Ministry says may examine need for husbands’ consent in women’s sterilisation

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Source: The Malay Mail Online

KUALA LUMPUR, Dec 17 ― The Women, Family and Community Development Ministry could look into the practice of requiring women to obtain their husbands’ consent for certain reproductive procedures if more women express disagreement.

Datuk Seri Rohani Karim today conceded that she was not familiar with the issue, but said that needing wives to produce their husbands’ consent for tubal ligation procedures was the “norm.”

The same requirement is not imposed on men obtaining vasectomies.

“The natural process is that there is discussion because this means they don’t want kids anymore.

“Because I’m not very aware but all along it’s not being brought up… But maybe we’ll look into it if the women want us to look into it,” she said during a press conference at the Putra World Trade Centre today.

Rohani did not clarify, however, if the ministry was for or against the practice.

Malay Mail Online reported earlier today that married women were made to obtain their husbands’ consent for sterilisation procedures, but not vice versa.

Health Ministry director-general Director-General Datuk Dr Noor Hisham Abdullah explained that consent from their spouse is “necessary” if women were “dependent” on their husbands.

Reproductive rights: Married women have less say than their husbands

Husbands appear to be given more rights when it comes to womens’ reproductive health decisions. ― Pictures by Choo Choy May

Husbands appear to be given more rights when it comes to womens’ reproductive health decisions. ― Pictures by Choo Choy May

KUALA LUMPUR, Dec 17 ― Did you know that in Malaysia a woman needs her husband’s approval if she chooses to undergo a procedure to prevent pregnancy?

This special consent form is for a surgical procedure called bilateral tubal ligation (BTL) which involves blocking the Fallopian tubes to prevent the ovum or egg from being fertilised.

By contrast, if a married man wishes to have a vasectomy, a procedure which prevents the release of sperm when a man ejaculates, he does not need his wife’s consent.

Both these surgeries are considered permanent forms of birth control, although in some cases they can be reversed successfully.

So why the double standards?

“The form is more of a practice and it is used to preserve marital harmony,” a gynaecologist at a government hospital said, referring to a special consent form specifically for the BTL procedure which requires the patient’s and the husband’s signatures.

When asked why the wife’s consent is not needed for a vasectomy, he said “by right there should be” and then shrugged.

He admitted, however, that legally all medical procedures only need the patient’s consent if he or she is of sound mind.

“So if the husband disagrees to the procedure but the wife is adamant, the doctor will not be penalised if the case was brought to court,” he said.

A medical officer at a government clinic called the situation a “grey zone” as Malaysia is a “Muslim country” so a lot of rules are based on that.

He said BTL requires husband’s approval but if he’s not around to sign it, verbal approval can be accepted.

“I’ve known surgeons who refuse BTL if the patient is young and of ‘child-bearing age.’

“They say, ‘muda lagi, baru dua anak‘,” he said, which means they are still young, with only two children.

The medical officer also said two months ago, he referred a woman to get BTL as she said she didn’t want any more children.

“She came back saying they refused to do it… she wasn’t too sure why.

“I’m guessing because she was in her early 30s and only had two or three kids,” he said, adding that she was not educated.

And there lies the heart of the matter. An uneducated woman who does not know her rights may be pressured into accepting her doctor’s personal opinion. It does not matter if she does not wish to have any more children.

If, however, a woman knows her rights she can insist on having the procedure. After all, it is her body.

And what about single women who wish to have the procedure? Although it is rare for single women to ask for BTL, medical officers told Malay Mail Online that it is generally allowed.

In the private sector, however, Malaysian Medical Association (MMA) president Dr Ashok Philip said most doctors in private practice do require both partners to consent to such an operation, whether vasectomy or tubal ligation, to avoid “future problems.”

“If both partners are not in accord, perhaps the relationship needs work, and you should avoid a potentially irreversible step. After all, there are many other methods of contraception,” he said.

Dr Ashok also said that he was not aware of any regulations in government hospitals that apply only to women but not men.

“Perhaps individual consultants may have different requirements, but I do not think it is government policy,” he said.

A source working at a private hospital in Perak, however contested his claims that both parties’ consent were needed. She said a surgeon from the hospital confirmed that married women need their husband’s consent for BTL but husbands do not need their wife’s consent for vasectomy.

As for doctors who refuse to do BTL, Dr Ashok said he did not think doctors should impose their own views on patients.

“As I said before, a mentally competent patient should be allowed to make his or her own choice. Even if some doctors refuse to perform BTLs, there are many others who will,” he said.

Patients ‘dependent’ on spouse require his/her approval in reproductive health decisions, ministry says

Forms such as these are used as a ‘practice’ to ‘preserve marriage harmony’ at hospitals in Malaysia.

Forms such as these are used as a ‘practice’ to ‘preserve marriage harmony’ at hospitals in Malaysia.

KUALA LUMPUR, Dec 17 ― Spousal consent is “necessary” for medical treatments where the patient is “dependent” on his or her spouse, the Health Ministry said.

Director-General Datuk Dr Noor Hisham Abdullah said although legally, only the consent of a patient who is of sound mind is necessary, there are “grey areas” where a patient is agreeable to medical procedures or surgery, but the spouse is not.

“This situation where spousal consent may be considered necessary needs to be explored further whether it is limited to conditions involving reproduction or to elective procedures, which may have impact on the quality of marital status,” he told Malay Mail Online via email.

He claimed that spousal consent “seemed to be necessary” before conducting medical and surgical treatment where a patient is dependent on her or his spouse.

He cited a High Court decision, which ruled that the doctors were negligent in their care for failing to inform both the patient and her husband, who is the plaintiff, of the risks involved in the surgical procedure.

According to the details of the Abdul Razak Datuk Abu Samah v Raja Badrul Hisham Raja Zezeman Shah & Ors (2012) case published on Cljlaw.com, the doctors had a verbal consent from the husband to proceed with the surgery. She, however, died the next day.

Despite citing the Malaysian Medical Council (MMC) Guidelines on Consent For Treatment Of Patients By Registered Medical Practitioners, which states that “any discussion between the spouses in this respect does not and should not deny the rights of the patient concerned in making the final decision and giving consent”, Noor Hisham said the patient should inform the doctor if she is dependent on her husband and feels that his consent is necessary.

In principle, he said consent for medical or surgical procedure is legally required from only the individual patient. But, he added that a discussion is needed between the couples before making a decision for any surgeries, which includes “mastectomy, tubes ligation or vasectomy” to be performed.

“The view of the spouse needs to be considered after detailed explanation has been given.

“However, based on the previous judicial decisions, spousal consent appears to be an important issue, which cannot be taken lightly, especially when the situation demands for such requirement and depends on the case involved,” he said.

Malay Mail Online understands that a special consent form is given to patients for the BTL procedure requiring the signature from the patient, her husband, and a witness.

By contrast, a regular consent form requiring only the patient, parent or guardian, is needed for a vasectomy.

The BTL consent form seems to be only for married women as medical practitioners say single women would not be denied the procedure.