This paper examines the establishment of standards of informed consent for sterilization from the viewpoint of the medical profession in the United States. Sterilization was previously a tool of eugenics, the science of racial betterment that developed around the turn of the twentieth century. Eugenicists discouraged the reproduction of “unfit” citizens and defined it as costly and harmful to the society. To prevent the reproduction of the “unfit,” eugenicists would segregate them from the rest of the population and subsequently came to favor the more cost-effective solution of sterilization. A number of states began to enact eugenic sterilization laws, and in 1927 the Supreme Court validated the right of the states to sterilize their “unfit” citizens.
The formal eugenics movement concluded by the end of the baby boom, but forced sterilization did not end. By the late 1960s and early 1970s, the fear of overpopulation reduced doctors’ resistance to the efforts of “fit” women toward birth control. Consequently, the rates of contraceptive sterilization rose steadily throughout the 1970s. This concealed a new pattern for forced sterilization. Instead of secretly performing surgeries, doctors began to require their patients to sign consent forms for surgeries that they did not want or did not understand.
In the late 1960s, consumer groups and health activists started to demand increased oversight of medical practice, the establishment of strict standards of informed consent, and the strengthening of the patients’ position within the doctor-patient relationship. Their demands led to the creation of clear standards of informed consent and the adoption of these standards by hospitals across the country, which slowed forced sterilization upon delivery by prohibiting doctors from obtaining consent from patients under duress and the influence of anesthesia and by requiring that they explain all the risks and side effects of surgery. However, doctors interpreted informed consent differently and a number of doctors refused to concede their professional authority to patients.
Forcibly sterilized the “unfit” filed lawsuits in defense of their reproductive rights and antisterilization abuse activists fought for the establishment of federal sterilization guidelines, because the existing policies failed to protect the reproductive rights of the “unfit.” A significant reduction in reports of forced sterilization and in forced sterilization litigation suggests that the practice declined in the mid-to-late 1970s. This can be attributed to the federal sterilization guidelines or to the changes of the standards of informed consent within the medical community.
However, even after the courts and legislatures established formal protocols for medical decision-making, reports of doctors’ violation of the federal sterilization guidelines continued to emerge. It is possible that informed consent conceals the coerciveness of sterilization, forcing specific people to “choose” sterilization, especially as medical technologies advances beyond the comprehension of non-professional people and the medical profession changes the interpretation of informed consent.
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