Reproductive Freedom I
Michael A. Gillette, Ph.D.

In the 1920's and 1930's, there was an extensive wave of eugenics activity in this country. It was widely believed that in one generation most of the country's crime and other social problems could be eradicated by eliminating the genetic predisposition for defects of various sorts, including anti-social behavior.

As a result of this way of thinking, thousands of individuals were forcibly sterilized, including one client residing in what is now known as The Central Virginia Training Center. Carrie Buck, an 'illegitimate' child and mother of an 'illegitimate' child, was forcibly sterilized. Her appeal was brought to the Supreme Court of the United States where the decision to sterilize Ms. Buck was upheld on the basis of the view that "three generations of imbeciles is enough".

The reasoning given by the court in the landmark decision of Buck vs. Bell was based on the idea that if society has the right to call on the best and ablest of its members to make sacrifices for the sake of the general welfare (a veiled appeal to the Civil War which was still in the mind of the presiding Chief Justice), then the state could certainly make demands upon those who already sap the strength of the state and promise to continue to do so in the future by producing non-productive offspring.

The American attitude concerning forcible sterilization has developed immensely since the days of Buck vs. Bell. Several court cases surfaced in the 1980's which tested our intuitions regarding the rights of individuals with mental retardation to maintain their reproductive capability and to avoid invasive surgical procedures. The Court in these more recent times has attempted to distance itself from earlier precedent by restricting the opportunity for sterilization of individuals with mental retardation. In many cases it is difficult for parents to make such choices for their own children, even when the parents feel that sterilization is truly in their children's best interest.

Two questions immediately come to mind when considering the cluster of issues surrounding the question of involuntary sterilization. First, is the original Supreme Court position as embarrassing as many people believe it to be? Is it unreasonable to make decisions that effect people in such personal ways on the basis of the greater good? Second, if these types of arguments are not appropriate, are there any tenable philosophical arguments that could be constructed to defend such practices?

In the interests of continuing the discussion that was initiated in earlier "Notes from the Ethics Committee", let us begin with the first question, and continue with the second question next month.

Is it permissible to make reference to the greater good in order to force people to endure surgical procedures and be restricted from behaving in biologically intrinsic human activities such as reproduction? On the face of it we cannot help but think that forcible sterilization is unacceptable. However, we may accept similar practices on these grounds without flinching. Much of the financial pressure to down-size facilities like ours is based on precisely the same view; that it is unfair to ask the general public to spend large amounts of resources for the benefit of a few.

In recent Brown Bag sessions, staff at this facility have discussed the ethics of intentional reproduction when parents know for a fact that they have a highly increased probability of generating developmentally disabled children. Some argue that such action is morally irresponsible by itself. Others argue that it is only morally irresponsible to have children in this way if the parents are unwilling or unable to accept the additional responsibilities and pressures (financial as well as emotional) that follow from such choices. In other words, most individuals in our discussion group are open to the idea that people have a moral responsibility to avoid placing increased pressures on the rest of society whenever possible.

However, even if we do admit that it would be morally wrong for couples to have children which they are not prepared to care for, that still might fall short of justifying forcible restriction from that behavior. It is possible to morally disagree with a person's behavior and still refuse to interfere with that behavior.

The response to the Buck vs. Bell reasoning does not have to attack the basic idea that the welfare of the group can be used to control the actions of individuals. In order to argue against that Supreme Court decision, we need only recognize that while the overall good is important in determining what is right, coercion itself entails a harm. The harm of coercing people to do their moral duty might outweigh the harm of letting people freely do what is wrong. So while we might tell people that they ought to act more responsibly, and may even accuse people of immoral action, we might still wish to avoid forcibly intervening. Prison and sterilization are extreme measures that must be reserved for extreme situations which offer no other alternatives.

Finding it theoretically possible to care for the overall welfare as well for the freedom of individuals does not solve this problem, however. As we shall see next month, there may be times when sterilization is a viable alternative.