Question A friend of mine has an adult daughter who is mentally disabled. Roughly speaking, her daughter thinks and talks like a seven-year old child, and cannot take care of herself. The disabled daughter is sexually interested in men, but as far as I know she never had sex with anyone. When she was 20-something, the mother had the daughter medically sterilized. This brought her no suffering, and she behaves as she did before. The mother's fear was that she would get pregnant. For a few weeks every year, the daughter is away from her mother in a clinic for mentally disabled people. I wonder if it was morally acceptable for the mother to have her daughter sterilized.

Accepted:
July 7, 2009

Comments

This is the kind of case that makes reasonable people feel very squeamish, and over which reasonable people can disagree. But though I won't be surprised if others respond and reject what I am about to say, I'm inclined to side with the mother.

Ethical theorists generally approach questions like these from one of three basic approaches. One of these is called the deontological approach, which tends to focus on our moral notions of basic obligations and responsibilities. If we think that everyone, no matter what their mental defects, has a fundamental right to autonomy, then the mother's actions obviously interfered with the daughter's autonomy with respect to having (her own biological) children. On the other hand, we may doubt that such a fundamental extends in an absolute or complete way to someone who is incapable of exercising that autonomy, which appears to be the fact about this case. The daughter could biologically have a child, but could not actually be responsible for the child she might have. So my own reaction is to think that this particular "right" (the right to have biological children) is not a basic right at all. If so, there seems to be no reason to think the mother violated her daughter's rights.

Another way to approach such questions is "consequentialism," which estimates the value of actions in terms of foreseeable and morally relevant consequences. A rough and ready way of thinking of this case in such a way is to ask, "What if the daughted did get pregnant?" The obvious answers are: (a) She could have an abortion, or (b) she could give birth and then give the child up for adoption, or (c) some family member(s) could raise the child for/with her. It is not clear to me that forcing the daughted into situation (a) isn't pretty much comparable to what the mother did: one way or the other this is to force the daughter into an invasive medical procedure for which the daughter has not the competence to give genuine assent. But in this case, it might actually be much worse than what the mother did, because not only could there be other medical risks here, but also possibly emotional risks--even seven-years-olds can feel emotions and have these be significant in their lives. Moreover, situation (a) is one that might have to be repeated, maybe even many times! I think you can see how this works, by just thinking about how (b) and (c) could play out. There looks to be lots of realistic and likely outcomes that are very negative in each case. The mother's action prevented any and all of these bad consequences.

Finaally, there is a virtue theoretic approach, according to which we assess actions as indications of, and motivated by, morally significant character traits. The mother had her daughter sterilized for what are likely to be many different reasons (including, as I have suggested, concerns about likely bad consequences). Are we prepared to say that in doing this, the mother's motives were (mainly) selfish ones? If so, we would condemn the selfishness--but this seems quite wrong to me, since the mother seems to continue to take care of the daughter in what sounds like a very unselfish way. Instead, I am inclined to think the mother did it out of concern for the daughter, and for those the daughter's actions might impact. That concern, and the mother's sense of responsibility in this matter, seem to me to indicate something more like virtue than vice.

By each measure, accordingly, I am inclined to think the mother did the right thing.