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.