The practice of sterilization among the handicapped emerged as a convenient way to avoid unwanted pregnancies. A request for sterilization can develop from concerned parents, professionals, or from the mentally disabled individuals who chose to remain childless. However, some of the mentally handicapped people have been coerced to undergo sterilization processes, leading to incapacity to procreate or enjoy other social responsibilities. In medical perspective, sterilization of the handicapped resulting from genetic factors may be necessary to minimize the population of mentally retarded people. Handicapped or mentally disabled people should enjoy the same rights as any other citizen. It is essential for obstetricians and gynecologists to consider ethical issues surrounding sterilization procedures on mentally disabled people, as each individual requires careful considerations before undertaking the process.
Sterilization is one of the methods of birth control that is available to most American adults, including the handicapped, which involves a surgical procedure to control reproduction for life. The issue of sterilization, particularly to women and girls, stirred a heated debate in the US at the start of the twentieth century due to its social implications. The first sterilization program, which occurred in Indiana State in 1907, was non-voluntary, and this made other states and countries to adopt the procedure. However, doctors usually face challenges when requested to perform a sterilization procedure to mentally handicapped individual, who have no capacity to give consent by themselves. Some parents may prefer their mentally disabled children to be sterilized so that they do not worry about those who take care of them.
In the initial stages, it appeared as a dreadful idea to propose sterilization without the consent of the handicapped person, but later it became a common practice. Sterilization was part of the eugenics, where ‘undesirable’ humans would be sterilized to avoid producing children that would be equally undesirable. This practice was carried out by the Nazi regime to get rid of hereditary illnesses. Sterilization affects procreation, thus, may interfere with the moral beliefs of mentally disabled patients, their families, and their personal physicians. Forcing disabled women and girls to undergo sterilization is denying them human rights, which include reproductive rights. A decision on sterilization should be made only when it serves the best interest of the patient.
Why Sterilization is good for the Handicapped
Sterilization to disabled people may save them from discrimination in society. According to Wertz and Fletcher, it is ethically acceptable to undertake sterilization on handicapped persons to limit procreation and to enhance their own best interests. In most cases, disabled people have experienced difficulties while taking care of their offspring, particularly when none of their family members is physically fit to assist in carry out daily routines at home. If procreation is likely to harm the handicapped, undertaking the sterilization procedure can be ethically justified. Due to their incompetency, mentally disabled people are not responsible for numerous consequences that may emerge due to their conditions. Thus, limiting their rights to procreation should not be perceived as a punishment, but rather a suitable measure to prevent misfortune, as well as family burdens. This would reduce the cost incurred by family members to afford them necessary care.
A decision to bear a child, or to prevent childbearing permanently are best made while taking full deliberation of the burdens that the disabled person may carry to parenthood. If the cause of disability is genetic factors, sterilization of disabled persons can be permitted to minimize the population of mentally disabled people. The burden of pregnancy may be too heavy for a disabled person, as pregnancy, birth, as well as parenthood may create emotional stress due to loss of sleep, and demand for caring for an infant. To avoid going through such conditions, it is better for a handicapped person to undergo sterilization process than to be left alone to bear the consequences of parenting. In addition, sterilization would minimize the proportion of children with disabilities who require special care, and who experience sadness, depression, and low self-esteem. Permanent sterilization is acceptable if an adolescent girl is not capable of taking care herself to avoid carrying a burden of parenthood during her adulthood.
Every person desires to live a comfortable life in society without becoming a burden to other people. However, disabled people have higher chances of developing additional health problems, thus, reducing their levels of functioning. Lack of physical activities increases the chances of becoming ill and this may come at a cost to the family members and society. Lack of movement may also restrain the handicap from accessing information on birth control and safe sexual behaviors. To avoid such incidences, it becomes ethical to undergo sterilization to minimize suffering that disabled people would undergo to get a child. Sterilization can be the best option in situations where individuals with disabilities are unable to learn about birth control and childcare.
Mentally handicapped individuals often depict poor communication skills that differ from one person to the other over time. It is quite hard to determine individual’s capacity to offer informed consent on sterilization, as this would involve the patient’s ability to understand risks, benefits reasonable alternatives, as well as capacity to express personal choices. In many countries, governments are involved in justifying sterilization on the basis of social factors that include (1) developing measures to sexual abuse to disabled people, (2) avoiding inconvenience to caregivers, and (3) to offer appropriate services to women who aspire to become parents. Numerous government entities are involved in ensuring that all individuals in society enjoy basic rights and that they have the capacity to utilize existing resources without interference. To avoid spending too much on designing individual programs for disabled persons, the government can opt to undertake sterilization procedure to prevent them from engaging in inappropriate sexual behaviors.
Criticism of Sterilization to Handicapped Individuals
Sterilization is a procedure that makes an individual incapable of procreation, and in most country, this activity is performed involuntarily as a form of social control and pregnancy prevention. Regardless of who permits the process, sterilization has raised an ethical and legal issue for parents of the mentally disabled persons, for medical professionals, and for the society. The United Nations Special Rapporteur stated that forcing women with disabilities to undergo sterilization is torture, and can be termed as crime against humanity that is directed against a civilian population. The practice characterizes disability as a personal catastrophe that requires medical rehabilitation. Sterilization without consent is a major attack on individual’s rights and dignity. According to state and local law, people with disabilities should have the right to marry, engage in sexual practices, bear children, and voluntarily manage their own fertility through existing legal means.
The law has failed to consider the fact that authorizing a person to undergo involuntary birth control procedure infringes that person’s freedom to decide on reproductive choice. Besides, courts cannot declare that an individual is incompetent to give permission just because such permission may be considered irrational. A legally incompetent individual should never be coerced to undergo sterilization procedure, and in case of voluntary sterilization, an approval from the court is necessary. Sometimes the court may fail to grant mentally disabled people opportunity to prove their conditions, leaving them with no option but to adhere to the procedure. Although the age of consent may differ from one state to the other, some mentally disabled persons are subjected to sterilization despite having the right age for consent.
The argument that mental disability is a hereditary practice, and should be curtailed, is unethical because some studies have proved that even physically fit individuals can also produce disabled offspring. The struggle against an infectious disease requires an individual responsibility to seek vaccination to protect the entire population, but in case of sterilizing the handicapped, a certain group becomes a target. If everyone in the region is advised to be vaccinated in case of an outbreak of an infectious disease, then this should also be applicable in the case of sterilization among the disabled person, and should be voluntary. This can be termed as discrimination against mentally disabled individuals. The principles of utilitarianism require individuals to maximize what brings happiness to others and minimize actions that bring pain to others. Society is capable of giving support to disabled people because they are part of it. The aspect of being a burden to society is unrealistic, particularly when involuntary sterilization is performed on a young person.
Forced sterilization to handicapped and disable people should not be justified on basis of best interests because best interests have failed to consider the rights of disabled women and girls. The best interests can be attained through other means, such as sexual education, parenting programs, training for self-defense, and offering personal assistance, as well as support services to minimize cases of sexual abuse. Such factors can be utilized to enhance ethical practices in society. It is justifiable to argue that some people, such as drug addicts, cannot become good parents, hence, society can exercise all means available to ensure they do not reproduce. However, it is quite difficult to measure the capacity for parenting without applying coercion and predictions, which cancel out ethical practices. Forcing disabled people to undergo sterilization based on predictions evades the concept of deontology, where everyone has a duty to perform in society.
Mentally handicapped people are not powerless in offering informed consent concerning sterilization or any other medical procedure. The aspects of informed consent are similar for both handicapped and normal people. Sometimes the agencies involved in involuntary sterilization do not take time to understand the patients, and rushing to undertake the procedure may not solve their problems. When the handicapped are denied the chance to consent or to reject sterilization, the question that emerges is who should ethically authorize the process of sterilization. Every individual, regardless of his/her physical condition should have an inherent freedom to reproduce and to become a parent. Sterilization is not the only way of birth control, as alternative methods of birth control can be sought instead of forcing mentally disabled people to undergo painful and disturbing procedure.
Sterilization to the handicapped has remained a hottest debate due to lack of effective measure of their competency in giving out informed consent. Across the globe, mentally disabled women and girls are usually coerced to undergo sterilization for eugenics population control, birth control, and prevention of sexual abuse. The procedure is permanent and its consequences are far-reaching. The legal position concerning sterilization is that doctors should adhere to the normal rules on consent. Physicians should thoroughly evaluate the capacity of patients with disabilities in making informed consent. In case of incapacity or handicapped, and the doctor suggests that sterilization is the only way to safeguard the patient’s interest, then sterilization can be carried out, but with an approval from the court. Sterilization should be a social choice, rather than a medical issue. Therapeutic sterilization should only happen when the procedure is deemed indispensable to save a person’s life, or to avert serious damage to an individual’s health. The court can also permit therapeutic sterilization through legislation of voluntary sterilization.
“Sterilization of Women and Girls with Disabilities.” Open Society Foundations, A Brief Paper, Nov. 2011. (accessed July 14, 2015).
Herring, Jonathan. Medical Law and Ethics. Oxford, UK: Oxford University Press, 2014.
Tännsjö, Torbjörn. “Non-Voluntary Sterilization.” Journal of Medicine & Philosophy 31, no. 4 (August 2006): 401-415. Academic Search Premier, EBSCOhost (accessed July 14, 2015).
Wertz, Dorothy C, and John C. Fletcher, Genetics and Ethics in Global Perspective. Dordrecht: Springer Netherlands, 2012.
 Torbjorn Tannsjo, “Non-Voluntary Sterilization.” Journal of Medicine & Philosophy 31, no. 4 (August 2006): 401-415. Academic Search Premier, EBSCOhost (accessed July 14, 2015).
 Jonathan Herring, Medical Law and Ethics. (Oxford, UK: Oxford University Press, 2014), 280.
 Dorothy C Wertz and John C. Fletcher, Genetics and Ethics in Global Perspective. (Dordrecht: Springer Netherlands, 2012), 203.
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 Torbjorn. “Non-Voluntary Sterilization.”
 “Sterilization of Women and Girls with Disabilities.”