Case history

A 26 year old woman presented to a general gynaecology clinic requestingsterilisation. She worked as the manager of a large legal practice in central London. She had never been pregnant. She was in a relationship that had lasted five years and was using condoms for contraception. At the age of 17she had discovered that she had a serious congenital heart defect. Neither she nor her partner had any desire to have children, and they had spoken about this at some length.

The reasons she gave for requesting sterilisation were that she did not have faith in other forms of contraception; had no desire to have children;did not wish to change her lifestyle or threaten her financial status (she saw children as a financial burden); felt that children would prohibit manyimportant life choices, including the opportunity to travel; thought the world was already burdened with enough people; and had serious anxieties about the risk of medical complications during a pregnancy as her cardiologist had told her that pregnancy would be risky.

The gynaecologist suggested alternative and reversible methods of contraception, including the intrauterine progestogen system. He also asked whether her partner would consider vasectomy. He explained the risks of laparoscopic sterilisation, which include a small risk of death and a risk of about1 in 300 of requiring an emergency laparotomy to repair damage done to internal organs. The patient declined the intrauterine system and refused to ask her partner to have a vasectomy as he was only 25. She explained that, should she die prematurely, he might meet a new partner who wanted to have children.

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The doctor reassured her that many of …