What Pap Testing Should Look Like in 2013

We know what pap testing looked like in the 50′s because on the surface not much has changed.  Even though it has been 60 plus years since the introduction of pap tests to screen for cervical cancer, the stirrups are the same, the speculum is the same, and there is the same direction to “scoot down, just a bit more, now let your knees fall apart . . .  that a girl”.  But anyone who has been following this subject probably knows that a great deal has changed in regards to pap tests, even though these changes are not showing up in the doctor’s office.  Given scientific advancements, new technology, clarification of legal and ethical issues, research and information sharing; here is what pap testing should look like today when a woman visits a doctor:

Doctor: Hi Sarah. What brings you in today?

Patient: I think I sprained my ankle when I was running, it’s kind of swollen and hurts when I’m walking . . .

Doctor: Well let’s take a look (doctor examines ankle and asks questions about pain, etc.)

Patient: What do you think?

Doctor: It should be supported and monitored (doctor wraps ankle and gives instructions for monitoring and care to patient).  If it isn’t improving come back and see me.  Are you having any other issues?

Patient: No, thanks . . . aren’t you going to ask me when my last pap test was?

Doctor:  No, cervical cancer in young women is very rare and the pap test has poor specificity . . . research has found that it often leads to further testing that can cause damage to your cervix.  The damage can then cause difficulties with pregnancy and giving birth, or can lead to further surgery.  If you like, in a few years when you turn 30, you can provide a urine sample to test for HPV.  If you test positive, and only about five percent of women test positive, then we could do a pap test.

Patient: Okay, thank you.

Doctor: You’re welcome.  Take care of that ankle now . . . and come see me if it isn’t improving.

Patient: I will, thanks again!  (Sarah leaves . . . happy, dignity intact . . . and feeling cared for)

images.jpghpy

References:

A comparison of pap testing in the Netherlands (begins at age 30) with the United States: http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0009.2011.00652.x/full

Balancing benefits and risks:  http://online.liebertpub.com/doi/pdfplus/10.1089/jwh.2010.2349

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746633/

http://www.medhelp.org/posts/Womens-Health/cervical-stenosis–cervix-scarred-shut/show/479102

http://www.ncbi.nlm.nih.gov/pubmed/8861048

Why doctor does not have pap smears: http://margaretmccartney.com/2012/03/20/why-i-dont-have-smears/

Common misconceptions: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2978229-5/fulltext

Should we abandon pap testing: http://ajcp.ascpjournals.org/content/supplements/114/Suppl_1/S48.full.pdf

http://www.theguardian.com/society/2003/may/22/genderissues.publichealth

Urine test for HPV: http://www.trovagene.com/Products-Services/Clinical-Testing-Services/HPV.aspx

http://finance.yahoo.com/news/trovagene-launches-urine-based-hpv-090000600.html

HPV testing for cervical cancer: http://www.telegraph.co.uk/health/healthnews/10118303/New-screening-test-cuts-cervical-cancer-cases-by-one-third.html

http://www.cancerresearchuk.org/cancer-info/news/archive/pressrelease/2013-06-14-HPV-testing-could-cut-cervical-cancers-by-third

About forwomenseyesonly

Hi. My name is Sue and I am interested in promoting holistic and respectful health care.
Gallery | This entry was posted in cervical cancer, health, pap test, pap test 2013, pelvic exam, unnecessary pap test, unnecessary pelvic exam and tagged , , , , , . Bookmark the permalink.

38 Responses to What Pap Testing Should Look Like in 2013

  1. cindy knoke says:

    Yuck. It is so obvious insensitive male physicians devised the whole annual exam nightmare. The question is why, now, aren’t there more sensitive physicians period? (Sorry for the term! :( Bravo to you for giving voice to the patients perspective.

  2. OverItAll says:

    I wish this could be true. I can’t even get through my 10mo’s appt without being asked this by HIS dr (not even my doctor and he doesn’t even have my record!)…a male gp. One can only dream of the day when women are treated as human beings who are capable of making informed decisions without being threatened/coerced into a decision someone else thinks is “appropriate/correct”. -OIA

    • OIA, have you seen the great post on Yazzmyne’s site by Somethingisamiss? It ends with the following: “Women’s Wellness will be changing. Women can accelerate this change by educating themselves and not allowing tough questions to go unanswered. The only real question left at this point is whether women will let ACOG’s old guard slither off unmolested or raise hell.”
      http://womenagainststirrups.proboards.com/index.cgi?action=recent
      Speaking of posts, did you get a chance to see my previous comment asking if it would be okay with you to publish one of your comments from the old Blogcritic’s comments? You went to a lot of work, wrote pages full of many many wonderful links.

      • OverItAll says:

        Feel free to publish whatever. I haven’t had much extra time lately, the baby’s been keeping me pretty busy! I’ll definitely take a look at that link tonight. :)

  3. Kleigh says:

    Overitall, that is none of his bussnes when you last pap was. I wonder if he asks the dads that take there kids there medical questions. If you do not mind me asking what do you tell him when he asks that.

    • Alex says:

      Why would the kid’s doctor be asking the parent any questions about their own practices? Oh, I guess it would be some kind of “connect the dots” bullsh*#. Maybe he just figured it was a vicarious target of opportunity (he wouldn’t be doing anything, but it would still occur).

    • OverItAll says:

      I just tell him “my midwife takes care of me and does the tests we deem necessary, like my gfr’s”. If he pushes for more, I just tell him he’s not my doctor and has no right to know about my health other than what’s necessary for my kid’s health (like whether I’ve been ill or if I’m having signs of ppd)

  4. Kleigh says:

    Somthing I notice alot of doctors think of children as an extention of the mother. I wonder if they think the moms pap smear is linked to the childs health after birth. It seems like a privacy issue also. Meadical people like the Acog probly know that mothers take there kids to the doctors so they see that as an opertunity to push womans health as well. Lately it seems like the Acog is really starting to invade womans lifes from pushing none pregnant woman to be treated as pre pregnant to domestic violance screening every time a woman sees a doctor. they are so intrusive and dont have any boundries it seems.

    • Alice says:

      There could be two reasons behind this:
      1. Doctors know that a woman who has recently had a child is more likely to produce an abnormal pap smear, which means the beginning of a money-making merry-go-round: colposcopy, biopsy, “treatments”, more pap tests, more colposcopies…
      2. Doctors think that the popular fear-mongering strategy “do a pap or you’ll leave your child motherless” will finally work.

  5. Tanya says:

    I am either seeing progress where I live (slow, but progress nonetheless), or I just didn’t notice it before. No, you know what? I’m pretty sure it’s progress. I commented a lot on one of your older posts. The one about women finding workarounds for birth control pills without a pap test.

    So, I had gotten them from my psychiatrist last time, if anyone remembers. It was an, “Oh by the way, could you please give me a prescription for birth control, too?” I don’t want to ask him again because I am pretty sure he’ll think something’s up. But, I’m on my last pack at the moment. I had to go to the doctor today anyway for another prescription, so I asked for bcp while I was there. The nurse asked me when my last pap was, and I said I didn’t know (it was about 3 years ago; maybe a little more). She told me I should get a pap. I asked her if that’s something they have to say, and whether it’s ultimately my decision. She said at the end of the day, it’s my decision, and they won’t withhold bcp over it.

    So then the doctor comes in, same lecture, but says the same thing. The catch is that I can only get three months’ worth at a time, and it sounds like I will be told I should get one every time. But I don’t think they’re going to force me or hold my pills hostage over it. Hopefully next time goes similarly. I can handle a lecture.

    • Alex says:

      Good, although they shouldn’t be making attempts to back you into these things. They shouldn’t be perveying things that are untrue or unsafe, anyway. But it is good to hear that you’ll be able to get it from them (be careful: they might change their behavior when they see that their nagging hasn’t worked- I’d still suggest bringing someone with you, in case theydecide to try a direct approach). People sometimes think that things won’t go combatively on a physical level with them, but it happens- take when they don’t want to stop when someone else says so. Sometimes the left-field tactics work more effectively (might be considered less credible, as well).

      • Kleigh says:

        They sould not even bring pap smears up when you go for birth control. they made it seem like paps were tied to birth control just by them asking about your pap date when you asked for birth control. they did say say it was up to you but only after you questioned. so they mislead woman that paps are tied to birth control. But I am glad that you were able to get bc with out being forced to have a pap smear done on your body that you did not want or agree too.

      • Tanya says:

        Alex, I’m often not quite sure I understand what you mean. What do you mean by “combatively on a physical level?” I don’t see my doctor trying something like that, but I’m pretty sure I’m bigger than him. I can take him!

      • Alex says:

        Well, I remember some stories about them threating & intimidating women like they would in a parking garage. No nuace or subtlety, just more directly aggressive things.

        Sometimes they’ll decide not to stop when someone says to, that’s an example of physical confrontation that maybe points out the possiblity of more direct approaches of imposing something. Horror stories abound on that subject (and it doesn’t seem like mothers tell their daughters about something getting out of hand like that).

  6. Kleigh says:

    I think well woman exams need to be unlinked to birth control.

  7. Elizabeth (Aust) says:

    The fastest way for that to happen is for more women to challenge doctors and refuse the test/exams. There is already a strong wave of support in the States to take the Pill off script, no doubt fueled by the fact about half of all pregnancies are unplanned, hardly surprising when you consider the barriers around the Pill.
    I was just reading that Tanya can now get the Pill from her doctor and decline the excess, albeit with a lecture. The writing is on the wall…and doctors know it.

    • Tanya says:

      I really think it might be! Like I said, this experience I had today was different than I have ever had before. Also, this doctor used to say you needed a pap every year, but now he’s saying every two years. Of course I would never go more than every 3 years, but even his recommendations are changing. And seriously, at a different doctor’s office in the past, that other doctor wanted to confirm that I had had my pap test when I said I did, before he would prescribe birth control to me. This is the first time I’ve ever had them say that no, actually, the decision is ultimately mine.

  8. Elizabeth (Aust) says:

    Talking about doing what’s best for women..look at this:
    “After our discussion, Michelle said, “Jordan, I know you have my best interests at heart. Let’s follow the guidelines.” We did her exam but left out the Pap test, since she had a normal one last year”
    http://www.sfgate.com/health/article/Annual-Pap-smears-no-longer-recommended-4747385.php

    So her trusted doctor tells her it’s now safe to move away from annual testing. It’s been known for decades that annual screening is of no additional benefit over 5 yearly, but produces the most false positives.
    Is it the case that more doctors now feel it’s unsafe FOR THEM to continue with annual pap testing with more women becoming aware of the evidence?

    AND, I’d like to know what else was included in the exam, a routine pelvic and breast exam?
    Did he mention to his trusting patient, who believes he only acts in her best interests, that neither exam is backed by evidence and are far more likely to harm her? The routine pelvic exam some believe is part of the reason why American women have more than twice the number of hysterectomies and oophorectomies than UK or Australian women. (who don’t have routine pelvic exams)
    I wonder when women will be told by their wonderful doctors when it’s “safe” to stop having these exams.
    I tried to post, but my password was rejected…hopefully, more American women will do the smart thing and start protecting their health and the first step: sack your gynecologist!
    There is absolutely no reason for a healthy, asymptomatic woman to see a gynecologist EVER. (unless she wants pre-natal care)

    • Tanya says:

      Oophorectomies? What’s that?

      • Elizabeth (Aust) says:

        The removal of an ovary or ovaries, it’s a risk with the routine pelvic exam. The doctor “thinks” she feels something and you end up in day procedure…a false positive pelvic exam. Ovarian cysts that are not bothering you are best left alone…they’re not worth finding or knowing about. The routine pelvic exam is also, NOT a screening test for ovarian cancer. American women lose more than twice the number of ovaries than UK or Australian women and Dr Carolyn Westhoff (US gyn) partly blames the routine pelvic exam.
        I think she’s dead right.

    • Elizabeth, well tackled, I love how you took on the flaws in that article. And there really is no reason a healthy woman needs to see a gynecologist even for pre-natal care, check out this encouraging bit of news: http://www.cbc.ca/news/health/story/2013/08/20/midwives-pregnancy-leaders.html From the article:
      “When midwives were the main providers of care, women had fewer epidurals, fewer assisted births such as with forceps and fewer episiotomies — surgical incisions to reduce the risk of a tear. Most studies also reported higher levels of maternal satisfaction in midwife-led models.”
      Also from the Cochrane Library: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract

      Tanya, thank you for the update and the good news. It really is progress, I’m happy for you! It’s sad you have to listen to a lecture, but great you are prepared for them to bring it on.

    • Mary says:

      Well we’ve all had the comparisons of cervical cancer rates with Africa, but this article that Elizabeth linked is a new one.
      ” In 2009, there were only 9,300 new cases of cervical cancer in the U.S., compared with 212,000 cases of breast cancer.”
      So???? He’s just another male gyn who insults women’s intelligence.

  9. Elizabeth (Aust) says:

    You’re right, midwives do a great job. I have friends/family who wanted an elective c-section or were older when they had children, so they needed/wanted an obstetrician. (and most wanted a female obstetrician so they had to be organized) Great midwives were also, involved in their care. Midwife care should certainly be considered by woman. There are lots of studies that show women go through fewer interventions and intimate exams with a midwife caring for them.

  10. Elaine says:

    I once had a doctor who tried do cut off my medications unless I agreed to a pelvic/pap. Some of these were cardiac medications. Filed a complaint…got a new doctor who, fortunately, had a brain.

  11. Moo says:

    I would totally go for a HPV urine test but at $150 a pee, I am have to going to wait until some cheaper test comes out. I would like to buy it along with the pregnancy tests at the dollar store.

  12. I was very disturbed by number 5 in the article, Instilling Sexual Confidence in Our Daughters (http://www.covenanteyes.com/2009/06/16/instilling-sexual-confidence-in-our-daughters).

    I was very unhappy with number 5:

    5. Confidence in Her Sexual Health (ages 12+)

    Sexual health is a matter that women can’t take lightly, including your daughter. I’m shocked at how many girls get their periods but have never received instruction from their mothers about proper feminine hygiene. I’m also shocked by how many teen girls are sexually active but tell me they’ve never had a gynecological visit. How many adult women struggle with infertility because of the STD they contracted years before? Mom, before your daughter graduates elementary school she needs to be prepared for the changes taking place in her body. Before she graduates high school (and prior if she becomes sexually active), escort her to your OB/GYN. Help her establish a good relationship with the doctor she’ll need to visit every twelve months for the rest of her life. Teach her how to do breast self-exams. Teach her how to be a sexually healthy woman.

    I think it is ridiculous that it is suggested that teenage girls be taken to their mother’s OB/GYN at an early age. I do not agree that it is necessary for a woman to go to the OB/GYN every year. Every woman has different risk factors. Also, women should be able to decide if they need a gynecologist or not. I am concerned that this may have caused many mothers to take their teenagers to gynecologists. I cannot help, but wonder how many teenage girls were forced to go to a male gynecologist as a result of this advice.

    What do you all think?

    Misty

    • Ro says:

      Misty – Here in the US, it’s common for women to take their daughters to the OBGYN as soon as they get their first period. It’s something I was unaware of until I tried to research the pap test. I typed in “are pap tests necessary” and on nearly all of the links, at least one person had commented and reprimanded a woman in her early twenties for not going saying that she should’ve started having exams and pap tests as soon as she first got her period. I have no idea of the logic behind that or how it all first started, aside from money and as Elizabeth put it before, to “groom” young girls into the habit of yearly exams and screenings. Another thing, cramps are seen as being symptomatic by many women now, when in fact, in most cases, they are “normal” for most women. During a cycle, a woman’s reproductive muscles are contracting to get rid of everything (I’m trying to word this without being too crude or explicit in detail). Obviously, there’s going to be some pain for lots of women as far as that’s concerned. There’s a reason why women who play sports or have rigorous workout regimes have less of a problem with cramps than other women. Their muscles have been worked out more and so the contracting muscles have less strain on them. I feel like, in general, things that tend to be normal for women have been turned into symptoms and so because of that, women assume the worst and take their daughters to the OBGYN for fear that something is wrong or is going to go wrong. As other commenters here have said, being a woman has become a pre-existing medical condition. It’s very sad. In regards specifically to what you said though, it’s very commonplace for women, no wait, girls here to start visiting an OBGYN at a very early age. Even if they have never been sexually active and are symptom-free. That part of the article was very, very disappointing. I don’t think there’s anything about these exams that gives a woman confidence. Even the thought of them makes me feel very powerless, out of control, and it makes me feel like I’m being told my female organs are going to fail me and I should’ve been born a man because they don’t have any health issues. It makes me feel disrespected as a human being because no one wants to respect the women who do want to make an informed decision and go against the grain or seek alternative methods for their health.

    • Alex says:

      Appalling! The situation being orchestrated by someone else is an issue, in itself. Doesn’t matter if it’s her mother (in fact, I think that makes things worse- why doesn’t she just “do the honors” herself?). Plus, there’s all the things that can happen as aggravating situations (pain, injuries, miscarriages, over treatment, misdiagnosis- any & all of these can be deliberate or accidental). The esteem something is held in doesn’t change it’s properties.

      This is an outside orchestration of a penetrative interface with severe additional ramifications as a possibility. It being an iatrogenic variation means nothing. A mother doing something like that isn’t any better than a father doing something like that, either.

      An additional issue is that this undermines someone’s autonomy, in general. She doesn’t think “It’s her body, her rules.” If the mother is so down-trodden that she has no self-governance of her own, that’s not her daughter’s problem. It’s not immature to have bodily autonomy, self-protectiveness, or to hold personal alignment as an influencial factor.

      Another point is that this girl is still gowing up. With grown women, they already read any kind of difference as a problem. If there’s all these developmental fluxuations, what are they going to read those as? Them causing one problem after another or conveying the impression of one in order to generate a repeat cost is a potential- now they might cause one that knock this girls whole development off-course & gives her massive problems when she’s trying to have a family or whatever. Whatever can be having heart problems from the effects of a hysterectomy, keep in mind.

      The woman that writes this is probably a lesbian or just a controlling bitch. I know that’s a bit of “hip-shot,” but that’s how I feel. These tests are risky for grown women, but they’re even more dangerous for younger girls. If it’s not even safe for women under 35, what help can be meant by aiming these things at girls even younger than 20? Maybe she’s too old to have kids, so now she doesn’t see someone else’s ability to have kids of their own as a serious concern. Maybe she’s just spiteful about someone else having that ability. Maybe any of this applies to the doctor or other medical personnel.

  13. Chrissy (UK) says:

    Re: the article ‘Instilling Sexual Confidence in our Daughters’, Number 2 and Number 5 appear to contradict each other:

    2. Confidence in Her Sexual Boundaries
    “Your daughter must be aware of her right to say ‘no’ to anything another person may try to get her to do – not just with strangers, but with any person at all. Teach her that no one should be allowed to touch her anywhere that a modest bathing suit would cover, nor should she be required to touch anyone, and that if someone suggests she do anything like this, she must let you know so that you can protect her and help her to protect herself.”

    Yes indeed, what about her right to say no to anything another person may try to get her to do? Does that include an OB/GYN? Apparently not! To the contrary, it appears that mothers have a duty to prepare their daughters for a lifetime of intimate exposure and scrutiny by escorting them to the OB/GYN themselves. If you don’t, you are a bad mother is the implication. Hell yes, let’s guilt trip mothers again, knowing full well that their children’s wellbeing is always going to be their Achilles Heel. The thought of these asymptomatic young girls being taken by their own mothers for highly intimate examinations and probing is nauseating. The psychological damage to these girls must be considerable.
    And who is instrumental in brainwashing the mothers themselves that their genitals are in need of lifelong medical surveillance? That their bodies (only the female bits though) are so prone to disease that only a yearly all-clear from their OB/GYN will suffice? Could it be the perverse GYN industry who have the most to gain financially from all of this? I think I know the answer to that one…

  14. Ro says:

    Alex – I think the reason behind why mothers take their daughters to the OBGYN is because they believe their daughters’ bodies will fail them and they’ll end up dying. If a woman tells her general practioner that she doesn’t want to get a pap test or see an OBGYN regularly, she’s told that she’s putting herself at risk and can die without screening. I think most women probably take their daughters out of fear, and it isn’t ill-intentioned, they just believe that women would be dropping dead left and right without pap tests or regular OBGYN visits.
    Perhaps the woman writing this article falls into that category? I’m not trying to defend what she said, but in general, there’s this belief that women would all die without the OBGYN industry and our bodies would all fail us.

    Chrissy – That’s a very good point. I think most people try to instill the idea of bodily autonomy in their children – unless the person in question is a doctor. Then it’s okay, because they went to school for it and it’s not sexual for them. It’s “for your own good” and anyway, a piece of paper stating a course of education changes the way a person views things, of course. I’m sure the psychological damage is very considerable. I can’t even imagine how those poor girls must feel. Fun fact: the pharmaceutical industry is the most powerful in the world. Which would include the GYN industry.

  15. Ro says:

    Misty – I definitely wasn’t trying to defend it, I just think that’s a big reason why. I know there can be permanent emotional damage. While I never went to an OBGYN, I played sports in middle school and so I had a physical done. There was nothing done internally (thankfully) but there was a visual and external exam. I can count my blessings that the doctor was a woman (as I can only imagine that it would have been much, much worse had it been a man), but it was still a very scarring experience. Neither of my parents were in the exam room, so I was by myself. I was young at the time and really had no idea what was going on. I felt like the situation was out of control and I still feel sick to my stomach thinking about it. I felt like I had no control over my body and having a stranger examine my most intimate body parts without any actual reason (I was symptom free and never sexually active, so in my opinion, there was no logical reason for it) made me feel very violated. I wouldn’t wish that feeling upon anyone. It isn’t something I talk about (actually, this is my first time mentioning it since it happened), but I think internalizing it all these years has only made it worse. Also, I think it’s a big part of the reason why I was reluctant to participate in pap tests or more exams. Thankfully, it spurred me to do some research and become informed, so I guess that is one blessing that came from it.

    • Alex says:

      You might be right about the fear thing, but I’d think they’d be more scared that someone was going to snatch their daughter up & do things like this to her than they would be of her having some kind of “biological malfunction.” They don’t seem to worry that their daughters will get fat & have all the problems that that causes, for instance. I don’t have any specific issue with fat people, but if it’s seen as “up to them if they eat that much” & it’s not seen as “up to them if they have this testing done,” what does that say?

      Not to yell at you or anything, but someone’s reasons don’t matter. I think that there’s a huge aspect of “utility generates justification.” That if there’s some possible utility to something, it’s somehow wrong for it to not take place (and no one has any right to deprive the doctor of whatever situation they are intent on [add sarcastic crying-like tone]. Also, their technique of attaching riders to something doesn’t dissolve that something out of existance. They establish that something is involved in a sports physcial & if it doesn’t happen, then a sports physical hasn’t taken place.

      It’s interesting that requisites aren’t more frequently abrogated. It seems like them mandating something (whoever “they” are & whatever “something” happens to be) makes a confrontational wall- like they’ve drawn a line & now it has to be broken. It’s definitely harder to launch a response when something wasn’t a question. “Social engineering” I believe is the term for that (I’ve already mentioned that, but it’s interesting to not even hear a term for something that happens all the time- like intellectual negation, coercive attack, malicious fraud, iatrogenic detriment, etc…).

  16. Ro says:

    Alex – I agree that when you say it like that, it does sound absolutely absurd. However, most women (and quite a few men these days too, you’d be surprised!) never hear it worded like that and have been raised to believe that these exams are the end-all be-all and not to question them or think twice about it. It’s wrong to impose them on anyone, I’m not trying to argue that. All I’m saying is that when a culture has been taught something as factual their entire lives, they believe it to be so. I definitely see your point, though, and it’s a shame that such things are being imposed without much thought given.

    I understand that reasons don’t really matter – at the end of the day right is right and wrong is wrong. There aren’t any gray areas there. I was just making the point of there not even being any “medical reason” similar to the “medical reason” (if you’d like to call it that) of “requiring” exams for women to get BC because “it could cause health problems” to justify it. The “medical reason” doesn’t necessarily have to hold any truth or real justification, but those in the medical field would claim that as their reason for doing such things. I hope that makes sense? I didn’t really know how to word that. I know they’re attaching lots of things as riders now, but it’s nothing new. It’s been going on for years and it’s disgusting (but if it were going on in any other industry, I’m sure it would not be acceptable and furthermore, punishable by law).

    Yes, the term would be social engineering.

    • Alex says:

      Yeah, I get your meaning- there’s a “linkage” to something with one, but the other is just random integration. It’s added in arbitrarily- just because the doctor elected to include this situation. There is a bit of “an I say, you do it” pattern with doctors, particularly in the American culture. The people frequently have a general support of that, too (whether it’s heart-felt or not). Their stance is more or less “the doctor outmatches you.” It’s weird how in a country that always raves about freedom, that they don’t really believe in autonomous decision-making.

      It very much aggravates me how “outnumbered” someone might be in this culture with regard to situations of that nature. How would things be if I had a daughter or if my son did? Might not even have these kids, in the first place- depending on the mother’s history (which, even though it doesn’t “taint” someone, this kind of thing isn’t something one would want to be the situation for someone you wind up with- past or present tense).

      Another thing is the “only life & death” mindset. Why worry about dying when you’re not even going to worry about how your life goes? There’s a prevalent attitude that the length of lifespan is truly the only important concern. Another observation: If you’re not going to have a good quality of life, what’s so good about having a longer lifespan? Something doesn’t have to be a massively frequent thing in order to be a problem, in the first place- but you have pervasive patterns & random add-ons to those patterns.

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