Sterilization of Women Who Are Mentally Handicapped

Abstract

The recent statement of the American College of Obstetricians and Gynecologists on the sterilization of mentally handicapped women (REF) is comprehensive and is endorsed in principle and substance by this Committee. As pediatricians, we reinforce and reiterate the following: 1. With rare exception, there is no indication for sterilization of a child before menarche. An example is when sterilization is not intended, but is an unavoidable consequence of other surgery, such as surgery for a malignancy. 2. The primary or contributing indications for sterilization (particularly surgical sterilization) based on presumed or anticipated hardships to others must be viewed with great reservation and in light of acceptable alternate care arrangements which might be made for the mentally retarded individual. The judgment of "hardship" is extremely subjective and must not be simply a matter of inconvenience or a preference for the easier of two alternatives. 3. When sterilization or pharmacological control of menses is chosen after the appropriate informed deliberations and attempts at obtaining consent, the pediatrician should always advocate the least permanent and intrusive methodology consistent with lowest risk for the patient. Present and future research and clinical trials may very well make newer forms of chemical contraception or pharmacologic amenorrhea preferable to surgical sterilization. 4. Even if satisfactory informed consent cannot be provided by the patient, all efforts must be made to communicate the procedure and intent of the planned intervention to the patient; estimations of the patient's ability to comprehend and participate in the decision-making process should be done by personnel who are familiar with the individual patient and who are experienced in communication with persons with diminished mental capacity.