This is the saddest article I've ever read!

[Chillyegg]

Women forced to be sterilised by courts!

m.bbc.co.uk/news/health-31128969
I feel so sorry for this lady and her children.

The action was brought because the local authority have a duty of care towards her as a vulnerable person. Very sad circumstances but at least she will now be free of the interference she hated, as well as there being far, far less risk of death from another pregnancy (for both her and a baby)

The Ashley x case I found horrific. It was in America and I hope not legal here. The term pillow angel I also find horrific. I can understand what would drive a parent to think it would be in the child's interest but I cannot understand why such invasive and life changing procedures could be legal without a risk such as the one in this case.

And of course Ashley has such a low cognitive level there is no way for her to indicate her risks.

This case, while I still feel unnerved by it, is completely different (not, fight, that I think you were inferring they were similar)

You're right, I wasn't suggesting a correlation RJ but I'd forgotten about it until now. This thread jogged my memory re: sterilisation and disabilities.

I think it turned out that it wasn't strictly legal as they should also have gone through the courts (but didn't). Of course, by that point it was too late anyway!

I know the feeling of visceral discomfort with the idea of forced sterilization
but reading this judgement (and the similar case of a man with learning difficulties who underwent vasectomy - think it was 2012, someone mentioned the case earlier?) the thing that really strikes is how detailed the judgements/information gathering/attempts to find non surgical solutions acceptable to the woman concerned as well as attempts to gauge her opinions/understanding and engage her with care have been. Its a horrible no win situation - but at least this judgement minimises the chance of her being found at home bleeding out (from uterine rupture or placenta praevia)/fitting/dead together with child number 7.

If difficult cases are scrutinized and considered in this way, as an individual matter how can it be considered as ' the thin end of the wedge' - there is nothing automatic about the judgement, and no suggestions that ' forced sterilization' should be common practice or broadly acceptable. If anything I think cases like this seem to strengthen the position that the sterilization and such a judgement are a position of last resort and should be only considered in individual and specific circumstances.

The Ashley X case was clearly about convenience for her parents. I know a young woman of 19 who has severe brain damage and is at the stage emotionally and intellectually of a girl of about 6 or 7.

She is fully grown, has breasts and periods and you know what? Her parents deal with it. They didnt put her through painful and extensive surgery in order to make their lives easier, they just fucking deal with it. I cannot express in words how angry that case made (and still makes) me.

The mother of the young woman I know has said often that the worst part isnt the periods or the nappies but the week where they both come together. She hates that she cant lift her DD anymore and needs help, she hates that her DD is in every way a woman, but with the mind of a child, but she deals with it. Oh...I wish I had the words to describe how I feel about Ashley and what was done to her so that her parents had it easier.

I agree with owllady. The sad thing about it is that is news. Poor sad girl having her life raked by all and sundry. There but for the grace of God and so on. I really hope she is ok and her feelings are not wrecked. She may not be capable of many things but she'll still have feelings like everyone else. It's a very sad story which should have been kept private in my view. Does she have Parents if so how do they feel? Life is so cosy on the other side isn't it

I know what you mean sugar - although theres anonymisation of the names etc the details are so specific that she is probably very readily identifiable
and yes, its a tragic situation all round, she sounds a poor soul

but if such a decision must be made in such a contentious issue then the judgement etc should be open to scrutiny? Id be worried by the idea of a court being able to make such a ruling without 'showing its workings' and letting us/society etc discuss them

I think the situation is sad. But I think the fact we only know about this because it went to court is not.

Once upon a time people were locked up and forgotten about and 'treatment' given was up to the staff in the home/hospital.

It is much better that this is decided by the court where the person is represented by an advocate who can argue on their behalf.

I remember back in the 1980s maybe early 1990s a woman being criticised. Her daughter had learning disabilities, not sure of the exact term on the scale of mild to severe but certainly enough that she could not grasp the concept of sex leading to pregnancy.

The mother took the decision to have her daughter sterilised before she was 16 while she could still make the choice for her daughter.

Her reasoning was that her daughter would probably go on to have sexual relationships but would not be able to use contraception or deal with a baby.

I've used the latter case in class a couple of times, it always causes debate.

I have a daughter with severe learning disabilities and complex needs, I don't think you can begin to imagine what an inconvenience it is :o I don't particularly make decisions based on myself as a parent, but I am expected to make ALL the decisions even if I don't want to and that includes contraception.

Wrt Ashley x. I understand why they took that decision, I wouldn't do it myself but I do understand. It's very difficult physically caring for someone as big or bigger than you. It's not short term care either, it's long term, decades and decades and if you are a capable parent the help is not forthcoming off your authority or otherwise. It's not like having a job as a carer (I've been a carer and a bank nurse previously) it's 24/7, you have the physical and the emotional and it can be completely overwhelming.

I know it's difficult for you to imagine if you haven't had to deal with severe disability day in, day out but most parent carers do the absolute best for their children. I'd be horrified if the 36 yo woman in the op was my daughter, I'd feel I'd let her down and I feel she'd have been let down by others. I've heard the human rights argument many times, including in a case similar concerning a younger woman with pregnancy whose guardians felt earlier abortion was necessary but it was overruled by ss who said it was against her human rights as she had no comprehension. The baby was eventually adopted as she couldn't care for it either.

I think my discomfort is that it's so public more than anything. The couple are already extremely vulnerable and now they're bbc news :(

It's a good thing that all legal judgements are made public. Justice cannot happen behind closed doors, there (rightly) was outrage when the Courts of Protection stopped details of their dealings being published in certain cases.

Yes, if you knew the couple you would most likely know it was them. But nobody is going to look scornfully upon THEM, it's more likely that people will have the reaction of the OP (isn't this outrageous) or think that it's a positive step for her to prevent any future pregnancies that may have come.

Hmmn I don't think what is written in the BBC report justifies the action of sterilisation. I would have to study the case itself, but in general, I mistrust local authorities and their interpretation of duty of care. Local authorities are one of the most fecund sources of case law relating to breaches of duty of care against themselves, and are not the most reliable source for determining moral issues of right and wrong, since they often appear to be run from a political perspective.

Anyone could suffer injury or impairment from a future pregnancy. Men are not sterilised when perpetuating their genes unwisely throughout a population and failing to look after their children.

I think there are other ways of dealing with this and its a very slippery slope. Obviously its been approached from a permissive viewpoint - of finding and justifying a reason for the sterilisation, rather than a more neutral perspective - the answer they wanted was already in their heads when they began this.

Did you read th part about the high risk placenta acreta/previa

the "tissue paper thin" uterus and the likely rupture /death from another pregnancy?

how do you stop someone getting pregnant who doesn't understand about sex or pregnancy or consequences and who resents the interference of outside agencies to a degree it's seriously impacting on her.

The choices are sterilisation or imprisonment/segregation.

The actual act of getting pregnant can take merely a few minutes you wouldn't he able to ever leave her alone with her partner.

what do you feel they should do to prevent her dying?

Local authorities are run as businesses

What other ways of dealing with it though?

I've looked at the judgement, but haven't the time to devote to the entire thing now. It sounds like this is the right course of action and it has been decided very carefully.

Still sad, but ultimately right in this case.

Giles Did you read th part about the high risk placenta acreta/previa

the "tissue paper thin" uterus and the likely rupture /death from another pregnancy?

how do you stop someone getting pregnant who doesn't understand about sex or pregnancy or consequences and who resents the interference of outside agencies to a degree it's seriously impacting on her.

Yes, I did. That's the part that concerned me the most. How many women are at the same or similar risk and what happens if one of them, of otherwise sound mind, expresses a desire to get pregnant again and have another baby, regardless of the risk of dieing? Would you also forcibly sterilise her?

What about women who have conditions which might worsen so as to likely be fatal, should they get pregnant again? Forcibly sterilise them too?

what do you feel they should do to prevent her dying?

The same as "they" do with regards to anyone else who endangers their health by their lifestyle.

The problem here is the failure of the policy of care on a national level, and empowering a local authority to act in such a heavy-handed way in a specific situation. The matter should be debated by Parliament as a whole and legislation passed if our elected representatives, following proper research, find it necessary.

But she's not of sound mind that's the difference here.

People otherwise will make a decision on the information they have been given. as foolish as that may well be.

This woman can't do that. her partner can't do that.

someone has to.

Don't think the chandler has read th full judgement.

I don't think they understand the legal process either. The local authority did not act, any more than a social worker can take a child into care.

The issue is not around someone making what may be a medically unwise decision, it's about someone not having th capacity to either make Thr decision in the first place or to understand the implications of it.

The trouble is that a lot of people on this thread (understandably) are not comprehending what capacity is about. You can make your own decisions, as long as you have the ability to understand and this lady, sadly, does not. For example; Many women go ahead with pregnancies that are medically inadvisable but they do so with understanding the risks, the ability to retain information and the ability to communicate their decision. Legislation (MCA 2005) states that people can make unwise choices with capacity.

imagine if this woman had another baby and ended up bleeding to death, that would almost certainly make it into the news due to the nature of her disability, what would the response be on here then? That someone should have done something? that she had been failed by the system?

If it were any other kind of medical decision her parent/carer/guardian would rightly be expected to make that decision on her behalf. Any kind of medical intervention be that surgery or other hospital treatment,and no-one would dispute a parent's ability to make a medical decision on behalf of their learning disabled child. Except when it comes to having babies apparently. Even though she is not able to take care of those babies, doesn't know how she gets pregnant and doesn't seek medical help even though pregnancy for her could be life-threatening.

There are parents on here who have to make decisions for their children with learning difficulties wrt contraception. Would you suggest that they shouldn't be able to do that either? Bearing in mind that a child with learning difficulties doesn't suddenly become an adult capable of making those decisions for themselves, so if you are making contraceptive decisions for your child with learning disabilities at fourteen then the reality is you will need to keep making those decisions for the rest of her life. If as a parent you know your child will need to take contraception for the rest of her life to avoid pregnancy, without exception, then why is it so wrong to suggest that that contraception could be in the form of sterilisation?

This woman is not having her right to be a parent taken from her. There is no romantic notion that she could have babies and be able to parent them successfully. She has already had six babies taken into care and any more babies could result in both her and the baby's death. Just what exactly do people suggest should be the alternative? seriously.

Wrt the Ashley case, in the beginning it didn't sit comfortably with me at all. But a lot of very elequant mn'ers who also had children with severe disabilities made very clear cases for why this situation was unique. This wasn't about parents who wanted their child kept small for their convenience, it was about parents who wanted the ability to care for their child personally for as long as they were able, without the depersonalisation of her by the use of hoists etc. This was a child with the mental age of a three month old baby, who they wanted to still be able to cuddle like the baby she mentally was. And her growing up with all that entailed would have involved releasing her from their care and signing her over to the state to live out her days in a home where she undoubtedly may have become a victim of sexual and physical abuse, as well as the fact that she would not have been able to have the personal love and care of those who loved her.

I'm not sure I would personally be able to do it if I had such a disabled child, but I do understand why someone would, and I don't judge them for it.

makeminea6x perfect sentiments

Just because this is the right decision doesn't stop the whole thing being sad. 6 children growing up in care, 2 adults confused and not understanding their children having to be taken away and a woman experiencing multiple births which must have been terrifying. Pretty sad.

Don't think the chandler has read th full judgement.

I haven't. Where is it published? ie whats the citation?

I don't think they understand the legal process either. The local authority did not act, any more than a social worker can take a child into care.

I do understand the legal process, being a solicitor, but am not an expert on mental health cases, although everyone knows that the State intervenes so as to act on behalf of the LA. However forced sterilisation is a very extreme act by the State and I cannot equate it with the floodgates argument. In fact, basing a positive act designed to take away fundamental rights of an individual on a lack of capacity is highly dubious, although lets face it, who is going to question it on the basis of the right to bodily autonomy on the part of this individual?

Don't you think it should be a matter for legislation, where the details and rules to be applied are laid down in one place, for transparency, accountability and clarity? As opposed to this ad hoc, random and heavily purposive approach?

Or would you quell all possible legal criticism?

Her you go Chandler

www.judiciary.gov.uk/wp-content/uploads/2015/02/re-dd1.pdf

Thanks. Quick look at the judgment, which is first instance. The woman in question has "an Autistic Spectrum Disorder and mild/borderline learning disability". In relation to long term contraception, she "has been clear throughout all discussions recently and historically that she does not wish for an IUD/IUS to be fitted, stating that she does not “want something inside” or “up” her; she would not consider any of the benefits or otherwise of the IUD/IUS, and in recent discussions has demonstrated no ability to ‘weigh’ the relevant information concerning it. She has stated that she does not want to be fitted with a contraceptive implant as (among other adverse side-effects about which she complained) she believed that it had given her a “slipped disc” (the suggested causative link is not possible). She could see no positive benefits of the implant (even though she had one in place herself in the past). DD has been opposed to any hormonal based contraceptive in the past (including the Depo-Provera injection)."

Expert medical witness: "[DD]’s black or white thinking is caused by her ASD and her rigid thinking relating to risks in future pregnancies is also caused by the rigid thinking caused by her ASD”"

The judgment is extremely purposive - the court brings several expert witnesses in favour of the sterilisation procedure, the judgment is concerned with finding reasons to approve it, although the 2005 Act is applied correctly. However Cobb, J only finds case law on the ECHR to support his interpretation - again, I would have to spend hours pouring over this but is there really no case law in existence which upholds the right? I would find that very improbable. Examination of the case law is actually quite cursory.

This part is odd, the right to marry and to found a family under Art. 12 ECHR: "In my view the words “this right” in the Article strongly suggests that these two apparently separate rights, which are capable of operating independently of each other (i.e. “to marry” and “to found a family”), are in fact to be treated as linked, indeed effectively as one single right"

The real reason for the decision becomes apparent: "It is no longer feasible, in my judgment, to continue to provide DD with a contraceptive Depo-Provera injection every three months. This would involve a long-term expectation on DD to comply with the regime, against a background of low level compliance in the recent short term. Were DD to withdraw her co-operation, the reactivation of court process, and short-term emergency measures (including possible forcible entry into her home and restraint) to secure contraception while further court decisions are taken would be a disproportionate (and as it is, an avoidable) interference in DD’s private life. My conclusion in this respect is reinforced by her GP who reported, following DD’s visit to the surgery a few weeks ago, that DD “… seems to be coming more ‘anti’ the injections to me rather than accepting them.”"

The reasons against IUD/IUS contraception include that it is invasive;
there would be likely to be short term distress at being removed from her home, possibly forcibly, for the procedure under general anaesthetic; (this arises in relation to sterilisation too, see below) and
here may be long term distress at her loss of child-bearing capacity; yet apparently these also apply to sterilisation.

"DD’s long held, and consistent, wish and feeling to be treated as normal as possible and to be left alone without interferences in her private life. She finds the involvement of agencies intolerable."

On the risks of sterilisation:
"Mr A said: “Following a sterilisation procedure, [DD] would not need ongoing contraceptive appointments or reviews, nor would be monitored in respect of future pregnancies; she would return to a much more independent lifestyle”;
There is a “considerable” risk that even if DD were to become pregnant again, an elective caesarean section would necessitate emergency hysterectomy to save her life; this would have the effect of removing her fertility at that stage in any event."

Eventually the conclusion: "Future pregnancy poses such a high risk to DD’s life that the option which most effectively reduces the prospects of this should be preferred; this is one of those exceptional cases where medical necessity justifies the considerable interference;

ii) Sterilisation is the treatment which most closely coincides with DD’s dominant wishes and feelings to be left alone to enjoy a ‘normal’ life free from intrusion by health and social services."

Strangely, there is no consideration of the right to bodily autonomy under the Charter, as opposed to the ECHR, which is directly effective.

The judgment is littered with references to DD and her partner finding contact with the authorities intrusive and upsetting.

I don't think anyone is arguing that there are benefits for the individual involved, but I think overall the floodgates argument is more important in the long term - this case sets such a strong precedent that you cannot be sure that it will not be used to further extend forced medical treatment in the future.

Possibly even more disturbing is the lack of comment from those who are educated to question legal judgments, and the criticism of those who do so. Obviously if I were being paid to do this, I would make a better job of it than 10 minutes on the internet late at night. But obviously no-one is ever going to appeal this...