You shall not have children

by alexandre.comeau-vermeersch on September 20, 2013 - 3:36pm

Sterilisation has been present in human societies for a very long time. As a voluntary medical procedure, it is really helpful for consenting citizens; however, it becomes a more sensible subject when the patient is a mentally disabled adult deemed incapable of personal choices. This is what happened a few weeks ago, in England, where a 36 year old man with a lifelong disability, identified as “DE” in the article, has been approved sterilization by the court following a request from his family. Due to the history of the eugenics movement during the 1930, small events like this attract a lot of attention from people around the world, including me, mainly because the final decision about whether or not to sterilize the man ultimately goes to the legal guardians (his family) and the governing authorities on this matter.

Should a mentally disabled person have the final word when it comes to his/her own physical traits, like fertility?

The present situation is not completely applicable to the latter ethical questioning, because it is stated in the article that the man expressed a “consistent and clearly articulated wish not to have any further children”, which was considered a key fact to the judge, in addition to the family’s claim that the procedure would increase the man’s quality of life. The man already has a 3 year-old child and since then, his guardians were compelled to supervise his meetings with his long-term girlfriend, who also has a learning disability. It is worth mentioning that the life quality improvements mentioned would only come from the fact that the guardians would no longer have to keep a watch on his relationship.

I think we must consider the whole situation of the guardians and the role they play in the lives of the people they help. The mentally ill person is believed to be unable to take rational and informed decisions about contraception. This would mean that, if DE were to declare that he does not want to be sterilised and wants to have children instead, his guardians would consider this decision as of low importance, because the man does not understand the whole picture, that is, he wouldn’t understand the implications and consequences of having a child. This means that every other argument ultimately taken into consideration, apart from the thoughts of wishes of the individual himself, is subject to interpretation by the guardians. I believe we must accept this, and let the guardians choose for a man like DE even if we are not entirely sure what the individual wants. We must assume the guardians are in the best position to know what is good for DE and they also intend to do what is best for him. This raises a question:

Should we assume without question that what others think is in DE’s best interests is actually what is best for him, his family, or his future children?

http://www.cbc.ca/news/world/sterilization-of-mentally-disabled-man-approved-in-u-k-1.1334649

Comments

I have always had a stubborn belief in the principles of free will and respect for autonomy. This reading forced me to consider the two sides of the issue, and ultimately convinced me that these principles can be secondary in certain situations. DE’s situation is one of those. To answer your question, I think we should trust that his closest relatives will take good decisions on his behalf, but not without question. As mentioned in the article, the parents were backed by social workers and doctors. All these people analysed the situation and agreed on the best course of action to take in order to make DE’s life better. We have to assume that their intention is genuine, because there is no other basis for the judge to make an informed decision. Obviously, we cannot only rely on the will of the mentally disabled because he does not have a broad understanding of the situation. So, in this way, I agree with your argument stating that DE’s wishes have a lower weight in the final decision. He has the mental age of a kid. If we were to let every adult with a mental disability like his have full autonomy, then I think we would also have to agree that children have enough autonomy to be guided by their own free will. But of course this cannot be; children need parents to make good decisions for them (register them in a school, prepare healthy food, or take them to the hospital for a vaccine or an important operation), until they mature and learn to make some themselves. Apart from their physique, there is no major difference between a kid and a man like DE. Therefore, it is normal for them to be taken care of in a similar way, for their own benefit. This is a view supported by the utilitarian principle of maximization of happiness and minimization of suffering. I think it also answers your main ethical issue. No, a mentally disabled person should not have the final word when it comes to his/her own physical traits, if and only if, the resulting decision can directly affect his or her well-being. Again, this is so because such an individual cannot fully grasp the implications of the circumstance.
Here is a link to a site describing the principles of The Mental Capacity Act (2005), a set of rules clearly defining who can take decisions, and in which conditions, for vulnerable people: http://www.patient.co.uk/doctor/mental-capacity-act