s who are sure that they don't want children remain so decided, if a significant number do change their minds (especially those that don't get the surgery and get accidentally pregnant and find that they do want children after all), and if other (albeit less convenient and perfect methods) are available, it seems to be a poor choice to make. I recall many women my own age loudly declaring in their early 20s that there was no way they would ever have kids. Now we are in our 40s, and almost all of them have kids, which they adore. I don't think that my experience is particularly unusual.

And I suspect that if you have been sterilized, you are of course going to rationalize it and have no regrets, so I'm not sure what surveys really tell us.

But then, I am a commitmentphobe I suppose, I always like to keep a door open myself, having a dread of irreversible decisions (don't have any tattoos either). (That, and, full disclosure, I am personally committed to having children as pretty much being the only thing in life that makes sense. I don't want to force that on anyone else, but it makes me sad to see people permanently preclude it from their lives.)

There is such a wide gulf between the determinedly childless and those otherwise. And you can't really be neutral on the whole thing, nor paper it over, but you can be tolerant.

Me, I believe in the future. If you don't have children, you haven't invested in the future. When you die, the world ends. You may have an academic or ideological or spiritual interest in the future, but you don't have a personal investment in it. Parents do.

Human beings evolved as an extremely child-centered species. Most of our social organization and culture is determined by the massive and very long-term investment of resources and attention our children require, compared to other animals. If you opt out of that effort, to pursue your vacations in France and spacious loft apartments and chichi dining arrangements, you have essentially opted out of the species. OK you pay your taxes for the school board, good for you. But compared to breeders, for the future, you are essentially wastes of space. Nullities. Have fun with your pleasures, drink and be merry, you don't matter at all. The public has no long-term interest in you.

I won't blame, condemn, or in any way penalize you (though you do have to wonder who is going to staff your lux nursing home; well, brown fertile people, natch). But for me, unlike you, my personal stake in the world does not end when I die. I rolled the dice and made the effort and invested my soul and tears and money and hopes and dreams in the future in the most concrete way possible.

Yes, I do believe that there is a deep public interest in the welfare of families with children.

Not to say that being a parent doesn't suck: it is hard exhausting work, frequently disgusting, liable to vicarious blame, and you just can't do a good enough job for anybody. That is what it is like, building the future.

To the other side of the gulf, well, enjoy your ephemeral party.