Do some goddamn math

It seems that my clinical activities this month have been assigned a theme: "cognitively disabled people who reproduce." Themes like this do not exactly renew one's faith in freedom of choice; after providing care to three developmentally delayed mother-child pairs over the last month, I feel that there are some people who maybe shouldn't have complete control over their uteruses. Uteri. Whatever--no more babies for these people.

On Friday, I did a newborn exam on a baby born to a 28-year old woman who's been pregnant nine times. This was the fourth child she's given birth to, and the fourth child to be removed from her care. She is a paranoid schizophrenic with some concurrent developmental delay who will accept only crack as pharmacotherapy. She has been repeatedly offered birth control, and has repeatedly declined.

On Wednesday, I saw a new clinic patient, a 30-year old developmentally disabled woman who secretly stopped taking birth control last year because she wanted to get pregnant. She is not able to take care of the resulting baby, and has been having mood and behavioral problems related to the increasingly tense dynamic between her and the family members who now substitute-parent her child. At one point in her adulthood, she considered a tubal ligation, but was ultimately convinced by a counselor at her workplace that this was not a good idea for her.

Forced sterilization does not have a happy history. In part for this reason, irreversible sterilization of mentally disabled people is a pretty touchy subject with clinicians. When I whined at one of my attendings about the "missed opportunity" to prevent the second patient from getting into this imbroglio to begin with, he jumped back as if stung by a bee, saying, "This is ground on which to tread very, very carefully, Signout."

What knots people's panties, apparently, is the issue of autonomy. This is the ethical principle which entitles people to make their own choices about their health care, however idiotic those choices might seem to us. People retain their ability to make their own decisions as long as they are able to express understanding of the consequences of those decisions. When someone becomes unable to understand the consequences, they can be disallowed from making decisions for themselves.

I argued with my attending that if you decide to have unprotected intercourse without understanding the demands of child-rearing, you are not understanding the consequences of your decisions. In my view, a person in this situation is incapable of making their own reproductive decisions and should be perhaps not sterilized, but definitively prevented from reproducing. (In women, Depo-Provera or intrauterine devices are practical solutions. Men, so far, have only sterilization.)

Understand that it's not for eugenic purposes that I advocate this, but rather because raising a child well requires resources and parenting. I feel strongly that if you cannot and will not be able to provide either of those things, you should make every effort to not reproduce.

It appears that babies and baby-making are so sacred and so freaking awesome, however, that we are legally prevented from considering this consequence when appointing a surrogate decision-maker for a disabled person. Check it out:

Bioethicists generally approve of surrogates making decisions for incompetent patients. However, due to the injustices of the past, physicians should be aware of undue pressure from family members whose interests are self-directed. Primary or contributing indications for sterilization based on presumed or anticipated hardships to others must be viewed with great reservation.

This is excerpted from an excellent review article, which cites an American College of Gynecology committee opinion in making the above statement.

To which my response is, uh, why? It seems almost excessively reasonable to consider familial resources and the self-interest of potentially responsible parties when deciding whether a developmentally disabled person should have contraception. Sure, reproduction is a right, but is it really that inalienable?

If an incapacitated woman who thinks babies are cute keeps squeezing them out so she can hold them for the few days she's allowed to before they're taken away from her, over and over again, do we not have both a reason and an obligation to every human being who can do some goddamn math to keep her from having more babies? Why does her desire to reproduce override the burden she places on her body and on the foster care system?

If one person's faulty reasoning equals two overly burdened lives--the subsitute parent's and the child's--what tools do we have to balance the equation? Can we eliminate it altogether?

More like this

This is a great and brave post. I was once strung up by the commenters on a feminist blog - who I usually agree with - when I suggested that action be taken (I didn't specify but had in mind counseling and nothing severe) in situations where a pregnant woman is abusing alcohol. I've also expressed that there are situations dealing with overpopulation for preventing people from reproducing (I don't intend to ever father a child for this reason). Reproductive rights are tricky, and they're particularly frustrating because they're so different for each sex - women bear the burden. But denying that reality doesn't help. Just because it's an unfortunate circumstance that one sex gets screwed this one doesn't seem to change the fact that when you're talking about a child you INTEND to have, you're now talking about another person - that will exist in the FUTURE. (This is where I got myself into trouble on the for mentioned blog despite being about as pro-choice as one can be.)

I can understand reservations about forced sterilization. At the same time, I agree with you - in some sense, surrogates have more control over a person's life or death than they do over their reproductive rights. Those who are unable mentally to cope with raising a child should not reproduce.

The best solution would probably be temporary - i.e. birth control for women, and if it ever comes on the market male birth control as well. Permanent sterilization still has too many negative connotations (and rightfully so, considering how it has been used) to allow it to be forced on individuals. Temporary birth control measures does not permanently remove a person's reproductive rights, but instead allows for re-evaluation of the situation at a later date.

By Brian Thompson (not verified) on 02 May 2007 #permalink

Understand that it's not for eugenic purposes that I advocate this, but rather because raising a child well requires resources and parenting. I feel strongly that if you cannot and will not be able to provide either of those things, you should make every effort to not reproduce.

Having gone through something similar during my OB/GYN rotation as a medical student, I can sympathize, but I don't think you truly realize that this is almost exactly one of the rationales used by the Nazis to justify its eugenics program. One major part of their rationale was eugenics, yes, but another was that birthing "life unworthy of life" or "mental defectives" produced useless mouths to feed, which consumed resources and (far worse in the mind of the Nazis) tied down the able-bodied adults needed to care for them who could, in their minds, be better utilized in the war effort as soldiers, military support staff, or workers in munitions factories. Such children become, in effect, a burden on society, and this was a burden that the Nazis wanted to shed. Indeed, one key rationale for the T4 euthanasia program, which began in 1939 on the eve of war, was that the hospitals and institutions being used to house the "mental defectives," as well as the doctors and nurses engaged in caring for these patients, would soon be needed for the war effort to care for wounded soldiers.

So, although I can see what you're saying, I get the distinct impression that you don't really understand the full extent of the history that leads to such revulsion at arguing that the reason such people shouldn't be allowed to reproduce is because of the burden to society that caring for their children results in. It's an argument that resulted in just as much suffering as eugenics-based arguments.

The thing is, nobody's saying that they're not "worthy" to breed, and Signout's concern isn't even that they're "mental defectives" but that it might be more kind, humane, and just to help protect some people from the consequences of their actions, consequences that they can't understand.

And although I don't favor sterilization for people who can't consent to it, I do think that DepoProvera and the IUD (which, incidentally, the Mirena IUD actually decreases your risk of PID (over the long term), so the medical risks associated with it are really minimal) are great options to encourage people to consider. The problem is that DepoProvera requires q3 month injections, and the IUD requires someone to be compliant with 2 visits over the course of a month. Most of the people who don't have custody of their children aren't going to be able to do that. If they could pull themselves together enough to do that, they likely would have kept custody of their children.

Orac

I don't think Signout ever stated or suggested that the child was the problem, per se... or that the birth weas in any way 'unworthy'. The issue is the unwarranted demands this behavior places on everyone else.

The US is a wonderful place, full of genuinely caring and warm individuals... but it is also increasingly 'challenged' by it's own inability to define boundaries.... when should we say 'enough'?

We put boundaries on children -- this is 'responsible' paranting.
We put boundaries on pets -- this is 'responsible' ownership.
We put boundaries on our corporations -- this is 'responsible' governance.

So why don't we allow any 'responsible' boundaries on ourselves -- this is truly irresponsible.

It goes back to the old joke, "You need a license to drive a car but not to have a kid." LOL!

I am in agreement with others that this is a slippery, slippery slope, but I respect what you are trying to say. I would add, as well, that since overpopulation is a genuine problem, it stands to reason that this issue is greater than one of simple on/off autonomy. The philosophers can argue for eons about where the good of the one should be sacrificed for the good of the many, but in practical terms, it is current crisis.

On the flip side, I begged my OB/GYN to get my tubes tied when I was in my 20s and they simply would not do it because "you might change your mind later." Now I'm nearly 40 and guess what? Never changed my mind.

It seems the ability to get pregnant trumps all other concerns, issues, problems, or decisions. That's craziness.

Of course, a LOT of people having unprotected sex don't really understand the demands of child-rearing. That includes married adults with full capacity who want to have kids.

If you can figure out a way to convince most people not to have unprotected sex, you have a great future in government or education!

I agree with Dr. Signout's assessment, but this is really just one manifestation of the generally muddled state of medical ethics, which seems to steer practitioners towards intuitively undesirable outcomes as often as it cousels those that seem appropriate.

I suspect that the problem is structural: it just doesn't seem to work to put medical institutions in the position of issuing unilateral ethical judgements that incorporate personal, professional, social, and financial considerations all at once. There are too many incompatibilities and inherent conflicts of interest. I think I'd prefer to see the locus of these decisions moved further away from the delivery of medical care.

Signout, oh my gosh we agree on something. Whether or not I agreed, excellent post. I would have berated Orac for not at all understanding what you were trying to convey had it not been done more tactfully by your other readers. And Garth, in saying "I think I'd prefer to see the locus of these decisions moved further away from the delivery of medical care" are you seriously arguing for what? governmental input or control on these decisions? Cause you can't yet be far enough removed from medicine to trumpet any more governmental oversight into medical decision-making. History has shown that it doesn't work well for politicians who know nothing of medicine to butt in...Heck, history has shown that politicians who do know something about medicine shouldn't have any input in medicine as their motivation is often not the patient's best interest. Was it not the ex-Senate majority leader MD who said something to the effect of "Ive never treated her but I can tell from that video that she's not brain dead" in the fiasco that was the entireley politically motivated prolongation of Terry Schiavo's brain-dead shell of a body? These are decisions that should be made on a case by case basis at the physician/patient/family/power of attorney level. I do agree that medical institutions' ethics boards' far-reaching edicts shouldn't dictate practice, but the locus should be moved as close as possible to those that deliver the medical care, not farther away.

Thanks for the many thoughtful comments, and--to most of you, anyway--for getting that this has nothing to do with eugenics. To the others--plug away!

I can certainly appreciate why this is a slippery and complex slope to navigate, but I'm glad that others identify that slapping the mandate of a far-off body of intellectuals onto real life situations doesn't make for practical solutions. I agree that the people who need to advocate for patient decisions need to be "in the shit," so to speak, but I think these kinds of conversations ultimately help the advocates do their jobs.

For those of you who brought up the gender dynamic at work: I agree that it's interesting--although perhaps not completely practical--to talk about this as a gender issue. It occurred to me while writing that I have no idea what a good feminist's position on this should be: total control over one's reproductive rights is good feminism, and the big argument against coerced contraception/sterilization (in women, anyway--more on that in a second) is that it violates reproductive rights. However, I feel that the spirit of this argument is more in the realm of "having babies is what women [should] feel they were born to do" than it is "my body, my choice." (This sense is based mostly on the review article I quoted in the post.) It all sounds a little "culture of life"-y to me, which generally chaps my hide.

Then there's the part where it's always about women. In the [admittedly small amount of] literature I read while preparing this post, there's not much discussion of how to cope with the reproductive potential of disabled men lacking decision-making capacity. Considering that one man can make way more babies than one woman can in a lifetime, this seems like a bit of an oversight. I imagine it's partly because their reproduction is invisible to the health care system that this happens.

No thanks to science, reliable male contraception = sterilization, which just won't fly with the patriarchy-lovin' ethicists (hee ha ho), so it's all a bit of a moot point.

Thanks again to all for the excellent conversation.

Did I just missed the train?

All comments and a reaction to them are already in place.

Responsible parenting brings mostly joy to all involved. Irresponsible "child producing" has the potential for being a heavy burden and a source for never ending pain to all involved... and then some.. Mom

By Anonymous (not verified) on 02 May 2007 #permalink

There is a HUUUUUGE difference between teenagers who do not understand the consequences of unprotected sex and the child-rearing that inevitably follows, and mentally disabled people doing the same thing.
The teenagers are at least _capable_ of rising to the occasion and take responsibility for their actions.

And don't even try to bring up the tired old drivel about the Nazi eugenics program. That's just poisoning the well and it's a cheap shot to make.
Crying 'nazis!' works well to scare the uninformed majority of people, but you're way out of your league on an intelligent forum like the scienceblogs where people actually know what happened back then.

This is just one of my pet peeves. The only reason everyone thinks all things nazi=evil is that that's the only thing they're allowed to learn in school. And it's about as useful as learning the the devil is behind all bad things that happen in the world.

If we were actually _allowed_ to teach everyone about the details of the regime and the eugenics program and the atrocities and their manipulation of a democratic system, then maybe we could avoid it in the future. But everyone seems to insist that the soundbyte nazi=evil is all we'll ever need to know, so we're doomed to repeat history that way.

I harbored similar thoughts during my fellowship days in the pre-antiretroviral AIDS years. The suffering of babies born with AIDS was and continues to be horrific, yet we were unable to convince some women (who were also many times substance abusers) to go on birth control and they wound up giving birth to several HIV positive children who then developed AIDS before the mothers died of the disease, leaving their children to foster care and an uncertain future.
These women were not developmentally disabled, so the argument for forced birth control was even more untenable. I guess society has to draw the line somewhere, and even after witnessing this, I'd rather draw the line on the side of more choice and freedom than less.

If a woman is incapable of giving informed consent to having sex, then any male who has sex with her is guilty of statutory rape.

It is not a matter of eugenics, it is a matter of protecting children. Anyone convicted of child neglect or abuse should be sterilized so that they can't neglect or abuse yet more children. And anyone who has a child they can't/won't care for is neglecting that child.

From that Wikipedia link David posted about Godwin's law:

"Godwin's Law does not apply to discussions directly addressing genocide, propaganda or other mainstays of the Nazi regime."

Forced contraception or forced sterilization seems squarely within that "other" to me. Those who don't see the connection might want to spend some time taking to their inner Nazi who would like to control everyone and everything around them.

Incompetent people should have a guardian to decide whether a woman should have long-acting contraception in place or a vasectomy for an incompetent man for that matter. That paragraph you quote does not mean that there is any limit on a guardian authorizing contraception or sterilization. Are you objecting to guardians not being responsible or to people reproducing who are too competent to have a guardian? Are you objecting to doctors or the state not being empowered to impose their judgments on patients and their guardians? You make it clear that you object to the existence of these babies you mention, but beyond that you're rather vague. Who should enforce this principle you have that people should avoid pregnancy unless they have good resources and parenting skills?

When I was a young physician, I learned to say, "I only give advice." Partly that was for people who wanted to argue with my advice, when there was no way I could tell them everything that went into my advice and wasn't going to hear anything that would make me change my advice. It's just advice. It's up to those patients and guardians whether to follow it, for contraception or anything else.

Under what circumstances should my advice be forced on people? That comes up for psychiatrists, though even then it's for hospitalization, not medication in general. Psychotic people cause enough trouble that the state makes this exception to autonomy. If babies caused as much trouble, I suppose the state might make an exception for contraception, but what is the trouble? There are many people looking to adopt babies as opposed to older children. Family members may seem burdened if they keep the baby, but it's their choice. Where does the "goddamn" come from in your title except from you putting your opinion on a pedestal?

I understand very well how it would be nice to license parents. Maybe as encouragement there could be special government benefits for licensed children who are loved and provided for, however that could be determined, as opposed to ones who aren't. I don't know if that would encourage more well-planned children. Maybe it would. No matter how utopian one could design such a policy, though, there would still be lots of accidental children, as I was. We didn't get to a world population of over 6 billion without biology often overpowering reason.

There's eventually someone competent to talk to for every physician, whether that's a guardian or a patient, and apart from some emergency that person has to consent to anything I do as a physician. Sometimes I'll feel strongly enough to make a very hard sell. If that doesn't work, it's not because the person I'm talking to is stupid. It's because that person wants something else. If that something else is a danger to the patient or to others, the state gives me options, but not just because I think I'm right.

Maybe the problem here is that you're not the one suggesting contraception or a tubal ligation before a woman gets pregnant or even afterward. If you see other doctors as the ones at fault, I missed that in what you wrote. We can be very persuasive. Could we have prevented those babies that set you off? Why don't you criticize us?

Humans will always be bound by their ethics. We as a mainstream society will always uphold personal autonomy even when it ends up in an unfortunate situation. As another commenter said, it's a slippery slope ... when we start taking a human's autonomy away, it brings us that much closer to having someone else take *our* autonomy away.

I don't think women should reproduce when they are literally mentally or physically incapable of caring for offspring. But it will continue to happen.

Because our ethics are just so much more important than the unfortunate situations. :/

Even worse, in my opinion, are anencephalic babies kept "alive" by artificial means, running up millions of dollars of expense, tying up valuable caregivers and resources, for NOTHING. The babies WILL die, the hospital care is a waste of everyone's time and money. Sometimes it's more humane to let nature take its course. Meanwhile, mentally functional but physically ill children who sorely need expensive medical procedures may be going without because their families can't afford the care. Go figure.

Be careful. Don't equate having an unwanted baby with either subnormal intelligence or child neglect. I was a Mensa member and a sophomore in college when I moved in with my boyfriend because I had no support from my family (Mom and Dad were deep in a difficult divorce). Once he had me under his control, he proved what a sociopath he was. He refused to wear condoms and refused to control himself. He took away my car keys and chased off my friends. When I stopped having periods he grudgingly let me go to the free clinic, where after a blood test and pelvic exam the doctor misdisgnosed my four-month pregnancy as stress-induced amenorrhea and weight gain from stress-related eating. (Yeah, really.) I know I was naive and scared to death, but I was just trying to do what everyone expected of me. I had the baby and kept him because my boyfriend threatened to shoot me if I gave his kid away, even though he ignored the baby and contributed nothing to support him. I went to a shelter with the baby one day when he finally left me alone, and while I was there the social workers noticed my son didn't respond when I called him, so they gave me tests that proved I was severely clinicaly depressed (duh, you think?) and assumed I was neglectful. They took my baby and put him in foster care and kicked me out of the shelter. When the court hearing came around a couple weeks later, they used my homelessness as an excuse to terminate my parental rights. Turned out my son was profoundly deaf.

He's 20 now and I haven't seen him since then. My dad went to try to see him once and said that despite being deaf he is extremely bright and accomplished. That's nice and all, but if I had it to do over again I think I would have just given him up for adoption and let my boyfriend kill me for it like he threatened to.

Is this an over-the-top story? Do you think so? Do you believe horrors like that can't happen to a nice, bright girl from a decent middle-class family? Do you really think I had to have been mentally retarded? I, too, begged the doctors to tie my tubes and they refused. I, too, still wish they had, 20 years later.

By speedwell (not verified) on 03 May 2007 #permalink

I'm sorry; I have a cold and I can't sleep. What I really want you all to take away from my experience is:

- Good, normal girls are easy prey for manipulators and rapists. They don't understand what they're going through and they blame themselves.
- Good, normal girls may have had sheltered childhoods and know nothing about how to ask for help, or may be too ashamed to ask for it.
- Good, normal girls in trouble deserve your help and kindness, not your condemnation and condescension.
- Even young women have the right to ask for surgical sterilization if it's available to any woman, even before they have three children they don't want (that was the rule, they told me).

By speedwell (not verified) on 03 May 2007 #permalink

I'm sure you guys are all very sincere and mean well, but...

In a democracy, all rights belong to the people.

Sometimes the people delegate certain powers to the state.

I know of no law that delegates to the state the authority to decide who gets to reproduce and who doesn't.

I wouldn't trust the state with such powers, despite how well meaning it is, mostly because of the horrible example they set the last time they usurped such powers (in the eugenics era).

Do you think politicians and bureaucrats are more intelligent or enlightened than they were in the 1920's? Did human nature radically change since then and I didn't notice?

I have read a few of your other blogs, this is all I have to say "Please leave the medical field!" You appear to have to high a morality persona to allow you to be a medical practioneer - you judge people and therefore you are 'passing judgement' on your patients - which ultimatly means you will pass judgement on who does or does not recieve treatment, who lives who dies - you are not objective - you are not detached - you do not belong in a field where it is paramount you can separate your values from those of your patients and uphold your patients because ultimatly it is their lives your are 'making decisions on'! There's already to many 'moralists' in the world who call themselves doctors - we don't need another one!

First -- uh, TG, Orac *is* one of the more intelligent Scienceblog bloggers; Google "Respectful Insolence". He is also both very concerned with medical care, and extremely historically literate. His caution to Signout isn't Godwinning, I would say it is attempting to point out just how deep the problems behind this particular issue really are, in public perception, and why.

And speedwell -- I'm not sure where you're coming from on this. The cases Signout is discussing here are not necessarily "unwanted" babies at all -- but they ARE babies being produced by people who are not only incapable of taking care of them, but who are likely to be incapable of taking care of them even under ideal circumstances and with ideal support. That does not include people like you; you would seem from your story to fall into the "no support" situation. It doesn't include normal-but-clueless teenagers like another poster mentions, who would at least potentially be able to rise to the occasion and provide a standard of care, even if they didn't know what they were getting themselves into. It's more about people who either can't change their level of ability to cope, or who have reliably demonstrated by their past behavior that they won't, and will force those around them to shoulder the costs of care forever.

Believe me, a lot of misery could be avoided if there were some way to enforce reproductive control on some people. I have fostered some of the kids to come out of these situations, and no-one should ever have to start out the way they have started, or deal with what these poor kids have dealt with. And in many cases, because of maternal rights, they don't get taken away until they are toddlers or older (thus, less adoptable) and have sustained enough damage to have serious behavioral issues (thus, less adoptable), and are more likely to be put in less-than-ideal fostering situations which will not help them solve those problems in the long run. We perpetuate generations of damaged lives that way, sometimes.

What you needed was support. What some of these people need is to not have babies. Different issues.

Speaking for myself -- I find it interesting, from both an anthropological and a zoological perspective, that there is a widespread perception that people have a "right" to reproduce successfully, because that is natural. I think people need to have a closer look at nature.

There are mammals like wolves and meerkats, where only the top couple in a group gets to reproduce; the underlings are kept sterile through the stress hormones which are released as a result of their getting beat up on a lot by the top couple. The underlings are expected to help care for the top couple's sprogs, though.

There are birds like, oh, eagles, hawks, kestrels, where they all make an attempt to reproduce, but less than a quarter of them are responsible for the vast majority of the long-term survivors, because most of the chicks die early or fail to reproduce, themselves.

There are birds like grouse, where many of the individuals aren't even guaranteed a mate in the first place.

A "right" to reproduce is more of a primate model, granted, but it is only one way in which "nature" deals with the problem; there is no universal "natural" about it at all. And in every other population of just about every other everything on the planet, some individuals are simply never successful parents because they aren't capable of caring for their offspring and those offspring simply die. THAT is "natural".

While I do not see any particular moral or ethical imperative to follow that "natural" model -- indeed, a few moral and ethical imperatives not to, really -- I also think that it is misguided to keep allowing this "right" to continuously create babies which others have to care for, on the basis that it is a natural right. No, it's not.

Which doesn't in any way minimise the problem of "who is capable or allowed to decide who is entitled to reproduce", but that is kind of another can of worms.

By Luna_the_cat (not verified) on 04 May 2007 #permalink

Oh, and mitch -- on Signout's behalf, piss off. Every doctor and medical professional under the sun is likely to deal with moral and ethical quagmires which have a profound influence on lives; better that they actually think about morals and ethics than simply make decisions by default. And everyone judges people. It is inevitable. It is how we interact. You cannot deal with other people at all without forming judgements with which to guide ourselves. Or do you somehow think that we don't? Defend!

Again, better that an individual be aware of their judgements of others, and of why they make them, than that they simply not pay attention.

By Luna_the_cat (not verified) on 04 May 2007 #permalink

"Godwin's Law does not apply to discussions directly addressing genocide, propaganda or other mainstays of the Nazi regime."

Forced contraception or forced sterilization seems squarely within that "other" to me. Those who don't see the connection might want to spend some time taking to their inner Nazi who would like to control everyone and everything around them.

I disagree. I find drawing a direct link between forced contraception/sterilization and the nazi regime fallacious. That's not meant to be a criticism to Orac, who merely articulated why this is such an emotive issue. Rather, that introducing nazi themes, which I thought this comment thread was on the cusp of, detracts from the discourse, precisely because it is so loaded. Which I'm sure you know, since you're trolling with that inner-nazi quip.

I'm a Master's student of Sociology, in the province of Alberta in Canada. One of the professors I TA'd for did a fairly large project on Alberta's forced sterilization program of "mental incompetents" that took place between the 1920s and 1970s. One of the things that the historical record revealed was that the label of "mental incompetent" was indiscriminately applied to immigrants who could not speak english, the impoverished, and those who did not fit into the WASP model of the British-descended people in power. One very famous case that came out years later, the sterilization of Leilani Muir, revealed that there were Albertans who were wrongfully sterilized on the basis of one faulty IQ test. Alberta has been dealing with lawsuits ever since Muir's case came into the public eye as others who have faced similar treatment come forward for justice.

Certainly this is a sticky subject. In the case of someone who IS truly "mentally incompetent" and will never be able to raise a child, allowing indiscriminate pregnancies is almost indisputably unkind and irresponsible. However, whenever there is talk about sterilization or forced-contraception for anyone, it is very important to think of the criteria used to judge incompetence, and whose interests are reflected in those criteria. Among the groups that the Albertan government considered de-facto incompetent were our native peoples, due to rampant poverty and alcohol abuse in the communities. These things are the result of societal disfunction, they are not genetic defects. Yet the government of Alberta still sterilized native women - in essence a genocide for racist reasons. The racism of the early Canadian government towards anyone not Anglo-Saxon is fairly well documented, and it can be argued that they had ulterior motives in their sterilization programs. Anytime you have a program that will be taking away someone's reproductive freedom, you need to watch the people making the decisions of who can and can't reproduce VERY carefully. There is a huge potential for abuse.

Errihu -- that is exactly the can of worms that makes any such proposal unworkable in an ethical society, unfortunately. People with the power to make such decisions inevitably end up abusing it, and there have been terrible abuses. In the US, as well, incidentally -- there were forced sterilisations of native Americans up to as late as the 70s.

Now, don't get me wrong -- I am very well aware that this isn't going to happen, but -- well, as a "wishful thinking" scenario, I rather like one idea that Lois McMaster Bujold bandied about in some of her SF books. A reversible biochemical "lockdown" of the gonads gets developed, for male and female both, which leaves libido intact but removes all possibility of actual reproduction. This biochemical lock is applied to every single person on the planet, bar none, a standard universal default across the board as soon as adolescence starts to kick in. And by everyone that means EVERYONE. -- And it isn't removed until the individual expresses a desire for children and passes a set of basic competency tests. Not an IQ test, just competency for parenting. To my mind that would be things like "how old must your baby be before you can even think of feeding him/her solid foods", or "your baby won't stop crying. Do you (a) shake him/her in frustration, (b) walk the floor with your baby for hours, or (c) pour boiling water over the baby to give it something to REALLY cry about." (Noting, of course, that certain answers should ensure that the biochemical lock is never removed, ever.)

Of course corruption would afflict a system like that as well, soon enough, but it's wishful thinking.

By Luna_the_cat (not verified) on 05 May 2007 #permalink

OK, Luna, that makes sense. Fair enough. Thanks for clarifying.

By speedwell (not verified) on 05 May 2007 #permalink

This is a really sensitive subject. Forced sterilizations weren't used only in Germany, but right here in the US, too. Almost invariably by doctors that thought that they were doing the right thing.

Having a policy on the right to reproduce should be looked at like you would look at a law that was up for consideration: Imagine this proposed power in the hands of the worst person that you can think of. Could it be misused at all?

Eugenics (the improvement of human traits through intervention) was first really seen as viable starting in the mid-Victorian era, and was widespread in the US until the mid-1940s - ushered in, oddly enough, by the great progress that was being made in both public and mental health sciences during the period.
My own state of Vermont has a shameful past where the poor, the mentally ill and anyone counted as "undesirable" -such as the native population as well as foreign immigrants who came to work in the lumber and granite industries- were medically sterilized in a (perhaps unconscious) effort to get rid of the underclass.

Here are just two chilling quotes from writings of the times:

"...I think we can safely say that in the sixty-two families that we have studied..."blood has told," and there is every reason to believe that it will keep right on "telling" in future generations. "Running water purifies itself." The stream of germ-plasm does not seem to."

Henry F. Perkins
Lessons from a Eugenics Survey of Vermont, 1927

"...The rights of the individual cannot be fully safeguarded when he is being compelled to support in the midst of his community the lawless, the immoral, the degenerate, and the mentally defective.... We are beginning to know enough about human heredity, about the working of the sterilization laws, to have a little courage, and to undertake a much needed reform. To make our state safe for decent citizens, to free the taxpayer from unnecessary burden in the support of the hereditary defective, to place upon a self-respecting, self-supporting basis the largest percentage of our boys and girls --- these are the objects for which constructive social betterment measures ought to be passed."

Henry F. Perkins,
Lessons from a Eugenics Survey of Vermont, 1927

To me, this is scary, scary stuff.
These people came to the attention of the state by being visible because of using public or private charities, being committed to the state mental hospital, the family being "asocial", criminal, and, in one case, because family members had been institutionalized in three states for having Huntington's Chorea, a degenerative neurological condition. Families of mixed racial ancestry were particularly vulnerable to eugenic investigations.
The people were forcibly taken from their homes and sterilized so that they wouldn't carry on their supposed genes for drunkenness, thievery, bad morals, and other undesirable traits.
The state also participated in prevention of marriage of "feeble-minded" persons.

This all happened less than a hundred years ago. I understand seeing something and saying "they shouldn't be allowed", but it's been done, and it was a tragedy to be learned from... and besides, it obviously didn't work - there are still plenty of stupid, impaired and folks of "poor moral fiber" all over the place!

You have NO frigging IDEA>>
it's ALLLLLL upto GOD...
and predestinedddd
so set back and enjoy or
HATE the ride..
HE controls alll
fing a

Did I just missed the train?

All comments and a reaction to them are already in place.

Responsible parenting brings mostly joy to all involved. Irresponsible "child producing" has the potential for being a heavy burden and a source for never ending pain to all involved... and then some.. Mom

I'm a grad student in educational psychology, supporting myself and my family teaching early childhood special ed. This discussion is highly relevant to the world of education now because all children in school(3rd grade and above) are part of assessing Adequate Yearly Progress as defined by NCLB. How are teachers supposed to be held responsible for the learning difficulties brought about by a developmentally delayed mom who birthed four babies on crack?

Additionally, it's horribly expensive to educate the very young children who require special education. I focus my efforts on the children and purposely do not ruminate on how they got this way, but sometimes I allow myself to imagine what they might have been like without being born with cocaine in their system, or as the first wanted child and not the 10th unwanted one.

Just another facet to consider. Eventually these children go to school...

I disagree. I find drawing a direct link between forced contraception/sterilization and the nazi regime fallacious. That's not meant to be a criticism to Orac, who merely articulated why this is such an emotive issue. Rather, that introducing nazi themes, which I thought this comment thread was on the cusp of, detracts from the discourse, precisely because it is so loaded. Which I'm sure you know, since you're trolling with that inner-nazi quip.

I have read a few of your other blogs, this is all I have to say "Please leave the medical field!" You appear to have to high a morality persona to allow you to be a medical practioneer - you judge people and therefore you are 'passing judgement' on your patients - which ultimatly means you will pass judgement on who does or does not recieve treatment, who lives who dies - you are not objective - you are not detached - you do not belong in a field where it is paramount you can separate your values from those of your patients and uphold your patients because ultimatly it is their lives your are 'making decisions on'! There's already to many 'moralists' in the world who call themselves doctors - we don't need another one!

So, although I can see what you're saying, I get the distinct impression that you don't really understand the full extent of the history that leads to such revulsion at arguing that the reason such people shouldn't be allowed to reproduce is because of the burden to society that caring for their children results in. It's an argument that resulted in just as much suffering as eugenics-based arguments.

Ust siralara gelmek icin ugrasmaktayiz elimizden gelen bu baska bisey yapamamaktayız bunu ister inanin ister inanmayin siz iyi olun bakalim herkes artik kendisini dusunmekte o yuzden boyle olmakta