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.)

I am the mother of a truly wonderful five year old. She is brilliant, beautiful and has a lot of personality. I adore her.

However...

I wish I had not had a child. I had been attempting to get my tubes tied since I was twenty. I got the "Oh, you'll change your mind" bit from every doctor I saw, and from my family. When I got pregnant, I was going to get an abortion...instead,I got sucked into one of these "abortion clinics" that show graphic videos of abortions and fetus body parts all gooey and bloody on a shiny aluminum tray. Suffering from depression and already hormonal from this pregnancy, I was horrified, and had the baby.

Don't get me wrong. I love my daughter. However, there is a part of me - and it's not a small part - that wishes that I had been able to get the tubal ligation procedure done. I am not a mother. I do my job as a mother: I love my daughter, I take care of her, read to her, and am putting myself in even more debt by enrolling her in a private school. As with any good parent, I want what is best for her. It is still against everything that I ever wanted for myself.

I never quite grew into the mother role as predicted by doctors, nurses and my family. I feel like a fraud. If I didn't think that there would be a deep emotional impact on my daughter, I would put her up for adoption. So now I have to deal with this for the rest of my life. I have a daughter I love, but I wish I didn't have (yes, it's possible).

I don't hold anything against the wack-jobs at the faux abortion clinic. I would not have been there in the first place if I had been allowed to make a decision affecting MY life.

ask any 25 year old, male or female, of any nationality, and of any ethnicity about anything and then ask them the same question five years later. The astounding lack of consistency

is proof that temporary forms of birth control are the only rational option for an ethical physician to offer. The physician's duty is to the well-being of the patient, and that includes NOT offering options that could cause extreme emotional damage subsequently in some predictable percentage of patients.

Yes, it is paternalistic. So are seat belt laws and so are drinking age laws. And look at what happens when underage people are allowed to make their own decisions about these two simple common sense laws.

Young people are stupid. All of us who have survived to adulthood can attest to at least one truly stupid thing we did that we wish someone had prevented us from pursuing. It isn't worth it for that thing to be your option to have children. It is too precious a gift to leave in the hands of people under thirty. Life can seem so utterly miserable when you are struggling to make it through your twenties that the burden of temporary birth control is very small indeed in exchange for the promise of future children.

And let the wailing an gnashing of teeth fall on my deaf and over thirty ears as I can still hear the echoes of my own desire for sterilization. But my little son has almost made me forget how stupid I was. I named my son after the doctor who denied me the sterilization. He believed in me when I was convinced that I would not and could not ever be a good mother.

But I am. He was right. And I am eternally grateful.