American charity pays British drug addicts to be sterilised

[HarrionGreyjoy]

I'm actually quite aware of the irreversibility rate (I don't enter into surgeries without as much research as I can manage), but my knowledge of exactly how often it happens dovetails with eion's much lengthier and more informed post.

The sperm bank idea's not a terrible one, though, just as a precaution. In my case and those of the addicts who have already had the operation it's kind of a ship that's sailed; I don't care, but they might, and it does definitely enter into the ethics equation.

[Serafina]

Sperm banks are expensive, the costs amounts to hundreds of € per year (tough that's arguably reduced with bulk) and several hundreds for the initial procedure. At least on the free market and here in Germany - but it's unlikely that this "charity" would be willing to pay for that.

Edit: Heck, i'll just post actual numbers. The sperm bank around here demands 250€ per freezing and 360€ per year for storage. Of course, that's with lot's of insurance and guarantees and bureaucracy and whatnot, but it's still unlikely that the cost would be reduced to a point where the charity would pay it.

[HarrionGreyjoy]

I freely admit my lack of knowledge on that front, Serafina. Thanks, I withdraw that idea.

Spurred by Broomstick's comments, I also google-fued up some familiar-looking data on the success rate of vasectomy reversals. As it happens, most everyone seems to use the same chart and study. I'm not proficient enough to format it properly in here, but the gist is that if it's done in three years or less, the success rate is 97% (awesome), while if you wait for more than fifteen it's more like 71% (rather less awesome).

http://urology.jhu.edu/infertility/vasectomy.php

It's worth noting that vasectomy reversal prices are not terribly cheap either, so that's definitely another point worth noting; this program doesn't really target people in upper socioeconomic strata. (I don't know enough about the British health care system to know how well it covers reversals.)

[Stark]

Has anyone being outraged actually met junkies with kids? I invite them to do so. When they come back they can tell us all about how it would be wrong to stop dirty drug addicts generating an underclass for us.

I'm glad we've got slippery slopes, though. Not only is this voluntary (inasmuch as any junkie ever makes a decision) but it's also related to a crime. Being a self-righteous fatass isn't illegal. Comparing it to people with legal addictions that they stop before pregnancy is fucking retarded; if a junkie quit before becoming pregnant, why the fuck would they be looking at this option at all? Drug addicts are pretty fucking stupid, but come on.

[PainRack]

Me. I knew a sabutex abuser who takes very good care of his daughter and wife..... apart from money issues due to his addiction to sabutex.

[Broomstick]

It's not a question of being worthy of reproduction, it's a question of them being so strung out they can't remember to use birth control. Perhaps an alternative program would be free IUDs (or some other maintenance free long term birth control) for women and reversible vasectomies for men.

If they're that strung out I question if they can legally/morally give informed consent to a surgical procedure.

Well clearly you wouldn't ask them if they wanted to be sterilized while they are still suffering from withdrawal. We can get people clean inside treatment centers, we've more or less cracked that, it's keeping them clean once they've left the centers that is the problem. You'd offer the choice inside, when they're clear headed.

Throw anyone in a padded room for a week they'll be drug-free... but are you sure they'll be clear-headed? There is more to withdrawal than just the physical craving.

Sadly the male reproductive system is proving more difficult to confuse than the female one. And while I know that not all vasectomies are reversible, I do believe it is the case that the testicles themselves continue to function normally and produce sperm normally, it is only that the vasa deferentia are severed and thus sperm cannot be ejaculated.

Exactly, the sperm aren't ejaculated but they can't spill into the abdominal cavity when the vas deferens are severed, and that's what leads to the auto-immune reaction. As years pass, the anti-bodies not only circulate in the blood, they can also get into the testicles. Sperm are then wiped out as fast as they are produced.

Of course, now that this is known surgeons can cauterize or block the cut ends of the vas deferens, but doctors don't always bother to do that, or do it correctly.

It may be a simple enough matter to extract a portion of sperm directly from the testicles of anyone whose vasectomy could not be reversed.

But that then requires IVF for conception and you're looking at thousands of dollars (or euros) to achieve conception, much less pregnancy.

Another solution would be to offer free sperm bank storage of the man's sperm to allow them to have children in the future

If non-addicts don't get free sperm storage I think giving it to addicts will be non-starter. Who is going to pay to freeze the sperm? The money has to come from somewhere.

or encourage them to adopt children.

Standards for adoptive parents are pretty high, I doubt "former drug addict" on your record will be a plus.

It is worth noting that the success rate for vasectomy reversal using vasovasostomy is somewhere around 95%.

Is that for simply reconnecting the plumbing, or for achieving actual fertility (i.e. pregnancy)? Because over half of all men who get a vasectomy wind up producing anti-sperm antibodies, and according to what I've read fertility is restored only 30-60% of the time at best.

My issue is not with the veracity of your experience, or with your relevant history of dealing with drug addiction and helping drug addicts. The issue is that the evidence you provided was not scientifically gathered, at least as I understood your statement. Now, if you were conducting a controlled study of the differing rates of success of those addicts who had outside support structures (family, children, etc.) vs. those that did not, that would be something I'd be very interested in hearing about. But if just in the normal course of your duties you observed that addicts with children seemed to do better than addicts without children that evidence carries far less weight.

The studies I'm familiar with were done over 15 years ago now, and pre-date everything being on the Internet. I no longer have easy access to back issues of journals, this does make providing evidence a challenge.

However, it has been long known that addicts better integrated into society are more likely to be successful at overcoming their addictions. So yes, having an intact family is an asset. However, it has to be looked at on a case-by-case basis because some families are more functional than others (if the whole family is addicted - which can happen - the asset turns into a liability for example). Because you're dealing with people the answers can't be reduced to a simple set of 3-4 rules. Also, you have to consider the best interests of all involved - which means for the children evaluating the parents' ability to parent as well as the problems and hazards of the local foster care system. Neither is an ideal environment, so you have to determine which, in a particular instance, will be better for the child.

Yes, it is VERY easy to give up unwanted children for adoption. And it's also often very difficult to place those children. Sure, the addict might overcome their addiction in the short term, for a year or two or five, or ten, but if it comes back it will do even more damage to the child's life, and if that child should be placed into foster care, well I'm sure you're as aware as I on the diminished chances of older minors being placed with new families.

Will you agree to permanently remove the children of people who drink alcohol or smoke cigarettes, then? Because unless you're willing to go that far it's not fair treatment.

My statement was not advocating the forcible removal of children from anyone's care based solely on their chemical dependencies. It was advocating the reduction in the number of unplanned and unwanted children being brought into environments that are far from ideal and more often than not cause lasting damage by providing the potential parents with choices.

Then why is this charity limiting this to ONLY addicts?

Especially in the UK, where, as I understand it, birth control is easily obtained from the national health service?

Again, you assume that the child of addict is automatically damaged by their parents' addiction. I am in favor of monitoring such parents, but not in summarily removing their children because, as you point out, there are some deep flaws in the foster care and adoption systems in many countries. Long term foster care can be as damaging, or worse, than leaving the children with their parents.

All the more reason that addicts should be presented with a variety of options to help reduce the strain on the foster care system and reduce the number of unplanned children brought into the world.

Of course, then there's the issue of planned pregnancy in an addict.... people don't stop wanting to have kids just because they're addicts, but maybe we should stick to the unplanned kids issues.

[Broomstick]

Has anyone being outraged actually met junkies with kids?

Yep, I have. Some were absolute shit parents - I even helped write a few letters to judges saying basically "For the love of God take this woman's kids away before she maims or kills them". I've also written letters to judges saying don't put these kids in foster care, they're better off where they are.

I invite them to do so. When they come back they can tell us all about how it would be wrong to stop dirty drug addicts generating an underclass for us.

Way to stereotype, Stark - got news for you, some drug addicts maintain the facade of being upper class success stories. As I said before, they aren't all sleeping in the gutter.

Comparing it to people with legal addictions that they stop before pregnancy is fucking retarded; if a junkie quit before becoming pregnant, why the fuck would they be looking at this option at all?

Legal addictions can be just as damaging, if not more so, than illegal ones. Pure heroin, for example, is far less toxic to a fetus than alcohol is. Alcoholic mothers aren't breaking the law, but they're far more likely to fuck up their kids physically and mentally during pregnancy, see "fetal alcohol syndrome".

And no, junkies don't quit before becoming pregnant. SOME of them quit when they know they are pregnant and usually relapse after the delivery.

Drug addicts are pretty fucking stupid, but come on.

Actually, drug addicts reflect the intelligence level of the population as a whole. Intelligence is no protection against drug addiction. Getting high or deep into withdrawal does fuck up your ability to make good decisions. That's still no excuse to manipulate vulnerable people into making decisions about surgery with permanent consequences.

[Rye]

Why the fuck would rich, successful addicts get their tubes tied for 200 quid if they want kids?

Getting high or deep into withdrawal does fuck up your ability to make good decisions. That's still no excuse to manipulate vulnerable people into making decisions about surgery with permanent consequences.

Clearly, having babies under such conditions is not better than "manipulating" someone into sterilisation. A better existence (or absence of existence in the case of the kids who would be conceived otherwise) for everyone involved looks like a pretty good excuse to me.

[eion]

Throw anyone in a padded room for a week they'll be drug-free... but are you sure they'll be clear-headed? There is more to withdrawal than just the physical craving.

If they're not fully cognizant after the standard 28 days then they shouldn't be released anyway.

Exactly, the sperm aren't ejaculated but they can't spill into the abdominal cavity when the vas deferens are severed, and that's what leads to the auto-immune reaction. As years pass, the anti-bodies not only circulate in the blood, they can also get into the testicles. Sperm are then wiped out as fast as they are produced.

Of course, now that this is known surgeons can cauterize or block the cut ends of the vas deferens, but doctors don't always bother to do that, or do it correctly.

Hmm. I wonder how tricky it would be to install a valve that could be actuated by a magnet to the vas deferens. Closed, instant vasectomy. Go to the doctor's office and have a magnetic wand waved over your balls and voila the sperm are flowing again.

But that then requires IVF for conception and you're looking at thousands of dollars (or euros) to achieve conception, much less pregnancy.

A turkey baster wouldn't suffice? We're assuming no other fertility issues with the woman.

If non-addicts don't get free sperm storage I think giving it to addicts will be non-starter. Who is going to pay to freeze the sperm? The money has to come from somewhere.

scratch the sperm bank idea.

Standards for adoptive parents are pretty high, I doubt "former drug addict" on your record will be a plus.

Former drug addict with 15 years of sobriety (backed by random voluntary drug screenings), with letters of recommendation from your doctors, social workers, sponsor, etc. might make a difference.

It is worth noting that the success rate for vasectomy reversal using vasovasostomy is somewhere around 95%.

Is that for simply reconnecting the plumbing, or for achieving actual fertility (i.e. pregnancy)? Because over half of all men who get a vasectomy wind up producing anti-sperm antibodies, and according to what I've read fertility is restored only 30-60% of the time at best.

The number quoted was the patency rate, the rate or return of motile sperm in the ejaculate, for men who have a vasovasostomy, and I believe it was for those reversals performed between 0 - 8 after the original surgery. The page HarrionGreyjoy linked to is fairly comprehensive, so I'll steal it.

According to Johns Hopkins the pregnancy rate for reversed vasectomies after less than 3 years is 75%, and after 8 years it is 50%, not bad odds considering. If the tradeoff for you getting clean and being able to function as an adult is that you won't be able to have children naturally (that is without IVF or adoption), I'd say that's a fairly simple decision, and that's before we even consider the potential pain and suffering you've prevented by not having children you wouldn't be able to care for.

My statement was not advocating the forcible removal of children from anyone's care based solely on their chemical dependencies. It was advocating the reduction in the number of unplanned and unwanted children being brought into environments that are far from ideal and more often than not cause lasting damage by providing the potential parents with choices.

Then why is this charity limiting this to ONLY addicts?

Charities often choose emotional touchstones to focus on, especially those charities run by individuals. It's the same reason a group like Locks of Love just does wigs for children, that's their focus.

Especially in the UK, where, as I understand it, birth control is easily obtained from the national health service?

Except the UK is well known for having the highest teen pregnancy rate in Europe. Obviously people aren't making use of those freely available birth control methods. Just because there's fruit on the table doesn't mean people won't go to the cookie jar instead.

All the more reason that addicts should be presented with a variety of options to help reduce the strain on the foster care system and reduce the number of unplanned children brought into the world.

Of course, then there's the issue of planned pregnancy in an addict.... people don't stop wanting to have kids just because they're addicts, but maybe we should stick to the unplanned kids issues.

Indeed. There's always going to a minority of addicts who just want to pump out baby after baby, and aren't easily swayed from that course. Better to focus on the people who would avoid pregnancy if they could.

I have a friend who got his girlfriend (who was not on any birth control) pregnant because he didn't use a condom; the pregnancy was unplanned. That staggered me. It had a similar effect on me as if one of my friends had told me they'd had sex with someone who was self-admitted HIV+ without a condom. I know that statement might offend, but I urge you to think about it carefully for a moment. Both involve a poor short term decision leading to a potentially irreversible long term consequence.

Young people and drug addicts aren't good at long term planning. Anything that can be done to improve their long term choices ought to improve their lives.

[Broomstick]

Getting high or deep into withdrawal does fuck up your ability to make good decisions. That's still no excuse to manipulate vulnerable people into making decisions about surgery with permanent consequences.

Clearly, having babies under such conditions is not better than "manipulating" someone into sterilisation. A better existence (or absence of existence in the case of the kids who would be conceived otherwise) for everyone involved looks like a pretty good excuse to me.

Clearly, you skipped over where I said I was entirely in favor of long-term birth control being made available to these people. Or do you not understand the difference between and IUD and surgery?

[Broomstick]

Throw anyone in a padded room for a week they'll be drug-free... but are you sure they'll be clear-headed? There is more to withdrawal than just the physical craving.

If they're not fully cognizant after the standard 28 days then they shouldn't be released anyway.

Except in the US (I don't know about elsewhere) there is no mechanism that would allow for permanent institutionalization of someone without a lengthy and expensive court proceeding. Our society routinely releases out to the street not just drug addicts but the mentally ill who are incompetent ot fend for themselves.

But that then requires IVF for conception and you're looking at thousands of dollars (or euros) to achieve conception, much less pregnancy.

A turkey baster wouldn't suffice? We're assuming no other fertility issues with the woman.

A turkey baster works when you have normal ejaculate containing millions of sperm. Needle aspiration recovers only a small fraction of that number, which lack the bathing layer of fluid generated by the prostate the protects and helps the sperm, and many of the sperm recovered are immature. Thus, someone has to pick through them and find mature ones. You don't get that many, so few in fact that conception is unlikely and, since you don't want to repeatedly puncture a man's testes, IVF becomes the most expediate way to conception. When you are going the IVF route you then have to use hormones to first cause the woman's system to puke up a lot of eggs, then get the cycle synched up with the sperm retrieval. It's routine, but not trivial.

Standards for adoptive parents are pretty high, I doubt "former drug addict" on your record will be a plus.

Former drug addict with 15 years of sobriety (backed by random voluntary drug screenings), with letters of recommendation from your doctors, social workers, sponsor, etc. might make a difference.

Except many agencies also put an upper limit of 30 or 35 on adoptive parents - which pretty much leaves your drug addict screwed unless he had achieved sobriety at 15 and maintained it all those years. Nope, pretty much once it's on your record you've been a druggie you won't be allowed to adopt in the US. There are probably exceptions, but few and far between.

Young people and drug addicts aren't good at long term planning. Anything that can be done to improve their long term choices ought to improve their lives.

Yes, but surgical sterilization doesn't increase their choices long term, it reduces them.

[Stark]

Me. I knew a sabutex abuser who takes very good care of his daughter and wife..... apart from money issues due to his addiction to sabutex.

Junkies, dude. We're talking sleeps-under-a-bus-stop, steals-from-grandmother, knee-deep-in-filth junkie living in a community of petty crime and violence. Not some regular joe who uses drugs; why the fuck would a person like that use this charity at all?