Mentally Retarded Women and Forced Contraceptives

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Mentally Retarded Women and Forced Contraceptives

http://www.uky.edu/Classes/PHI/305.002/ret.htm

February 23, 1998

IUDs

Intrauterine devices, or IUDs, are tiny metal or plastic loops or coils that are placed in he uterus; their effectiveness ranges from 95 to 99 percent. IUDs are thought to work by interfering with the implantation of the fertilized egg into the lining of the uterus. An IUD must be inserted by a physician, but once in place a plastic one can remain until pregnancy is desired. Some women, however, experience uterine cramps and increased menstrual flow when using an IUD, and some evidence exists that the devices increase her risk of pelvic infection. A rare, but potentially serious side effect is puncture of the wall of the uterus.

Mental Retardation

The inability to learn normally and develop mentally. A mentally retarded person exhibits a low level of intelligence and impaired adaptive behavior; these deficiencies become apparent during childhood.

Some 3% of the American population can be described as mentally retarded, and about 126,000 infants born each year are expected to fall into this category. Of these, some 87% will be only mildly retarded and often not distinguishable from normal children until they attend school. They can learn academic skills up to about the sixth-grade level, although at a slower pace than normal children, and as adults they can usually support themselves if given ample help during times of social or economic stress. In most cases no medical or physical signs are involved. Such retardation occurs most frequently (and tends to recur) in disadvantaged families; thus many experts believe it can be caused by poverty in combination with other social and cultural conditions and a lack of stimulation during the child's development.

10% of retarded individuals are moderately retarded, 3-4% severely retarded, and 1-2% profoundly retarded. As children, the moderately retarded progress to about the second-grade level in academic subjects, the severely retarded develop only minimal speech and communication skills, and the profoundly retarded have little capacity to move about or profit from sensory information.

The Rights of People with Mental Retardation

People with mental retardation have the same basic legal, civil and human rights as other citizens. Fairness and justice dictate the need for additional legal protection to enable people with mental retardation to exercise such basic rights. These rights, as for all citizens, should never be limited or restricted without compelling state interests and due process.

Sexuality:

People with mental retardation have fundamental rights as individuals to:

have privacy;
love and be loved;
develop friendships and emotional relationships;
learn about sex, sexual exploitation, sexual abuse, safe sex and other issues regarding sexuality;
exercise their rights and responsibilities in regard to privacy and sexual expression and the rights of others;
marry and make informed decisions concerning having children; and
develop expressions of sexuality reflective of age, social development, cultural values and social responsibility.

Privacy Rights Collide in Sterilization Case

Parents of Lora Faye Wirsing vs. Advocates for the Disabled

Lora Faye Wirsing:
- 34 years old
- moderate mental retardation
- born with brain damage and epilepsy
- youngest of 5 children
- IQ in low 30s - cannot read, write, tell time, or care for herself
Parents want Lora sterilized - fear she could give birth to baby she is incapable of raising.
- "We are not denying her of something she would ever want to have."
- She does not understand connection between intercourse and pregnancy
- Birth control pills would interact with other meds.
1986 - Wirsings sought Lora to undergo tubal ligation
- Hospital officials needed court approval
- Genesse County Probate Court decision in Wirsing's favor
- Overturned by Michigan Court of Appeals
- Wirsings appealed to Supreme Court - to rule by August 1998

Mentally Retarded Women and Forced Contraceptives

This presentation was based on whether or not mentally retarded girls and women should be forced to use contraceptives (for example subdermal implants or IUDs).

Debates have gone on for years over certain cases concerning the rights and abilities of mentally retarded persons. Are they capable of properly caring for an infant? Is this fair to the child? Or should forced contraceptives be used to at least "buy them time"?

One main cause of controversy is where to draw the line. Are some mentally retarded persons more capable than others and should this give them more rights? Both doctors and families have disagreed on when a person becomes incapable of caring for a child, let alone themselves. Many also disagree on the definition of a mentally retarded person.

Mental retardation is defined as the inability to learn normally and develop mentally. A mentally retarded person exhibits a low level of intelligence and impaired adaptive behavior; these deficiencies become apparent during childhood. Some 3% of the American population can be described as mentally retarded, and about 126,000 infants born each year are expected to fall into this category. Of these, some 87% will be only mildly retarded and often not distinguishable from normal children until they attend school. They can learn academic skills up to about the sixth-grade level, although at a slower pace than normal children, and as adults they can usually support themselves if given ample help during times of social or economic stress. In most cases no medical or physical signs are involved. Such retardation occurs most frequently (and tends to recur) in disadvantaged families; thus many experts believe it can be caused by poverty in combination with other social and cultural conditions and a lack of stimulation during the child's development.

Another frequently used term when discussing contraception is intrauterine devices, or IUDs. IUDs are tiny metal or plastic loops or coils that are placed in the uterus; their effectiveness ranges from 95-99%. IUDs are thought to work by interfering with the implantation of the fertilized egg into the lining of the uterus. An IUD must be inserted by a physician, but once in place a plastic one can remain until pregnancy is desired. Some women, however, experience uterine cramps and increased menstrual flow when using an IUD, and some evidence exists that the devices increase her risk of pelvic infection. A rare, but potentially serious side effect is puncture of the wall of the uterus.

People with mental retardation have fundamental rights as individuals to:

have privacy;
love and be loved;
develop friendships and emotional relationships;
learn about sex, sexual exploitation, sexual abuse, safe sex and other issues regarding sexuality;
exercise their rights and responsibilities in regard to privacy and sexual expression and the rights of others;
marry and make informed decisions concerning having children; and
develop expressions of sexuality reflective if age, social development, cultural values and social responsibility.

To illustrate these concepts we discussed the story of Bertha. Bertha grew up during the 1960's and 70's in a poor, white family in the Appalachian mountains of southwest Virginia. Bertha's mother bore 10 children, of whom Bertha was the oldest girl. The mother appeared overwhelmed by this large family, and consequently Bertha took care of the 8 younger children- an experience that made her want to have children of her own.

Bertha, nearly illiterate, stumbled over reading and was held back year after year. During her teen-age years, Bertha's problems worsened. She stayed away from school more and more often. At age 15, Bertha was cute, sociable, and friendly. It was at this time, during one of her foster placements, that a foster father tried to molest her. A social worker learned about the incident and placed Bertha, briefly, in as state institution.

Bertha was intent on having children; but the social worker was afraid that if Bertha did give birth, the child would be taken away from her and felt that this would be "the worst thing in the world for her." Bertha was eventually tested at Johns Hopkins and diagnosed as "mildly retarded" with an IQ of 68 (normal range beginning at 69 or 70). At Johns Hopkins, on the basis of the diagnosis, an intrauterine device (IUD) was inserted in Bertha, without her consent. Bertha's pediatrician was "buying time" for Bertha, so that she would not become pregnant too early and have to raise children on welfare, without a father. On hearing the official explanation - that the intent was to protect her - Bertha asked, "What are you protecting me from?" When told, "You might otherwise get pregnant," she replied, "So?" She objected intensely to the own good required "protection" from childbearing.

Stories like Bertha's bring up many controversial issues. Reasons can be said for both requiring forced contraceptives and against forced contraceptives. Some of the reasons for forcing contraceptives include: other family members, harm to the mother, harm to child, harm to society, sexual abuse, and other contraceptives. Reasons against forced contraceptives would include: autonomy, provide sense of purpose, adverse psychological affects, competency, side effects, and the promotion of education.

In considering the support for forced contraceptives, one issue would be the other family members. If the mentally retarded girl was unable to take care of the child on her own, this may put additional stress on the grandparents of the child who may be facing enough difficulty caring for their own mentally retarded child. Another aspect to consider would be the affect on the mother. The mother may not completely understand what is happening with her body, the possibility of physical harm from pregnancy, and the psychological affects on the mother if she is not capable of caring for the child and it is taken away from her. Another issue involved is the harm to the child. Is it fair to bring the child up in an environment with mentally retarded parents? Will the child be able to mentally and socially develop the way it needs to, considering the parents are mentally retarded? One must also look at the affects on society, such as the costs to society to care for the child if the parents are unable to care for it. Sexual abuse must also be taken into account. Mentally retarded females are easy targets for sexual abuse because they are very friendly people and are very trusting. If pregnancy does result from the abuse, the psychological affects on the girl may be overwhelming. Lastly, the mentally retarded girls may not be able to use other contraceptives, such as the pill, because of the high rate of heart problems that many mentally retarded people have and the possible drug interaction with medications they may already be taking.

While many people are for forced contraceptives, many are against them. The strongest argument against forcing contraception is that of autonomy. Autonomy is the right to control one's own body and given that the right to procreate is a fundamental right all humans possess, the mentally retarded girl should have the right to decide. The mentally retarded individual holds the same rights as other individuals which means a mentally retarded teenager has the same rights as a "normal" teenager - we would not force contraceptives on "normal" teenagers. Also to consider, a child would give a mentally retarded woman someone to love and improve their self-esteem. It would also give them attention and gain status. There may also be adverse psychological effects for the mentally retarded girls. Some of these girls who were forced to be sterilized recalled "the operation vividly and in many cases saw it as a humiliating process." Others saw sterilization as punishment and did not understand what was happening. Furthermore, mentally retarded individuals are loving and caring people. What sets their ability to be a mother apart from the abusive parents or alcoholic parents? There may also be side effects with contraceptives as discussed with IUDs or possible psychological damage and confusion. When discussing contraceptives, it may be necessary to just educated these mentally retarded women. Retarded persons can be realistic about parenting and through proper education they may realize it would be in their best interest to not raise a child.

Receiving the class responses, there were a few questions the class felt were unanswered. One question was whether there was an increased risk of mentally retarded parents having mentally retarded children. Yes, there is an increased risk, however, there is also the possibility of having a normal child. Another question was if other forms of contraception, such Depro-Provera, would have the same effects as the pill and if they hold the same medical effects toward heart disease. This is a very good point to bring up, however, we did not find any information regarding this in our research.

As you can tell by the above issues, this is still a heated debate. The real question is again, who is to decide and what standards are decided upon. It seems that as of now, there is no clear cut answer, rather, it should be determined on a case by case basis. We all have fundamental human rights and who is to judge the competency and abilities of those less fortunate than us?