The Department, of Health, Education and Welfare's proposed new rules on federally funded sterilizations came under fire from all directions yesterday, as women's groups said they leave too much room for potential abuse, while doctors contended they are overly stringent.
The proposed new regulations culminate a four-year review of federally funded sterilizations begun when two black Albama teenagers charged in court that they had been sterilized against their will.
The regulations are an attempt to assure that sterilizations are available for those who want them while also assuring that they are not forced on anyone who does not want one or is incapable of making an informed judgement on the issue.
Most of those who testified at yesterday's day-long hearing said they support the general thrust of the guidelines. But most witnesses also brought with them the criticism that, from where they stand, it appears that HEW as wandered into dangerous territory.
Alice Rothschild, an obstetrics resident at Beth Israel Hospital in Boston and medical director of the Women's Community Health Center in Cambridge, said the regulations should stipulate that consent for sterilization must not be obtained from women while they are in labor, near delivery, or in conjuction with an abortion.
"A patient may be particularly susceptible to coercion or suggestion while under the effect of anesthesia, tranquilizers or other medication," she said.
Rothschild also suggested that consent forms that would be required under the proposed rules "be co-signed by a health professional such as a nurse or social worker who serves as an advocate for the patient."
"This policy would help safeguard against a situation where the patient feels obligated to sign simply because of the authority and posture taken by the doctor."
The regulations would ban government-financed hysterectomies performed for the sole puspose of sterilizatio. Several witnesses feared the move would encourage doctors inclined to push sterilization on poor or minority women to claim that unneeded hysterectomies are performed for other medical reasons.
Dr. Sydney Wolfe of the consumer-oriented Health Research Group said the government should require a second doctors' opinion for all government-paid hysterectomies.
Wolfe said black women are far more lilely than white women to undergo hysterectomies for sterilization.
On the other side of the issue, Dr. Tommy Evans, a spokesman for the American College of Obstetricians and Gynecologists, said a 30-day waiting period between consent to sterlization and the actual operation could pose a danger to the health of some women.
"This is true because spontaneous deliveries, as well as surgical procedures related to or arising during pregnancy, are frequently not possible to predict 30 days in advance," Evans said.
He said the regulations should provide for waives to prevent women from having to undergo two operations - one for emergency surgery, another for sterilization - in short time, and to avoid compromising the safety or well-being of patients.
Most witnesses also questioned HEW's ability to enforce whatever guidelines it adopts. Several claimed that proposed new ones, are widely flouted in hospitals around the country.
In addition to the 30-day wait, the ban on government financed hysterectomies soley for the purpose of sterilization, and the requirement for written consent the regulations would bar sterilization of period under 21.
The major ussue the guidelines have vet to resolve is whether to permit sterilization of people over 21 who are mentally incompotent under the law.