On the recent UK sterilisation case

Picture of Archway Tower, site of the UK Court of ProtectionIt is vital these difficult decisions are heard in public | Deborah Orr | Comment is free | The Guardian

Recently the UK Court of Protection has been hearing a case in which a mother is trying to have her daughter sterilised, to prevent her having any more children that the family cannot support. The daughter, aged 21, has learning disabilities and has had two children already (most recently yesterday) that the mother is looking after, but she says she cannot look after any more and will have to give them up for adoption, which would distress the daughter who cannot understand that the children will “get a new mummy” and that she will never see them again. Although there have been a few news reports about this case, the only opinion piece is the one by Deborah Orr in today’s (Thursday’s) Guardian, linked above. (The court has delayed ruling until expert evidence is heard; the mother had been seeking to have her daughter sterilised during a Caesarian section.)

I’ve written about the Court of Protection before, when the BBC broadcast a story last July about how it enables lawyers to sit on people’s compensation money to their own advantage, while preventing their clients from becoming re-empowered over their own money when their services are no longer needed. The court looks after the interests of those without the capacity to make financial and medical decisions for themselves, although until 2005 its remit was purely financial. In recent years it has had to decide whether various mentally incapacitated adults could have (or refuse) surgery or, in one recent case, sex. It usually holds its hearings in camera, but in this case (and a few other recent ones), it has held them openly, on condition that no identifying details about the litigants are made public, hence the woman with learning disabilities here is being referred to as P and her mother as Mrs P.

Still, while I agree that it is unnecessary to tell us all who the woman is and where she comes from, there are salient details about this woman’s condition and lifestyle that are being hidden, such as what the cause of her disability is and whether she has a steady partner or has had several. To quote from the article above:

P lives at home with a mother who clearly has no wish to chaperone her all the time, thereby curtailing her daughter’s freedom as an adult. Clearly P, on at least two occasions, has had sex with a man who is eminently capable of having unprotected sex with a woman of limited mental capacity, with no great concerns about whether she becomes pregnant, and no discernible wish to actually care for her and any children she may have by him. Yet, the ability of people to saunter around irresponsibly impregnating others seems, in this case, sacrosanct, even when the recipient of such attention may not have the mental capacity to consent in a meaningful fashion.

Compare this to the court’s decision earlier this month to authorise a council to prevent a man from engaging in sexual relations with another man in his accommodation, where the risk of pregnancy is clearly absent. It is more than likely that the man has a learning disability as well rather than being a merely feckless or immoral man taking advantage of a woman’s learning disability, something that Deborah Orr does not seem to consider, but nowhere is it mentioned that he (or they) are in any way involved in the child’s care or upbringing.

I normally strongly disagree with forcibly sterilising anyone on the grounds on disability; for the purely physically disabled it is simply unacceptable (but has been done, if not in the UK recently then in other English-speaking countries, notably Australia), and for the most severely mentally and physically disabled it is unnecessary (as with the so-called Ashley treatment, in which a young girl whose parents called her a “pillow angel” arranged for her to have a hysterectomy and for her growth to be terminated, so that she would not grow bigger than a “manageable size” for her parents or later carers; they also speculated that she may suffer period pains or become pregnant through rape). In between, however, there are a minority of individuals who are capable of having a relationship, or enough of one to have sex, but do not have the capacity to raise children, and that becomes others’ responsibility. This is not a case where a girl is sterilised in her teens because of some parental fear; it is someone who is incapable of raising a child yet shows no signs that she will stop having them.

Sarah Ismail (of Some Difference) says she can’t see anything wrong with putting the children up for adoption outside the family, and that it would be better than forcibly sterilising “P” against her will. What’s wrong with it is that it will obviously cause great distress to this woman to have her children permanently removed (as it does for any parent in that situation, regardless of mental health or capacity), and her mother cannot make her understand that she will never see them again. Of course, it might be better to find others in the family that might care for them so as to maintain some contact between P and any future children, or provide some financial support for the family, but surely the first option has already been considered and the second may raise other issues, such as whether Mrs P is already too old to be taking on more children.

As has been said already, “P” is fortunate to be looked after by her mother who has agreed to care for her existing child and the one born this week, and to allow her some measure of freedom. In the past, someone with that degree of impairment might have lived in an environment with much closer supervision and would have been prevented, as much as was possible, from having sex at all. P is allowed a degree of liberty approaching that of others of her age group, but with liberty comes responsibility, particularly where sex is concerned. As that responsibility is going to fall to someone else, and her family has already said they cannot deal with much more of it, it is surely better to spare her the distress of having any future children taken away, if not by sterilisation then by some kind of long-term contraception.

Image source: Wikipedia

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