In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In (...) the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques. (shrink)

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children (...) should have their requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians’ reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result (...) from this reluctance serve as a useful filter for women who are not seriously committed to their expressed requests for sterilisation. As women already disproportionally bear the birth control burden, less resistance that men might be getting in terms of voluntary sterilisation works to women’s advantage, providing a much needed balance. Societal attitudes towards women and motherhood should not be confused with individual physicians’ reasonable reluctance to jump at a serious elective procedure at fairly mild expression of interest. (shrink)

Despite a “spatial imaginary” which constructs Europe as a location of sexual and gender freedom (Rao, 2014), presently, twenty countries in Europe require sterilisation in order to legally recognise transgender people’s gender identities, including four of the seven countries in the INFERCIT study: Greece, Italy, Turkey, and Cyprus (but not Spain, which since 2007 does not require sterilisation for gender identity recognition [see Platero, 2008]. In Bulgaria and Lebanon no gender identity recognition for trans people is provided by (...) law; the latter lies outside the “European” region) (TGEU, 2014). Compulsory sterilisation—classified as a crime against humanity in the Rome Statute of the International Criminal Court (UN General Assembly, 1998: art. 7.1)—is widely in force against transgender people, who constitute “the only known group in Europe subject to legally prescribed, state-enforced sterilisation” (Hammarberg, 2009: 19). However, forced sterilisation of trans people is not generally conceptualised as a eugenicist or genocidal policy, in part because sterilisation is conflated with gender reassignment surgical interventions which, widely considered as that which brings transgender bodies into being, are in turn conflated with embodied transgender subjectivities. On this view, transgender individuals could not exist except through a medicalised process that, by design, precludes their “natural” reproductive capacities and is generally not accompanied by fertility preservation or the provision of assisted reproduction technologies (Plemons, 2014: 38; De Sutter et al., 2002; De Sutter, 2001). Sterilisation laws are justified through a pathologising discourse on transgender lives which constructs gender reassignment interventions as medical “treatment” of gender identity disorder (Suess, Espineira & Crego Walters, 2014: 73-76). Adopting a depathologising perspective enables us to contextualise compulsory sterilisation (which naturalises the sexually dimorphic, cisgender, heterosexual body) as a form of “gendercide” which has historically been instrumental in the imposition of a Euro-colonial binary gender system (Miranda, 2010; Lugones, 2007). The state-imposition of medical interventions on trans people not only has deleterious effects on their reproductive rights, “effectively undermin[ing] their right to found a family” (Hammarberg, 2009: 21; see OHCHR et al., 2014)—as “family” is hegemonically defined by a heteronormative and bio/ logical kinship order (Butler, 2002; van Anders, 2014). I argue that state regulation of transgender reproduction constitutes a form of institutionalised gendered violence inasmuch as it impedes transgender people’s ability to exercise inherent first-person authority over the materiality and meanings of their gendered embodiments (Bettcher, 2009; Spade, 2013). Efforts to renaturalise gender and kinship inextricably intersect (Kantsa, 2006) in the biopolitical attempt to regulate transgender embodiments and reproduction, which conditions the emerging legal recognition of transgender subjects as a rights-bearing minority (Stryker, 2014). (shrink)

Many women identify sterilisation as their preferred form of contraception. However, their requests to be sterilised are frequently denied by doctors. Given a commitment to ensuring women’s reproductive autonomy, can these denials be justified? To answer this question, I assess the most commonly reported reasons for a denied sterilisation request: that the woman is too young, that she is child-free, that she will later regret her decision, and that it will lower her well-being. I argue that these worries (...) are misplaced and hence insufficient reasons for denying a request. I also argue that even if concern for patient welfare provides doctors with a valid reason to withhold sterilisation, this is overriden by respect for patient autonomy and the importance of enabling women’s reproductive control. Consequently, I suggest that adequately informed, decision-competent women should have their requests for sterilisation agreed to, even if they are young and/or child-free. In addition, I examine the impact of pronatalism on how women’s requests are understood and responded to by doctors. I show that the equation of women with motherhood can make it unjustifiably hard for them to access sterilisation, especially if they are child-free. Consequently, part of ensuring women’s access to sterilisation involves challenging pronatalist beliefs and practices. (shrink)

Doctors are regularly confronted with requests for sterilisation of mentally handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a model for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select and classify certain factors which could enable us to arrive at an (...) ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting competence, and six minor criteria: conception risk, IQ, age, personality, medical aspects and prognosis and finally support and guidance for the mentally handicapped person. The major criteria give rise to a "situation of necessity". In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical order. They can only be considered once the major criteria have created a "situation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, where efficient contraception is the end and irreversible sterilisation is the means. (shrink)

The view that eugenics was based on unscientific views has been put forward by a number of historians. It has been claimed that the early phase of eugenics, so-called mainline eugenics, was unscientific, biased against the lower classes, and racist. An ensuing reform eugenic phase, however, has been considered scientifically sound and politically progressive. This paper, based on recent studies of eugenic sterilisation in Scandinavia, challenges this view. The political and scientific arguments in favour of eugenic sterilisation laws (...) in Scandinavia were complex and ambiguous, and it is empirically impossible to identify a problematic mainline eugenic phase and separate it from a more acceptable reform phase. Social and scientific arguments for sterilisation appeared side by side. To improve the gene pool was only one of a host of aims of eugenics, which “was” not a fixed, well-defined ontological entity with one definite purpose, but a concept with multiple meanings. (shrink)

Sterilisation has been increasing in the United States in recent decades. Using the National Survey of Families and Households, this paper examines sterilisation among married couples using event history techniques, viewing husband and wife sterilisation as competing risks. Wives are more likely to experience sterilisation and at shorter durations of marriage. Number of children has a curvilinear effect on sterilisation, increasing and then decreasing its likelihood. Wives who are older than their husbands are more likely (...) to get sterilised themselves. Black and Hispanic husbands are more likely to undergo sterilisation. (shrink)

In the Fall of 1997 the leading Swedish newspaper, Dagens Nyheter, created a media hype over the Swedish policy of compulsory sterilisation that had been in operation between 1935 and 1975. In the discussion that followed the moral condemnation of our medical past was unanimous. However, the reasons for rejecting what had gone on were varied and mutually inconsistent. Three strands of criticism were common: the argument from autonomy, the argument from caution, and the argument from biological scepticism. In (...) the paper it is argued that what point of departure you choose in your criticism of the past should be of consequence also for your ideas about present and future medical practice. In particular, if you rely on the argument from autonomy, you should be prepared to accept a liberal (present and future) use of reproductive techniques. (shrink)

Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec’s healthcare in general and in vitro fertilisation in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion—prior voluntary sterilisation—has prompted little critical commentary. The two justifications offered (...) for restricting funding for IVF on the basis of voluntary sterilisation are that there are cheaper options than IVF for sterilised individuals who want children, and society should not have to pay for IVF for persons who are infertile by choice. I argue that both of these justifications are unsatisfactory, insofar as they contravene the chief value underlying, and current practices of, Canadian healthcare, and rely on problematic ascriptions of personal responsibility for health. (shrink)

In her paper, Sue Teper outlines the various methods of contraception or fertility control and their relationship to sterilisation. She also considers a particular group of women in Aberdeen as a mini case-study. From these two aspects of sterilization develops a third--that of broader medical and economic issues. Sterilisation usually concerns patients who are free from illness, therefore the attitudes of medical personnel are much more relevant to whether or not the operation is performed on request purely as (...) a means of fertility control, rather than for medical reasons where the patient may be at risk were a pregnancy to occur. Ms Teper calls for medical staff in this instance to clarify their own attitudes in decisions which involve surgical skills and healthy patients. (shrink)

This paper discusses the importance of informed medical consent through a case study examines the implications this case had for the medical rights of EU citizens. I start by describing a case of a Slovakian national of Roma origin against the Government of Slovakia, which appeared at the European Court of Human Rights in 2007-2012. The twenty-year old woman, who had been sterilized at a Slovakian hospital during the birth of her second child, claimed that the procedure took place without (...) her full and informed consent, and argued that the doctors’ decision was connected to the society’s long-standing negative attitude towards Roma people. After presenting the background of the case and the legal proceedings, I discuss the relevant national and European law in order to explain the positions of both sides and the rulings of the courts. I conclude by putting the case in a wider context of racial discrimination in the EU and providing a policy analysis regarding both the Slovakian and the European policies toward the Roma minority. (shrink)

Sterilisation is the most desired method of contraception worldwide. In 1996, the Brazilian Congress approved a family planning law that legitimised female and male sterilisation, but forbade sterilisation during childbirth. As a result of this law, procedures currently occur in a clandestine nature upon payment. Despite the law, sterilisations continue to be performed during caesarean sections. The permanence of the method is an important consideration; therefore, information about other methods must be made available. Tubal sterilisation must (...) not be the only choice. We argue that review of this restriction will not contribute to the increase in caesarean sections but will allow for greater sterilisation choice for men and women. (shrink)

This note examines two recent judgements of theEnglish Court of Appeal, Re S.L. and ReA., concerning the sterilisation of a womanand a man with learning disabilities. The casesare significant for health care lawyers in thatthey effect a reworking of the common lawdoctrine of necessity, which serves as thelegal justification for providing medicaltreatment to adults lacking capacity to giveconsent. The cases are also significant forfeminist scholars engaged in the project of`sexing' the subjects of legal discourse (forexample, Naffine and Owens, 1997). (...) Thejudgments of Re S.L. and Re A.,consistent with earlier sterilisation cases,fail to offer a conception of learning disabledsubjects as `sexed'. (shrink)

The recently reported cases of coerced sterilisation of women at a privately operated immigration detention facility in the USA are egregious in their disregard for human dignity and professional ethics, but sadly not surprising. These abuses represent a continuation of efforts to control the reproductive capacity of women, fueled by racist and xenophobic motives. Physicians helped create and legitimise the pseudoscientific framework for the eugenics movement, which would implement forceful sterilisation as its tool of choice to eliminate undesirable (...) traits that were thought to be biologically inherited and predominant among racial and ethnic minorities. Although state-endorsed forcible sterilisation programs have ended, incarcerated women have remained particularly vulnerable to sterilisation abuse. The intersectional vulnerabilities of racism, xenophobia and carcerality must be addressed to prevent such abuses from recurring. There are no data in this work. (shrink)

Some National Health Service healthcare boards in the UK will approve a request for female sterilisation only if the patient first accepts a trial period of 1 year with an intrauterine device (IUD), a form of long-acting reversible contraception. In this article, I argue that this requirement is not justified by appeal to any of (or any combination of) promotion of informed consent, paternalistic concerns regarding patient regret in later life and health service budgetary considerations. Informed consent and patient (...) autonomy may be promoted by a mandatory waiting period, but the concomitant imposition of an IUD trial during this period cannot be justified on these grounds. As long as elective vasectomy is offered by the healthcare system, elective female sterilisation should be accessible under reasonably similar—even if not identical—conditions. (shrink)

The 2015 judgment of the Namibia Supreme Court in Government of the Republic of Namibia v LM and Others set an important precedent on informed consent in a case involving the coercive sterilisation of HIV-positive women. This article analyses the reasoning and factual narratives of the judgment by applying Neil Manson and Onora O’Neill’s approach to informed consent as a communicative process. This is done in an effort to understand the practical import of the judgment in the particular context (...) of resource constrained public healthcare facilities through which many women in southern Africa access reproductive healthcare. While the judgment affirms certain established tenets in informed consent to surgical procedures, aspects of the reasoning in context demand more particularised applications of what it means for a patient to have capacity and to be informed, and to appropriately accommodate the disruptive role of power dynamics in the communicative process. (shrink)

Zürich: Chronos Verlag 2013. 351 S., br., ill., € 39,50. ISBN 978‐3‐0340‐1134‐1.

L’ouvrage d’Élodie Serna porte sur l’histoire des stérilisations masculines volontaires en Europe dans l’entre-deux-guerres (1919-1939). Souvent assimilée à une castration, la stérilisation a parfois au contraire été utilisée pour régénérer la virilité. Promue par les milieux eugénistes, elle a aussi été envisagée comme instrument de l’autonomie reproductive des couples. Ces contradictions sont articulées en deux dimensions d’analyse : premièrement l’étude de ces « multiples conceptions conte...

What are the duties of carers and health professionals to people with mental incapacity? How ought we to think about the ethical and legal issues? What can any of us do to improve and safeguard the lives of those cared for? This book seeks to examine in detail and find ethically robust answers to such questions. Among the topics discussed are withholding treatment, tube-feeding patients with dementia, the 'persistent vegetative state', medical research, and sterilisation of intellectually disabled adults. Contributors (...) come from a wide range of disciplines, including psychiatry, nursing, philosophy, theology and law. The book includes an account by Wendy Hiscox of non-voluntary euthanasia in the Netherlands and Belgium, and a chapter by John Finnis exploring some aspects of Britain's Mental Capacity Act 2005. (shrink)

The Mental Capacity Bill endangers the vulnerable by inviting human rights abuse. It is perhaps these grave deficiencies that prompted the warnings of the 23rd Report of the Joint Committee on Human Rights highlighting the failure of the legislation to supply adequate safeguards against Articles 2, 3 and 8 incompatibilities. Further, the fact that it is the mentally incapacitated as a class that are thought ripe for these and other kinds of intervention, highlights the Article 14 discrimination inherent in this (...) and related legislation. The financial, medical and research interests that underpin the legislation highlight how the legilsation endangers the ulnerable. It appears to be both a responsibility shifting exercise. Most alarmingly of all, efforts to permit non-therapeutic research on the non-consenting vulnerable as well as sterilisation and abortion on those who do not consent suggest that the legislation heralds a new era o gross human rights abuse in instutions around the UK. (shrink)

Introduction -- Historical perspectives of medical ethics -- The medical ethics Renaissance: a brief assessment -- Risk disclosure/'informed consent' -- Consent, control and minors: Gillick and beyond -- Sterilisation/best interests: legislation intervenes -- The end of life: total abrogation -- Medical ethics in government-commissioned reports -- Conclusion.

This article addresses India's contemporary population control policies and practices as a form of gender violence perpetrated by the state and transnational actors against poor, Adivasi and Dalit women. It argues that rather than meeting the needs and demands of these women for access to safe contraception that they can control, the Indian state has targeted them for coercive mass sterilisations and unsafe injectable contraceptives. This is made possible by the long-term construction of particular women's lives as devalued and disposable, (...) and of their bodies as excessively fertile and therefore inimical to development and progress. It further considers how population policy is currently embedded in the neoliberal framework of development being pursued by the Indian state. In particular, it argues that the violence of population policies is being deepened as a result of three central and interrelated aspects of this framework: corporate dispossession and displacement, the intensification and extension of women's labour for global capital, and the discourses and embodied practices of far-right Hindu supremacism. At the same time, India's population policies cannot be understood in isolation from the global population control establishment, which is increasingly corporate-led, and from broader structures of racialised global capital accumulation. The violence of India's contemporary population policies and the practices they produce operate at several different scales, all of which involve the construction of certain bodies as unfit to reproduce and requiring intervention and control. (shrink)

Between 1905 and 1945, 31 states in the Untied States and 2 provinces in Canada enacted sterilization legislation. Over 70 statutes and amendments were enacted to guide, oversee and regulate sterilization practice, while over 24 distinct conditions were offered as grounds for sterilization. Although excellent legal, historical, and philosophical scholarship has investigated the motivations, causes and consequences of this legislation, little work has been done to explicitly systematic analyse the language used in sterilization legislation. This brief study attempts to fill (...) some of the gap by attending to a number of questions that arise in the context of sterilization legislation. Five questions are addressed: Are there any patterns to the eugenic language in sterilization legislation? Does the eugenic sterilization language reflect what is found on other eugenic lists? What can sterilization language tell us about the mechanics of eugenics? What can sterilization legislation reveal about the role of feeble-mindedness or mental deficiency in eugenic history? And finally, what might sterilization language tell us about eugenic thought more generally? In answering these questions, we look to add one more piece to the puzzle that is eugenic history in North America. (shrink)

On voudrait croire que, quand les choses en viennent enfin à s'accorder, c'est là le bonheur... Or, c'est précisément quand les choses se recoupent complètement et coïncident que cette adéquation, en se stabilisant, se stérilise. La coïncidence est la mort. C'est par dé-coïncidence qu'advient l'essor. Dieu lui-même dé-coïncide d'avec soi, en mourant sur la Croix, pour promouvoir la vie vivante. Dans la faille de la dé-coïncidence, une initiative est à nouveau possible, se déployant en liberté. Or, comme l'Age classique a (...) fait de l'adéquation la définition même de la vérité, ou de la coïncidence avec la Nature le grand précepte de l'art comme de la morale, il est revenu à la modernité de rompre avec ce confort de la pensée. François Jullien fait jouer ici le concept de "dé-coïncidence" dans la Bible, la peinture, la littérature, la philosophie, pour montrer comment il est à la source de l'art et de l'existence. (shrink)

The essay considers the influence of Christian ethics within the political order. It considers first the witness of Thomas More, then developments in Roman Catholic moral theology since the Second Vatican Council, and finally the dispute over the moral evaluation of the use by AIDS-infected spouses of condoms in order to sterilise their procreative acts. The whole discussion proceeds as a commentary on what Thomas Aquinas says about the temporal promulgation of Eternal Law, and also aims to locate moral argument (...) within the macroscopic context of divine revelation on health and salvation, which the Church must proclaim in its fullness. (shrink)

Le propos de ce recueil est de développer deux thématiques : raison et folie et déraisons de la raison. D'un côté, on interroge la décision spéculative et politique qui "lie et sépare à la fois raison et folie" dans les termes mêmes employés par Michel Foucault (1961). L'âge classique, le siècle de la raison, commence par constituer un autre de la raison : le fou, renvoyé "au jardin des espèces". Il faut donc revisiter cette archéologie des dualismes mutilants : raison (...) et folie, normal et pathologique, âme et corps, à la lumière des travaux les plus récents. La folie aujourd'hui s'aborde de manière préoccupante dans les politiques de santé mentale qui visent à criminaliser la folie : psychiatrie menacée d'un retour de l'enfermement et de la violence. Psychiatrie sinistrée mais qui est déjà sur la voie de la résistance, notamment dans la culture, comme l'atteste la présence de la mélancolie en son sein, mais aussi dans les développements contemporains de la psychothérapie institutionnelle et de ses équipements comme de ses concepts. Sans négliger d'autres initiatives. Enfin, la rationalité elle-même n'est pas une donnée immédiate de la science. Elle se construit sur fond d'irrationalité. Là aussi, les dualismes familiers et stérilisants sont dissipés. (shrink)

Official statistics on abortion in South Australia for the period 1971–86 are analysed in terms of incidence, age of patients and nuptiality, reasons for abortion, method of termination, period of gestation, previous abortions and concurrent sterilisation. Demographic implications are discussed and recommendations are made for more education and counselling, especially for younger and unmarried women for whom the incidence of abortion seems to be rising.

The use of single-use items is now ubiquitous in medical practice. Because of the high costs of these items, the practice of reusing them after sterilisation is also widespread especially in resource-poor economies. However, the ethics of reusing disposable items remain unclear. There are several analogous conditions, which could shed light on the ethics of reuse of disposables. These include the use of restored kidney transplantation and the use of generic drugs etc. The ethical issues include the question of (...) patient safety and the possibility of infection. It is also important to understand the role of informed consent before reuse of disposables. The widespread practice of reuse may bring down high healthcare costs and also reduce the huge amount of hospital waste that is generated. The reuse of disposables can be justified on various grounds including the safety and the cost effectiveness of this practice. (shrink)

This study focuses on eugenics in Spain, and more specifically on the ‘official’ eugenics whose platform was the Primeras Jornadas Eugénicas Españolas . The aim of this paper is to relate eugenics to ‘governmentality’ rather than to State politics alone and to ‘Latin eugenics’ rather than to ‘mainline eugenics’. On the one hand, the FSED were largely centred on the development of a new sexual code which would set Catholic sexual morality aside. For this reason, sexual pedagogy was one of (...) the most relevant topics during the FSED, personal responsibility becoming the first step to social change. The concern about making people play an active role in their own self-regulation is typical of governmentality. The latter refers to societies where power is decentered and where the objective is to structure the field of action of others . On the other hand, the FSED emphasised preventive eugenics such as welfare programmes and health campaigns rather than negative eugenics such as the sterilisation of the unfit. The situation in Spain was mirrored in countries such as Brazil, Argentina and Mexico, which allows us to think about them in terms of ‘Latin eugenics’ rather than ‘mainline eugenics’ from countries such as Great Britain, Germany and the USA. (shrink)

The seat belt analogy argument is aimed at furthering the success of coercive vaccination efforts on the basis that the latter is similar to compulsory use of seat belts. However, this article demonstrated that this argument does not work so well in practice due to several reasons. The possibility of saving resources in health care does not usually apply in our societies, and the paternalist mentality that contributed to the implementation of seat belt–wearing obligation was predominant 30 years ago, but (...) it does not apply at this moment. Furthermore, the risk/benefit analysis is totally different in both scenarios. In the case of seat belts, there is no way to discriminate between the users. In the case of vaccines, individuals present with unique circumstances that may differ substantially from those of another and might be foreseen a priori. This means that an analysis must be performed individually before vaccination is imposed. Finally, one must keep in mind that seat belts are often the only way in which we can protect third parties against a tragic hit by the occupant of another vehicle and are very efficient tools for this purpose. Vaccines, in contrast, do not always create sterilising immunity and are definitely not the only way by which we can avoid spreading a virus; immunity certificates, isolation, or even confinement may also serve as viable methods to achieve this purpose. (shrink)