One of the most complicated ethical issues that arises in children’s hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.
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June 2017
Ethics Round|
June 01 2017
Ethical Controversy About Hysterectomy for a Minor
Alyssa M. Burgart, MD;
Alyssa M. Burgart, MD
aDepartment of Anesthesia, Perioperative, and Pain Medicine,
bStanford Center for Biomedical Ethics, Stanford University, Palo Alto, California;
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Julie Strickland, MD;
Julie Strickland, MD
cDepartments of Pediatric and Adolescent Gynecology and
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Dena Davis, JD;
Dena Davis, JD
dDepartment of Religious Studies and
eProgram in Health, Medicine, and Society, Lehigh University, Bethlehem, Pennsylvania; and
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Arlene B. Baratz, MD;
Arlene B. Baratz, MD
fAndrogen Insensitivity Syndrome-Differences of Sex Development Support Group, Pittsburgh, Pennsylvania
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Katrina Karkazis, PhD;
Katrina Karkazis, PhD
bStanford Center for Biomedical Ethics, Stanford University, Palo Alto, California;
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John D. Lantos, MD
gPediatrics, Children’s Mercy Hospital, Kansas City, Missouri;
Address correspondence to John D. Lantos, MD, Department of Pediatrics, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos@cmh.edu
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Address correspondence to John D. Lantos, MD, Department of Pediatrics, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos@cmh.edu
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2017) 139 (6): e20163992.
Article history
Accepted:
December 05 2016
Citation
Alyssa M. Burgart, Julie Strickland, Dena Davis, Arlene B. Baratz, Katrina Karkazis, John D. Lantos; Ethical Controversy About Hysterectomy for a Minor. Pediatrics June 2017; 139 (6): e20163992. 10.1542/peds.2016-3992
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