Reproductive Freedom II
Michael A. Gillette, Ph.D.
This document and
the ideas presented herein are the intellectual
property of Bioethical Services of Virginia, Inc.
and may be used and reproduced only with proper
In the last issue of this newsletter, we discussed an
argument which was designed to show that forcible
sterilization is not as easily justified as was believed
fifty and sixty years ago. Thankfully, the eugenics
programs that flourished in the United States over a
half a century ago have long since been eliminated.
However, we must wonder if we have moved too far in the
opposite direction. Have we inadvertently created an
environment in which the best interests of some
individuals with mental retardation are not secured
precisely because we refuse to permit forcible
Consider the case of a thirty year old man and woman,
both of whom have mild mental retardation, but who love
each other and want to live together as husband and wife.
Let us assume that the couple does understand the likely
results of their sexual activity and that they have
specifically noted a desire to have children together. Let
us also assume that they have been ruled by a court to be
incompetent to make their own medical decisions and that
their respective parents, acting as their guardians, are
willing to permit the marriage but do not want to take any
chance that the couple will have children.
An argument has been presented in the philosophical
literature that would support the use of surgical
sterilization in this case, all other things being equal,
even over the objections of the man and woman themselves.
The reason that I must note "all other things being equal"
is that an obvious first step in examining this case must
include a discussion of the goals that the parents wish to
achieve for their children, as well as the possible
alternative methods for achieving those goals.
We must learn why the parents of this man and woman are
willing to let them marry, but not willing to let them
have children. Have the capacities of these people been
properly determined and are the parents truly acting out
of a concern for the best interests of their children and
possible grand-children? The possibility of initiating the
use of a contraceptive like Norplant would seem to be a
desirable option over the prospect of sterilization
without patient consent.
Even if Norplant were an option, however, that would
not solve our problem. Norplant is reversible, so the
impermanence of using such therapy relieves much of the
difficulty. Nevertheless, we must still wonder whether
forcible drug therapy in such situations would be
ethically permissible itself. The very same issues
regarding individual rights would crop up when drug
therapy is utilized against a person's will rather than
surgery. case. We can safely assume that similar ethical
issues will arise whichever option we choose from among
the available treatment alternatives.
Robert Neville argues carefully in "Sterilizing the
Mildly Mentally Retarded Without Their Consent: The
Philosophical Arguments" that the above outlined case is a
prime example of a situation in which non voluntary
sterilization is morally appropriate. (This article
appears in a book entitled Mental Retardation and
Sterilization which is available in the Ethics Office,
Neville argues that if the goal in working with people
with mental retardation is to provide them with as normal
a life as possible, complete with the autonomous control
over as many life choices as possible and the freedom to
maintain a healthy sex life, then sterilization will
provide the greatest benefit. By reducing autonomy in one
area of these people's lives, we actually increase the
overall capacity of these individuals to live
substantially autonomous existences. In other words, a
little loss of autonomy now is worth experiencing if it
will generate a greater freedom later.
It is important to notice that Neville is not arguing
as people did sixty years ago. He is arguing out of
concern for the best interest of the individual with
mental retardation, not on the basis of overall social
good. That fact makes the argument much more reasonable to
many. In fact, the argument seems compelling. We all
accept short term pain (inoculations) for long term
benefit (avoidance of disease). If the argument works in
most cases, why won't it work in these cases as well? If
my only other alternative is to deny the two people in our
example the opportunity to live together in a loving
relationship, and perhaps to keep these two people
physically separated, is it not best to select the option
of allowing them some measure of a normal romantic
involvement even if that entails denying them the
opportunity to have children?
While I do not wish to argue that Neville's points are
without merit or that they must obviously be false, there
is one significant counter-argument to consider. Is
autonomy the sort of thing that can be traded off from one
day to the next? Is autonomy the sort of thing that we are
merely attempting to maximize over time, or is it the
inviolable right of human beings to be honored in their
autonomy, come what may?
We find in this discussion, as in most ethical
disputes, the need to think theoretically about the
conflict between inalienable rights and expediency. The
next step then, in determining the merit to Neville's
view, would be to consider the extent of the right to
bodily autonomy and the right to reproduce.