Dr.Diekema’s official views on involuntary sterilization: Why did he do everything he himself had said “Don’t” without doing things he had said “Do” in the Ashley case?

Don’t use permanent lack of competence as your justification for involuntary sterilization because it is just a necessary condition and not by itself a sufficient justification. Don’t sterilize unless it is urgently necessary. Don’t sterilize a person who will not have sex or doesn’t possibly get pregnant. Don’t sterilize before the procedure becomes actually necessary. Don’t ever sterilize anyone prior to puberty.

 

So says an ethicist. Which one? Dr. Douglas S. Diekema, Department of Pediatrics & Medical History and Ethics, University of Washington, and Children’s Hospital and Regional Medical Center, Seattle, Washington, in his paper titled Involuntary Sterilization of Persons With Mental Retardation: An Ethical Analysis, in Mental Retardation and Developmental Disabilities Research Reviews in 2003. Not exactly in these words, of course, but they are some of his “do”s and “don’t”s from the paper. Incredible, isn’t it?

 

After I wrote about the paper in my previous post based on its abstract, someone helped me to find its full text. I read it and was dumfounded.

 

Dr. Diekema made some more points in the paper which are also relevant to the Ashley case. For example;

 

If you want to sterilize someone with mental disabilities, you have to prove by providing with “clear and convincing evidence” that it is in the best interest of the person.

 

You have also to provide with “clear and convincing evidence” that there are no less intrusive and permanent alternatives to achieve the best interest of the person. In doing so, consider “a range of options without the invasiveness or irreversibility of sterilization” such as oral contraceptives, intra-muscular injections, Norplant, transdermal contraceptive patches and long-term progestin-releasing intrauterine devices. Do not forget that there’s always a possibility for some more novel contraceptive means to be developed in the future, another reason you have to wait till sterilization becomes urgently necessary.

 

Make sure there’s enough safeguard to ensure a fair decision making process on behalf of the person. Have the person completely evaluated by “an independent professional and lay group”. Abide by the statutory requirements of your jurisdiction including the requirement of court authorization. Do not simply assume the caretaker’s interests are the same as those of the persons with mental disabilities in considering the decision by parents or guardians even after all the other conditions are satisfied. Remember that “sterilization requires a higher level of justification because of the greater harm that can result”.

 

 

Wow…….All this makes it look like he did everything he himself had said “don’t” without doing what he himself had said “do”　in the Ashley case. The paper and the case were only one year apart. I wonder how Dr. Diekema can ever explain all these inconsistencies.

 

Oh, by the way, sterilization cannot be justified by saying it eradicates the possibility of pregnancy in case of rape with either men or women with mental disabilities, according to his paper, because it does not eradicate the possibility of sexual abuse. Fertility and sexuality are not identical, says the ethicist.