Abstract

In their practice doctors are confronted with the question of sterilization of mentally handicapped persons. The handicapped person, his family, the family doctor and other concerned individuals involved in the decision act in a medical and legal vacuum. There is a medical vacuum because no medical consensus as regards the criteria for indication and the use of a standard procedure exist. There is a legal vacuum because a patient must voluntarily give permission for sterilization to be carried out, and in most cases the mentally handicapped person concerned is not capable of giving such permission. The doctor who carried out a sterilization could be prosecuted. ;The first part of this study reviews the literature on this theme from 1965 to the present. The information is arranged into six chapters: the historical evolution of the concept of mental retardation, sexuality, birth control, marriage and parenthood, ethical aspects and finally legal aspects. ;The second part consists of an empirical survey. By means of a case-study method the variety in behavior concerning sexuality, relations and birth-control is investigated on 52 mentally handicapped adolescents between 16 and 21 years old. Further the attitude of parents and family doctors regarding sexuality, relations, prospectives and possible sterilization of the mentally handicapped adolescents is examined. Finally the possible role of the family doctor in sterilization requests for mentally handicapped adolescents is investigated. ;The third and last part formulates the medical-ethical criteria that make it possible to evaluate whether a sterilization of a mentally handicapped adolescent is ethically justified. These criteria are measured as major and minor criteria and ordened in a practice-directed algorithm, which can be used for the adolescent, as well as for the mature, mentally handicapped person. Finally the proposal of procedure is formulated paying attention to legislation