Should we sterilize the mentally disabled?


There was a story in Tuesday’s Guardian about a mother in the U.K. who is fighting in court to compel her mentally disabled daughter to undergo sterilization after carrying two pregnancies to term. The article goes on to explain that “Mrs. P”, the grandmother, has been fully responsible for raising her daughter’s first child and will be responsible for the care of the second child, born by C-section Wednesday, but that caring for any future children will continue to put undue strain on her and her family. In fact, Mrs. P stated that she would place any subsequent children borne by her daughter up for adoption — an assertion with which presiding justice Hedley agreed.

The court of protection postponed the hearing until April in order to gather more evidence to determine whether sterilizing the daughter, who is 21, is in her best interest. Another option proffered is to compel the daughter to receive an IUD, an effective but less permanent contraceptive. What isn’t made clear in the article, mainly due to protecting the identity of the daughter, is the nature of her mental disability and whether (and to what extent) she understands the concept of pregnancy, parenthood, and the consequences of what could happen to her.

Jessica over at The Frisky posted a commentary on the article this morning which is what initially turned me on to the discussion. Jessica, ever the reproductive rights activist (and rightfully so), maintains on one hand that “everyone gets to make their own health decisions about reproduction without force or coersion (sic)…” but acknowledges that in this particular situation Mrs. P has every right to be concerned with her daughter’s continued sexual activity and the impact that future pregnancies would have on their welfare. Most of Jessica’s protests against compelled sterilization center around the actions of groups like Project Prevention that pay addicts to “voluntarily” submit to sterilization, and to question precisely where the line would be drawn in terms of what disabilities could render someone incapable of having or raising children in the eyes of the state.

To that effect, I agree with Jessica — someone who is physically disabled, for example, but fully in possession of their mental faculties should not be prevented from becoming parents as long as they are thoughtful about what additional steps they may need to take in terms of procuring help with childcare, etc. (because let’s face it, despite the interest in equality there are some things that people with various disabilities are incapable of doing).

My thoughts regarding those suffering from drug and/or alcohol addictions are somewhat more complex; addicts by nature aren’t very well known for making good decisions and so are unlikely to be very responsible in terms of contraceptives. Also, children born to addicts — if not addicts themselves from exposure in utero — are more likely to be surrendered to the system and to be shuffled back and forth between subpar homes, therefore rendering them more likely to fall into similar negative patterns. That being said, I think it’s more productive to counsel addicts to help them overcome their addictions and to exercise responsible judgment when having sex (much like providing condoms to prostitutes) than it is to permanently keep them from having children. Rehabilitation is possible, after all.

However, the question of the mentally disabled brings me to my most difficult thought process yet. I have a cousin who is learning disabled, though not so severely that she is unable to care for herself; she lives with her now-husband, who is also learning disabled, and they have two children. Of course I am concerned that their children will grow up with learning disabilities of their own, and that they weren’t exercising the best judgment when they decided to have children, but as long as they demonstrate the ability to care for their children and for themselves then I don’t think it’s my right or anybody else’s to restrict their ability to have a family.

The real issue arises when you have a family such as that of Mrs. P, in which the daughter’s mental disabilities apparently are severe enough that her mother must step in as guardian and caregiver. Though we don’t have all of the details, it is reasonable to surmise that the daughter is not capable of making decisions for herself or for her children; while she refused a contraceptive treatment at a family planning clinic we aren’t told why — did she understand the full implications of the treatment, or only that she wouldn’t be “the mummy” anymore? How does she understand the concept of parenting? Or, was her refusal based on something as simple as a fear of needles (the treatment was an injection)?

While the details in this case will continue to leak as proceedings continue, I have to say that under circumstances like this I believe that a legal guardian has the right to consent to some form of contraception on behalf of an individual who is incapable of otherwise caring for and making decisions for her/himself and others. Sterilization is the most severe path, of course, so I would advocate something less invasive but nearly as effective, such as the IUD suggested in the article. I may be criticized to the ends of the earth for that position, but I firmly believe that when a person is unable to understand the consequences of their actions then it is the responsibility of their caregivers to protect them to the best of their ability — if that means birth control for a sexually active individual who doesn’t get that sex can lead to pregnancy and so on, then I’m in favor. In the meantime, like Jessica, I’ll be keeping an eye on this case to see what happens.

(There was an entirely different, though related, question that arose from the comments on Jessica’s piece: if the daughter lacks the capacity to understand pregnancy and parenthood, what is her capacity for understanding sex and being capable of consent? It’s also a compelling question, but one that really really skeeves me out. Maybe another day…)

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  1. I agree with the ‘what is her capacity for understanding sex and being capable of consent?’ question. Should there be laws against having sex with an individual who does not have the mental capacity to understanding it? Here in the US, we have statutory rape laws because it is assumed that those under the age of 15 do not have the capacity to understand or know if they are being taken advantage of sexually. Should the blame be placed on the partner who does understand? What if the partner is also mentally disabled? The IUD is a great idea, but if she doesn’t understand sex, how can she be protected against STDs? “Mrs. P” has opened a huge can of worms!

  2. It is a touchy issue. There are so many mentally able people with children who do not parent well and I really do wish a license was required to raise children. Ideally, prospective parents would have to take and pass parenting courses. However, since a began working with Developmentally Delayed individuals, I have changed my thinking and now believe absolutely that they should be required to use a contraceptive method of one kind or another depending on their level of understanding and and willingness to comply. The last resort would be sterilization.

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