In 1936, Ann Cooper Hewitt filed a lawsuit against her mother — and with good reason. At the age of 20, her mother Ann had sterilized her against her will. Having succeeded in classifying her as having an intellectual disability, Ann’s mother was legally allowed to authorize the operation over Ann’s objections. Her mother’s lawyer responded by claiming that Ann’s sterilization had been “for society’s sake” due to the girl’s “erotic tendencies.”

Even in the age of the eugenics movement, where tens of thousands were involuntarily sterilized by state governments who sought to breed “better” human beings by removing disability from the gene pool, the Hewitt case attracted nationwide attention. Could a diagnosis of disability allow parents to control their child’s reproductive future against his or her will?

Ann believed it could not, summarizing her fate matter-of-factly. “I had no dolls when I was little, and I'll have no children when I'm old,” she said. “That’s all there is to it.”

We’ve come a long way since the age of the eugenics movement, particularly when it comes to matters of reproductive choice and bodily autonomy. And yet, state laws still allow people with disabilities to be sterilized without their consent. Today the state of Washington is considering a proposal that the ACLU believes could expand the use of sterilization for individuals under guardianship.  Guardianship is a surprisingly common legal arrangement where a third-party is authorized to make virtually all decisions for a person with a disability.

Currently, state law fortunately prohibits guardians from authorizing sterilization without court approval — but the state judicial system is currently considering a proposal to create a form to more clearly articulate how guardians can request permission for this procedure. While the proposal is designed to clarify existing law, advocates with disabilities and the ACLU believe that creating this form will streamline the process and increase the number of guardians requesting the sterilization of those under their power.

Ivanova Smith, a new mother with a developmental disability, has written beautifully in the ACLU of Washington’s blog about how people with disabilities can become loving, responsible parents, if they so choose. People with disabilities should not be denied this choice. Given the unfortunate history of involuntary sterilization of people with disabilities across the country, states must take extra caution to avoid imposing sterilization against those who, for whatever reason, do not freely choose it. It is vital that we leave behind the days in which people with disabilities lacked reproductive choice.

Whether it comes from parents, the court system, or anyone else, sterilization should never be imposed on a person without their consent.

For those who do choose it for themselves, sterilization can be an appropriate medical procedure. But the presence of guardianship seriously complicates the issue. Guardianship entails loss of legal adulthood, meaning that an individual lacks capacity in the eyes of the law to make their own decisions or express their own will and preference on how they should be treated. Measures to make it easier for guardians to permanently sterilize people with disabilities should be viewed as suspect. The Hewitt case is only one example in a long line of disagreements over who gets to make choices about medical procedures applied to people with intellectual disabilities.

Such decisions are often treated as family choices rather than questions of individual autonomy, which should require an expression of preference on the part of the person receiving the procedure. Some guardians cite fears of sexual assault in choosing to sterilize people with disabilities — yet sterilization in no way prevents the sexual assault of people with developmental disabilities, an all too common occurrence. Instead, it can merely hide evidence of it. As such, there are credible concerns that guardians may seek sterilization as a means of lessening the complications emerging from abuse, rather than taking the measures necessary to stop it.

The state of Washington should decline to streamline the process for guardian-imposed sterilization. The state can ensure that individuals who require decision-making support have a clear process by which they — rather than their guardian — can request such a procedure (if it is truly their choice to do so). Guardianship, with its total loss of decision-making authority by the individual, is not the appropriate mechanism for this. Instead, the state should consider joining Texas, Delaware, and jurisdictions around the world in implementing supported decision-making, a new legal arrangement that allows people with disabilities to choose trusted advisors to help them with their choices without surrendering final decision-making authority.

Control over one’s own body is one of the most fundamental civil liberties. Everyone deserves the right to have the final say about what happens to their own body. People with disabilities are no different.

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I'm a mentally disabled Washington resident myself and I find my opinion is mixed. On the one hand, I side with the government on this issue, often, disabled individuals are incapable of caring and raising for children. On the other hand, for the individuals that are mentally capable enough to be able to do so, whether or not to have children should be left to the individual to decide.

As an aside, my disability is genetically-based, and so could be inherited. I haven't had myself sterilized, but I'm quite determined to not have children of my own, and adopt instead.


Disabled folks, as you know, vary widely in what they can and can't do. I'm also disabled and I think the suggestion in the article for implementing supported decision making is far better than taking away our autonomy.


There are many many individuals and couples who are not considered mentally handicapped and are NOT suitable to babysit-never mind have children of their own. However, these particular individuals are not forced to be sterilized. There are many people out there I believe-for the safety and or health of a newborn-that should opt in for sterilization. There are also people with congenital health issues that could be dire and I believe giving birth sometimes to be selfish. The option for adoption is always there. Help a child that is in need and adopt. But, I feel many are perfectly capable of making this decision on their own. Government is to work for the people-not against them. Leave the government out of it. It should be a talked about decision with medical professionals (mental health, Ob-Gyn, advocate for individuals), AND the person involved.


What happens if there is a birth? Who is responsible to raise the child? I can only imagine how difficult it would be to care for an intellectually handicapped person who then is a parent.


I have mixed feelings as well. I think it should only ever be for people who are absolutely incapacitated for whom pregnancy would be an unmitigated disaster. But anyone capable of objecting, however they are capable of doing so, should be strictly off limits.


Egads. The picture with this article couldn't be worse. There is no where that male or female sterilization would be performed without sterile technique. I believe this is taken at a veterinarian's office.


Gee, I looked and I looked, and no matter how hard I looked at the photograph, I just couldn't tell whether those surgical tools had been sterilized or not, how could you?


Sterilised tools are not automatically obvious in a picture. Also, what on earth makes you think vets don't sterilise tools?


In a proper OR, all surgical staff are fully gowned. In vets office when they're doing spay or neuter, they just have sterile gloves on. Hairy arms would not be allowed in a human OR.


It's a...y'know...stock photo. The point of this one, I assume, is to elicit a feeling of surgery being a repulsive idea. Hence the grubby hands, etc. Accuracy isn't the..y'know...point.


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