Friday, February 18, 2011

Part II: The Ethics of Sterilizing "P"

The case in Britain--and Summer's reply--is an interesting one for us ethicists, especially for those of us who distinguish a personal from a social or institutional ethic. I love to argue with Summer.

I propose that society would be best served by P's not being sterilized at the instigation of the court. My reasoning may be devious--but what is done by an official body has far reaching consequences, and I would hope that no nation would begin a practice of involuntary eugenics on a class of people which the state itself would define.

I agree that the woman is incompetent and ought not bear more children but why are not less drastic measures applicable? Specifically, Summer, why do you descry the use of an IUD?

-- Rosemary Flanigan

Rosemary, I love to argue with you too. So let me say that I have the same concerns about an IUD as I would with any form of birth control--whoever is caring for "P" (given that she has no decision-making capacity, one can assume she probably requires a caregiver of some kind) has to ensure that she in fact has adequate birth control to prevent unwanted pregnancy.

We must consider "P" and her overall well-being. She may not want to undergo tubal ligation--but how likely is she to want to go to have repeated IUDs or Norplant or Depo or whatever they might elect to try as a method of birth control.

If we are in agreement that P should not be reproducing (whether one is a eugenicist or not), then it is simply a question of how to render her unable to become pregnancy. Reversability is not a concern as her mental status is not going to change and thus the rationale for her sterilization is the same.

The rationale, as I said in my blog post, is NOT about her genetics or mental deficiencies, but the consequence of those deficiencies. She cannot care for her own children, and maybe herself. The fact is that if she is not made unable to reproduce she is likely to keep having children for whom she cannot care. Whether that obligation falls to her family or to the state, it is a burden upon P, her family, and her society that can be prevented, and should be.

I know we all reel at the notion of "sterilization" because of our own American history with eugenics and the case of Carrie Buck, but we have to acknowledge that sometimes (unlike in the case of Carrie Buck) denying those without capacity the ability to reproduce is actually in their best interests, and secondarily the interests of society as well.

-- Summer McGee


UK Court Mulls Sterilizing Mentally Disabled Woman, Associated Press, February 15
Blog: Eugenic or Not, Sterilization Makes Sense for "P", Summer McGee, PhD,, February 17, 2011



Blogger Tarris said...

I don’t particularly like arguing with either of you, Drs. Flanigan and McGee, but your responses draw me in.

I am wondering how either of you, or I, could possibly make a cogent argument for what ought to be done to/for/with Ms. P and her mother in regard to something as personal and particular as sterilization and birth control and having babies. We have read a journalist’s brief account of this case occurring in a faraway place. That’s all. Even if we have found and read other accounts, they are merely that—second-hand information, at best.

I have formulated opinions on too many clinical ethics consultations that ultimately proved wholly in error upon meeting and interviewing stakeholders. It happened again this week. After hearing one or more first person narrative accounts of what’s going on, seeing their tears, feeling into their frustrations or fears, reading the documents they thrust at me in explanation, meeting their partner or parents or siblings or children—after being present with those whose ethics dilemma it is, my opinion of the ought or ought not nearly always is changed.

Were we to have opportunity to sit at Ms. P’s bedside after C-section delivery, if we could cuddle her babies and listen empathically to their grandma’s distress and worries, how differently might this situation then appear?

What we surely can do as ethics thinkers at a distance is to: list and ask the ethics questions this or any case provokes in us, tease out and name the moral conflicts that likely make this a dilemma, project possible scenarios of responsive action, anticipate potential consequences of this action versus that, consider wider societal implications of whatever is done in an individual case of this type. And we might acknowledge that even on these matters elucidated without firsthand experience of the particular situation, we are quite apt to be mistaken.

On these claims of mine, I expect we three may agree, while arguing vociferously perhaps about what should be on our respective lists of relevant questions, conflicts, scenarios, consequences, and implications.

Terry R

Friday, February 18, 2011  

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