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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Anonymous

It does sound like some kids of people with developmental disabilities will face a lot of challenges, but does that justify stripping their parents of their reproductive capacity and opportunity to parent based on their disability? People are born into adverse circumstances all the time, but typically only particularly neglectful and/or abusive parents lose their right to care for their kids. Forced sterilization does not sit well with me.

Anonymous

IF YOUR DISABLED CHILD CANNOT MAKE THESE DECISIONS, IT IS YOUR RESPONSIBILITY TO PREVENT HIM/HER FROM BEING SEXUALLY ABUSED OR VICTIMIZED. If this woman you mention in your neighborhood was sterilized, that gives every creep and predator within a 2-town radius the opportunity to rape her and not face any repercussions or have ANY reason to think twice. It is her parents' job as her caregiver to KEEP HER SAFE, not to mutilate her in a way she can't understand and expose her to a surgery with potential complications just because they don't want to do their job and PROTECT THEIR CHILD.

Anonymous

I can think of no issue more complicated than this one. It is very easy for me to imagine people with good and kind motives on all sides of this question.

Anonymous

I agree wholeheartedly, also, as a parent of and a former wife of also a genetic paranoid schizophrenic I do not wish my son was never born, but after several psychotic breaks triggered my son to beat me black and blue like his Fad did I have considered that this is a dangerous genetic disorder, and a condition that is only non-violent after being medicated. I could have lost my life anytime in those gaps between diagnosis and my family members excepting this disorder is what they have. It’s a huge discussion as each di

Shayana

I couldn't agree more. Individuals with disabilities are people too. Therefore, it's unlawful to sterilize anyone against their will. Additionally, its a form of assault, because whoever is forcing the disabled person to endure sterilization, is touching him/ her physically without consent. That's unacceptable. I'm going to pray that both this woman( the mother of the disabled woman) and anyone else who falsely thinks it's ok to sterilize anyone against their will, is held accountable for his/ her actions.

anonymous

This is extremely misleading information. Washington State is trying to educate medical providers, guardians and advocates that this procedure is illegal. There is NO intent to make sterilization easier or to advocate for it. The issue is the development of a special form which clearly outlines the special legal process that is required if sterilization is considered.

As a healthcare professional who worked in the surgical arena of a major healthcare facility, I know that medical professionals tend to be unclear about what a guardian is able to consent to. I can not recall any surgeon specifically asking to see the court guardianship papers prior to a guardian signing a consent for surgery. This was a major ethical problem for me working in the field and I did my best to educate the surgeons and anesthesiologist that I worked with.

Below is a quote from Commissioner Zinn regarding the form and the intentions behind it.

"Guardians are not authorized to consent to sterilization on behalf of the incapacitated person. That consent can only be authorized through a court order, after appointment of counsel for the incapacitated person and formal court proceedings. However, within the subcommittee members’ experience, some doctors have performed these procedures without a court order. Sometimes, the court only learns about a sterilization of an incapacitated person after it has occurred. The subcommittee believes that education about this issue should be increased.

In the spirit of education, the subcommittee has already changed the order appointing a guardian to specify that the guardian does not have authority to consent to sterilization. The subcommittee also asked that this information is included in the family guardian training. It is ideal to educate medical professionals about this, but the subcommittee members are in the legal field and do not know how to effectively reach medical practitioners.

The subcommittee is currently grappling with whether to create court forms that are specific to sterilization. The goal in doing so is to make it very clear that there is a special court process. Anyone accessing the guardianship forms on the Washington Courts web site could see the sterilization forms, which could itself trigger awareness. The presence of forms could also increase awareness by judges and lawyers, who may not know that court cases outline a special procedure for sterilization motions. The court cases would be cited so the correct law can be followed."

The issue of making sterilization easier is from an assumption that seeing a form with that title will make people think it is common practice. There will be no changes to the legal process from the development of the forms but they may provide education to those who need it and make them think things through prior to committing an illegal, immoral, unethical act upon another human being.

Anonymous

Anyone incapable of taking care of themselves due to physical or mental disability cannot take care of children either, and should be sterilized. Anyone reliant upon public assistance for food and shelter should be sterilized after one child. It’s about responsibility. Any addict who gets pregnant and uses through pregnancy should also be sterilized at the time of birth. When these factors are made the law, one’s personal choices determine the outcome. Cause and effect.

Anonymous

Where do you draw the line?

How about people who don't love their children? How about people who spank their children? Abuse them verbally? Psychologically? How about Nazis? How about cult members? How about anyone ever doing any kind of harm to their children? Oh wait...that...is pretty much everyone.

How do you really know whether or not anyone should have a child? Forever? How do you know 5, 10, 15 years from puberty they wouldn't be able to do it? You don't.

No person can EVER forcedly sterilize another person. That's shit the Nazis did. It's eugenics. It's wrong.

What needs to be done is a proper social support system needs to be created to help the ones who need help.

Anonymous

When we want to say "People with X Condition could never do that" or "Their kids would just have a hard time" we should take a moment to reflect on what supporting a DD person in their parental role could look like. A DD parent might need a lot of support from other people in order to take care of their child. There might be multiple caretakers in that child's life. Having different needs or a different role doesn't make the relationship between a DD parent and their child insignificant or damaging. A lot of kids grow up in adverse circumstances. We ought to support their families when possible, not to attack their reproductive freedom and bodily autonomy.

Anonymous

Someone who has a Gardian, is incapable of living independently. The state has already looked at the person and decided this. I believe that this person may be rife for sexual predation. This person would not be judged capable of adopting a child. A court review should be done in each individual case to determine if the procedure is appropriate. If it is deemed appropriate, it should be done.

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