Abstract

PIP: After 6 months of public hearings and a controversial climate, the Department of Health, Education, and Welfare's rule governing federal financial participation in sterilization programs went into effect in the United States on March 8, 1979. The regulations attempt to formulate a government policy for some difficult ethical questions -- the meaning of "voluntary consent," the boundary between justifiable protection from abuse and unjustifiable paternalism, and the rights of those judged "incompetent to decide." Before examining the regulations themselves, focus is on the issue of what is reproductive freedom, voluntary and involuntary sterilization, and sterilization abuse. The following are included among the most important provisions of the regulations: 1) requiring the voluntary informed consent be obtained, using a mandatory, standardized consent form provided in the patient's preferred language; 2) prohibiting any overt or implicit threat of loss of welfare or Medicaid benefits as a consequence of nonconsent; 3) prohibiting the obtaining of consent during labor, before or after an abortion, or while an individual is under the influence of drugs or alcohol; 4) abolishing the distinction between "contraceptive" and "noncontraceptive" sterilizations for purposes of federal regulations; and 5) requiring a 30-day waiting period between consent and operation. Attention is given to the questions of what is to be regulated -- what is surgical sterilization, what are the conditions of informed consent, and under what conditions is voluntary consent unobtainable. A final question is the ethics of sterilization regulation. Opponents of the sterilization regulations made 2 different kinds of cases: 1) regulation creates obstacles to the exercise of "free choice" by consumers and patients; and 2) the state (through the courts) ought to sanction the involuntary sterilizaiton of certain groups, particularly retarded individuals, in the interests of caretakers, taxpayers, parents, future children, or the retarded themselves.