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According to the following statistics source from the Centers for Disease Control, the "Mississippi Appendectomy" (aka hysterectomy) is alive and well in the south:
Status by State, Race/Ethnicity, and Age, 1996-2000. Behavioral Risk Factor
Surveillance System, 2000. Survey data, National Center for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
U.S. Department of Health and Human Services.
57.1% of women ages 65 and older in Mississippi report having undergone a hysterectomy.
1 out of every 3 women over the age of 18 in Mississippi no longer have a uterus.
As a nation, 45.1% of women ages 65 and older in the United States report having undergone a hysterectomy.
As a nation, 21.4% of women ages 18 and older in the United States report having undergone a hysterectomy.
As a nation, WE HAVE ONE HELLUVA PROBLEM GOING ON HERE!
The state with the LOWEST hysterectomy statistics in the nation? New York. The ONLY state with a comprehensive INFORMED CONSENT law on the books which REQUIRES the Department of Health to publish a booklet on hysterectomy containing information about all treatment options. This booklet is mandated for distribution to every woman given the hysterectomy recommendation in the state of New York.
Many, many states in the United States do not have adequate Informed Consent laws when it comes to the performance of a hysterectomy. Some are simply outdated and yet others are nonexistent. It's appalling to me how many women undergo hysterectomy without adequate information on what, exactly, is going to occur during surgery. What is going to be removed? If the doctor is unsure, what are the guidelines that will be followed in removing the uterus or ovaries? Additionally appalling are the number of women who never have a discussion with their doctor about the aftereffects of the surgery. What are the potential outcomes? What could, possibly, go wrong?
And let's not forget to mention that frequently forgotten issue of hormone replacement therapy. Whether the ovaries are being removed or not, the potential for ovarian failure post-hysterectomy is 50% within 5 years. It seems to me that a discussion regarding the potential need for hormone replacement therapy should be right up front in any discussion of hysterectomy and outcome. But oftentimes it's never mentioned until the woman begins asking questions post-hysterectomy due to problems she is experiencing.
First and foremost, before you ever get to the hysterectomy, did your doctor tell you anything at all about the other treatment choices available for uterine fibroids?
Not a single physician recommending hysterectomy in my 14 years of refusing surgery and allowing the fibroids to continue to grow ever discussed ANY of the issues listed above. Even when I attempted to discuss myomectomy with several different doctors it was immediately dismissed as not an option for me. And, no other options were ever even presented or discussed. In addition, surgical outcomes and hormone replacement therapy was never mentioned. Post-procedure side-effects were not issues up for discussion as, of course, those things wouldn't happen to me.
How do doctors get away with this?
Through inaction, we give them permission to continue to:
- make limited recommendations (i.e., hysterectomy-only option)
- perform potentially unnecessary procedures, and
- retain control over the future health of our bodies.
Ultimately, WE are the bearers of the consequences of our inaction and ignorance of medical procedures. WE are the ones who must live with the surgical outcome.
Do you live in a state with inadequate Informed Consent laws? Wouldn't you prefer to be assured that when you visit your gynecologist and are given the hysterectomy-indicated song and dance for your fibroids that the physician would be obligated to inform you of 1) other treatment options 2) potential surgical outcomes and 3) potential need for hormone replacement therapy? If so, learn more about the Informed Consent laws in YOUR state and get involved in changing the laws to more positively reflect the needs of the women in your community.
If you're a bit unsure of what Informed Consent law is all about, start by reading a little bit about the background of Informed Consent Law by going to the Law and Physician web pages. Written for physicians to help them gain an understanding of how to better protect themselves against lawsuits, it is truly valuable information that may give you insight as to how doctors are protecting themselves. What I want to know is how are we, as patients, protecting ourselves?
To develop a stronger understanding of the driving principles behind the need for informed consent, begin by learning about the historical foundation of gynecology in this nation by reading about J. Marion Sims, the "Father of Gynecology" and his captive slave-patient, Anarcha -- a black woman who underwent over 30 surgical procedures without benefit of anesthesia in order to advance the "research" on gynecological surgery. The initial abuses of gynecological medicine forced upon enslaved women who knew nothing of the concept of "informed consent" are astounding facts that are difficult to digest -- but critical to a basic understanding of the need for informed consent laws.
Next, read Ethics of Informed Consent and then move on to Cutting the Legal Risks of Hysterectomy. After that, check out Diary of a Third Year Medical Student (pay special attention to the chapter entitled OBSTETRICS AND GYNECOLOGY:Miscarriage of Justice) by Dr. Michael Greger and learn a bit more about how easy it is for women to have their "consent" compromised even today. Surprisingly, we truly have not come very far (since the days of J. Marion Sims and Anarcha) in terms of garnering control over the right to informed consent.
Finally, get involved in your own state's legislation of informed consent and help us to change this travesty in medicine.
HEALTH AND SAFETY CODE
Sample informed consent document that meets the requirements of this statute (but certainly doesn't do what the authors of the statute intended it to do!):
|District of Columbia|
|Florida||The Patients' Right
to Know Bill
|Association for Responsible Medicine|
|Illinois||Draft of proposed
|Dr. Eileen Marie
1302 7th Street
Moline, IL 61265
|New York||New York State
Public Health Law
New York Department of Health
|Oregon||1997 Oregon Revised
Statutes Chapter 436
STERILIZATION PUBLIC HEALTH AND SAFETY
Oregon's limited interpretation of obtaining informed consent in regard to "sterilization."
(4) "Sterilization" means any medical procedure, treatment or operation for the purpose of rendering an individual permanently incapable of procreating.
Court case in Pennsyvlania regarding hysterectomy and informed consent:
Vernon's Civil Statutes
Chapter 21 Medical
Liability and Insurance Improvement
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This page last updated Wednesday, April 10, 2002