Sample Forms

Sterilization Consent Form

March 1, 2019

What is sterilization???

Sterilization is a process in which a person, either male or female, is unable to reproduce. It is a method of contraception and one of the most effective ways of birth control. Sterilization does have an old history, but the latest evolution in science and medical studies has provided more knowledge of its implementations and methods.

Types of sterilization

Sterilization is done both in men and women, and there are different methods of sterilization. We will mainly discuss the surgical methods because that is when informed consent carries the utmost importance.

Sterilization Consent Form

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Male sterilization

Male sterilization is done by vasectomy. The Vas deferens is a structure in males that connects the testicles to the prostate and is the reason for the mechanical transport of sperm. This connection is cut and ligated, and a male becomes infertile for life.

Female sterilization

Female sterilization is done either by bi-tubal ligation or by hysterectomy, depending on the situation and case background.

  1. The most common method of female sterilization is tubal ligation, in which both the fallopian tubes are cut and ligated, and thus the passage of the egg is blocked forever. The success rate of tubal ligation is very high, at 99%. There are certain prerequisites for tubal ligation that must be fulfilled before performing any procedure.
  2. The second method of female sterilization is hysterectomy. In a hysterectomy, the entire uterus of the female is removed. The uterus is the site where an embryo implants and nourishes itself, and a womb is formed. Hysterectomy is often done in older females and is now restricted to only cases of uterine fibroids or fatal and cancerous uterine conditions. The contraceptive purpose of hysterectomy is not recommended nowadays.

Pre-requisites of sterilization

  1. The family of the couple must be complete
  2. Both partners must agree on the decision
  3. For whoever is undergoing the sterilization procedure, fully informed consent is necessary.

Consent for sterilization

Consent for sterilization is very important because it has many implications on social, psychological, and social grounds.

Who can consent to sterilization??

The person who is undergoing the procedure has to consent to it, and no one else can legally sign the consent form other than the patient himself.

However, in Asian countries, especially the central Asian countries, it is common practice that the consent of the husband is given prime importance. Without the signatures of the husband and consent written in the husband’s handwriting, the procedure is never performed.

What should I write in the sterilization consent form?

The patient writes his complete name, his date of birth, and the date when consent is being signed, and he has to mention that he was fully informed about his condition and that he fully understands the procedure and outcomes, especially the fact that this procedure cannot be reversed no matter what.

The patient has to carefully read the form and then sign it in the presence of the doctor and witnesses from both sides.

Similarly, a doctor also signs the consent form, and, in the end, witnesses from both sides have to sign the consent form.

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