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Can forced sterilization ever be ethical?

A British court still needs to decide whether to authorize the sterilization, at her mother’s own request, of a mentally disabled woman (see e.g. here and here). Reading only the headlines and initial paragraphs of the news entries devoted to the case, one might become worried that we are seeing here a resurgence of an abhorrent practice that gained much favour in the first half of the 20th-Century, in countries like Germany or the United States: i.e. the compulsory sterilization of the mentally retarded for eugenic purposes. However, it is important to look at the particulars of this case in order not to be misled. The 21-year old woman, referred to as P, is pregnant with her second child, and her mother (“Mrs. P”) says that they “can’t carry on supporting more and more children”. She also said that after the birth of her second child her daughter would have “a complete family” (a girl and a boy). But her mother is worried that she will soon fall pregnant again, in which case the child will have to be given away for adoption – something that her daughter, she says, is unable to understand, yet an outcome that would cause her much distress were it to happen.

Reacting to the case, bioethicist George Annas, from Boston University, commented that “this is eugenics if they are doing this because she’s mentally disabled. This decision needs to be made based on the person’s best interests, not the best interests of society or her caregivers.”

I agree with Annas that if the court were to decide to have this young woman sterilized for purposes of eugenics, this would be morally wrong. Yet this should not be taken to mean that the simple fact that some procedure amounts to eugenics is enough to make it wrong. Selecting one embryo over another for implantation in a case of IVF on the grounds that the former has a much lower probability than the latter of developing Tay-Sachs disease might count as a eugenic procedure, but I do not see that it is morally problematic. The problem with forcibly sterilizing mentally disabled people for eugenic purposes is not simply that it is eugenics, but rather (among other possible issues) that it constitutes an unjustified infringement on these people’s reproductive rights.

Annas is also right that the court’s decision should take into consideration the young woman’s best interests. I am less sure, though, that this should be the only relevant consideration: shouldn’t the interests of society as a whole carry at least some weight, as John Harris suggests? If it were in that woman’s best interest to have as many children as possible, even if most them ended up being adopted out (say, because she hugely enjoyed having babies but was not too upset about having to part with them soon afterwards), should she be allowed to have all those children no matter what burden this placed on the social services? Yet we do not need to provide an answer to that dilemma, which is based on rather extravagant assumptions. In actual fact, it seems that it is in this woman’s best interests not have further children, at least for the time being. And this consideration would seem more important than the need to uphold Ms P’s reproductive rights. Given the evidence available, it seems plausible to think that her mother does have her daughter’s best interests at heart and that she is accurately representing how things will likely turn out if she keeps having pregnancies in the future.

Of course, before being able to reach a decision, the court will have, first, to ascertain that Ms P really lacks mental capacity; and secondly, to inquire into the possibility of alternative procedures of a less radical sort (notably because they would be reversible) that could bring about the same benefits as full-fledged sterilization. If it were effective enough, it seems to me that a contraceptive implant would be a more attractive solution in Ms P’s case.

In order to show that sterilization was in fact the best option in Ms P’s case, one would obviously need to demonstrate that the procedure would in fact promote her own best interests more effectively than any alternative. Eugenic considerations would simply be irrelevant: besides the fact that Ms P already has children, we are not debating here whether we should revive some of the darkest pages in the recent history of the West.

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7 Comment on this post

  1. "The problem with forcibly sterilizing mentally disabled people for eugenic purposes is not simply that it is eugenics, but rather (among other possible issues) that it constitutes an unjustified infringement on these people’s reproductive rights."

    We do not think that preventing children from engaging in sexual acts is an infringement of their reproductive rights. Why? Because we believe they do not have the capacity to fully comprehend the consequences of their actions. If Ms P's mental capacity is equivalent to, or less than, that of a child of particular age, then it seems reasonable not to grant her the same reproductive rights as a normal adult.

  2. Surely there is also the question of capacity in terms of her getting pregnant? If she lacks capacity (in the legal sense) to make decisions regarding her reproductive system, is she legally capable of giving consent? And surely there are less drastic ways of managing this situation – injections, rods, etc. if the issue is simply one of avoiding pregnancy.
    Having worked in learning disability services and in mental health services where capacity is an issue, I would suggest that there is real concern with regard to the whole subject of sex and reproduction when considering capacity. When then combined with the impact on the individual of having children taken away (which apparently she is unable to comprehend will happen), I think there is clearly an argument that suggests that it is in the best interests of the individual (and also happens to be in the best interests of the mother and (without wanting to sound too Daily Mail about this) society more widely).

    I can't help feeling that work around personal safety, contraception, safe sex, etc. should also be going on, but maybe that's just me.

  3. Matt: I'm not aware that we normally need to prevent children from engaging in sexual acts. First of all because children typically do not yet want to engage in sexual acts that might lead to procreation, and secondly because they are not yet able to procreate.

    It is true that we usually try and discourage teenagers from procreating. But that is because we believe it is too early yet for them, and that it is both in their own interests and those of the future baby to wait until they have become more mature, have a secure financial situation, etc. before procreating. But in the case of mentally retarded people we cannot expect that the individual's further psychological development as an adult will lead to more propitious circumstances for procreation in the future. In such cases, either it is ok for them to procreate as they are right now, or it is never ok for them to procreate. The latter viewpoint sounds rather callous to me, as it simply gives no weight at all to the needs and desires of the mentally retarded.

    1. @Alex:

      1. In light of the case of P, shouldn't we also consider the best interest of her future baby and her current children?

      2. If we "believe that it's best for teenagers to become more mature and have a secure financial situation before, etc. before the procreate", when would be the best time for mentally disabled people like Miss P to procreate?

  4. @Alex: I found myself in strong agreement with all of your comment until you reached your conclusion. How odd that wecould be thinking the same words and having such different thoughts.

    I don’t think your second alternative (never to procreate) allows no weight to the desires of the mentally incapable. I think it allows the proper amount of weight when compared to the overall impact of having as many children as one wishes with no hope of ever being competent to raise them. There are callous ways to express it, but the logical conclusion is clear. Ms. P does not and will not ever be an adequate parent. If she didn’t have generous, living parents who can and will care for their grandchildren, would you still support her right to procreate? I can only hope not, for the sake of those babies.

  5. Sass and PMG: I entirely agree that the future children's interests carry great weight and that people, whether mentally retarded or not, should not have children if they cannot be expected to take good care of them. It also appears likely that Ms P does not have the capacity to raise her children on her own. Does that make talk of reproductive rights inappropriate in her case? I am no expert on the topic of rights, but it does seem plausible to me to say that Ms P has a right to procreate to the extent that she has a loving family who can help her raise her children – a condition that was satisfied in the case of her first two pregnancies.

  6. I cringe at the terminology used in the blogs. She is not 'mentally' anthing…she is a woman who has learning disabilities. The term covers a wide range of difficulties with learning, understanding or communication. Under the MCA 2005 the issue is whether she understands the information, can retain it and weigh up the pros and cons (she can be helped with this within the law.). If she can, she has the right to make her own choices and we need to respect and support that.

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