Brazilian women rely on sterilization as the main source of birth control. Sterilization has been one of the causes of the steep decline in fertility in Brazil, at least since the second half of 1970. It is hypothesized that understanding couples’ relationships might be key to explaining this high rate of female sterilizations. Possible reasons for the higher level of fertility among women in unstable unions than among women in stable ones could be the less effective use of (...) contraceptive methods, or that women in unstable unions tend to use less effective or reversible contraceptive methods. In this paper discrete time modelling of the timing of sterilization according to union histories is presented. The analysis uses the calendar data of the 1996 Brazilian DHS. It is shown that women in second or higher order unions have a lower risk of sterilization. This result should be taken into account in the analysis of the determinants of female sterilization in Brazil. (shrink)

Approximately 47 percent of women ages fifteen to forty‐four are currently without children, and slightly more than 20 percent of white women in America will never bear children, the highest percentage in modern history. Many fertile women who are childless are voluntarily so. Although any competent person twenty‐one years or older is legally eligible for voluntary sterilization, many doctors refuse to sterilize childfree women. This essay explores various reasons a woman would want to continue in her childfree lifestyle, evaluates (...) the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization—both from the woman's and the physician's perspective—and assesses the legal status of voluntary sterilization for nonparous women. The essay also urges physicians to follow recommended guidelines for counseling women who, regardless of parity, desire sterilization and to provide this contraception if, after careful consideration, there are no outstanding health or other reasons that the procedure should not be performed. (shrink)

Sterilizations sponsored and coerced by the state occurred at the Laconia State School in New Hampshire for decades as part of the American eugenics movement in the early twentieth century. The context of that movement is summarized, the case of the Laconia State School is presented, and arguments are offered to explain the immorality of the affair.

The moral standing of involuntary sterilization has long been subject to debate but has only recently been looked upon with disfavor. When sterilization of a mentally handicapped minor is entertained, issues of eugenics, medical ethics, and legal precedent specially arise. Ethics consultants and ethics committees have been asked to consider such cases.

SummaryIn contrast to the USA and the UK, vasectomy is less popular than tubal ligation in Australia, and this may reflect differences in husband-wife communication. Using data from the 1979 Canberra Population Survey, it seemed that although a majority of respondents would use sterilization, female sterilization would be preferred, largely because males were more resistant to the idea than females. Respondents born outside Australia, the UK, and Eire were more resistant to the idea of sterilization, but reported (...) higher use of tubal ligation. (shrink)

Cowdin and Tuohey argue for a rethinking of Catholic bioethical principles and the Church's moral authority. Citing the Second Vatican council for support, they argue that if the Church were to respect the proper autonomy of medicine, it would allow sterilizations. In this essay I argue against Cowdin and Tuohey's understanding that the Church has derived its moral laws independent of consultation with medicine and that it treats medicine simply as a source of technical expertise. I also argue that they (...) misunderstand the nature of autonomy as well as the Church's position regarding the type of autonomy they request for medicine. I will especially argue against their understanding of the principles of totality and double effect as “dispensations” from the moral order. I conclude that they have provided no grounds to cause the Church to reconsider its condemnation of all sterilizations. (shrink)

I defend a novel account of the wrong of subjecting people to non-consensual sterilization (NCS), particularly in the context of the state-sponsored eugenics programmes once prevalent in the United States. What makes the eugenic practice of NCS distinctively wrong, I claim, is its dehumanizing core: the fact that it is tantamount to treating people as nonhuman animals, thereby expressing the degrading social meaning that they have the value of animals. The practice of NCS is prima facie seriously wrong partly, (...) but crucially, on these grounds. I consider and reject accounts of the wrong of NCS that make no reference to its animalizing character, such as that it violates victims’ (procreative) autonomy, amounts to treating them merely as a means, inflicts psychological harm on them, or constitutes an affront to their human dignity. My discussion suggests that the critical vocabulary of bioethics should be expanded beyond talk of rights-violations, benefits and harms, and equal treatment—and that the language of dehumanization is indispensable to bioethicists. (shrink)

This paper focuses on the concept of sterility as idealized in the Biblical text and exemplified in the stories of Sarah and Abraham, Rebecca, Leah, Rachel and Jacob. My analysis of these stories leads to the hypothesis that sterility is one of the foundational themes of Israel’s ancient past, by condensing some of the main obstacles inherent to the emergency of a people who believe to be guided by God. This new perspective on sterility was achieved by focusing on the (...) spectrum of meanings of the Hebrew root ‘qr, which includes infertility and uprooting; these, added to famine in the land, are experiences that will shape the religious conscience of Israel. This approach amplifies the perception of sterility in the Hebrew Bible, as it emerges from the text as a liminal state of deprivation , in opposition to the contents of the divine oath to the patriarchs (progeny and land). But even while enclosing lack of productivity, weakness and death, which have a negative value, Biblical sterility is not a closed circle, but a space open to potentiality, where divine revelation occurs. God reveals himself through sterility and in sterility. The originality and the notion of specificity in the biblical idea of sterility lie in this cyclical trait, which breaks the circumscription and negative orientation of sterility. The Bible presents sterility as a transitory state, an area for individual and corporate transformation of status. In an ideological system, such as ancient Israel’s, where contractual relations replace natural relations, sterility functions as a powerful symbol of the relationship among men and between men and God. And this may be the reason why sterile matriarch’s traditions were continually re-interpreted, from the 10th century BCE. until the 1st century CE, and could be adapted to new contexts and make sense to distinct communities, particularly in times of crisis and transition. (shrink)

Disagreement over the legitimacy of direct sterilization continues within Catholic moral debate, with painful and at times confusing ramifications for Catholic healthcare systems. This paper argues that the medical profession should be construed as a key moral authority in this debate, on two grounds. First, the recent revival of neo-Aristotelianism in moral philosophy as applied to medical ethics has brought out the inherently moral dimensions of the history and current practice of medicine. Second, this recognition can be linked to (...) Catholic morality through Vatican II’s affirmation of the legitimate autonomy of culture, including the sciences. A partial precedent for understanding the moral authority of medicine can be found in the recent history of Catholic medical morality, and we further argue that a full contemporary recognition of that authority would weigh against an absolute prohibition of direct sterilizations. Institutionally, we propose the allowance of direct sterilizations in cases where the clinically perceived biomedical good of the patient is at stake. (shrink)

ABSTRACTBased on the case of Rosa, a nine‐year‐old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an (...) ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity. (shrink)

From 1966 to 1990 there was a marked rise in the use of voluntary sterilization in Flanders, followed by a fall in women under the age of 40. In the last three decades a remarkable change has occurred in the choice between male and female sterilization. Compared with many other European countries, sterilization of men and women is widely practised in Flanders. In 1996 40% of 40- to 44-year-old women underwent voluntarily sterilization or had voluntarily sterilized (...) partners. Additionally, another 9% of these women were sterilized for medical reasons. Voluntarily sterilized couples are on average older than non-sterilized couples, and, obviously, consider their families to be complete. For couples with a complete family, parity is the most important predictor in the choice between sterilization and non-sterilization. Regularly practising Catholics undergo sterilization least. Also, highly educated couples are less likely to have a sterilization. Couples who ever experienced a contraceptive failure choose sterilization more. Voluntary sterilization has no substantial effect on the fertility of the population since the effect on the prevented numbers of both wanted and unwanted births appears to be small. However, if voluntary sterilization did not occur, differences in fertility within the population would probably increase. It is presumed that the popularity of voluntary sterilization in Flanders has passed its peak and that its use will decline in the near future. (shrink)

Fertility levels have dropped substantially in Latin America in recent decades, fuelled by increased contraceptive use and notably a method mix skewed towards female sterilization. This study examined choice of female sterilization in four Latin American countries: Brazil, Colombia, the Dominican Republic and Peru. Data were drawn from national Demographic and Health Surveys conducted in 1995s reproductive histories to consider the effects of a number of sociodemographic and contextual determinants as they pertained to status at the moment of (...) the event. The results revealed that the likelihood of a womans propensity to choose sterilization. (shrink)

This article discusses the experience of an Icelandic woman with intellectual disabilities who was sterilized and how she has dealt with it. It also reflects on some ethical and methodological issues that arise during inclusive life history research. The article is based on cooperation between two women, Eygló Ebba Hreinsdóttir, who was labelled with intellectual disabilities when she moved to an institution in Iceland in the 1970s, and the researcher Gu?rún V. Stefánsdóttir. Since 2003 we have worked closely together on (...) an inclusive life history project. The article is based on a recorded conversation between Ebba and Gudrun and the work of the Icelandic women's history group in which both participated for three years. Ebba was sterilized when she was 14 years old but didn't know about the sterilization until she was 27. The article describes the deep emotional impact and how she came to terms with it. (shrink)

The Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision, first leaked to the public on 2 May 2022 and officially released on 24 June 2022, overturned Roe v. Wade and thereby determined that abortion is no longer a federally protected right under the Constitution. Instead, the decision gives individual states the right to regulate abortion. Since the Dobbs decision first leaked, our institution has received numerous requests for permanent contraception from individuals stating that their motivation to pursue permanent contraception (...) was influenced by the Dobbs decision and concerns about their reproductive autonomy. Discussions with patients seeking permanent contraception since the Supreme Court’s leaked decision have led us to ask ourselves, is legislative anxiety an indication for surgery? This article presents a case series consisting of a convenience sample of 17 young, nulliparous individuals who sought out permanent contraception in the six months following the leak of the Dobbs decision. Healthcare professionals often feel discomfort in offering permanent contraception to young and nulliparous individuals. Accordingly, we discuss pertinent legal issues, review relevant ethical considerations, and offer a framework for these discussions intended to empower the consulting healthcare professional to center the bodily autonomy of every patient regardless of age, parity, or indication for permanent contraception. (shrink)

Whether its title, ύπέρ τοῦ μ γεννᾶν is authentic or not, the work transmitted as ‘Book X’ of Aristotle's History of Animals deals with a wide range of possible causes for failure to conceive and generate offspring. It sets out by saying that these causes may lie in both partners or in either of them, but in the sequel the author devotes most of his attention to problems of the female body. Thus he discusses the state of the uterus, the (...) occurrence and modalities of menstruation, the condition and position of the mouth of the uterus, the emission of fluid during sleep , physical weakness or vigour on awakening after this nocturnal emission, the occurrence of flatulence in the uterus and the ability to discharge this, moistness or dryness of the uterus, wind-pregnancy, and spasms in the uterus. Then he briefly considers the possibility that the cause of infertility lies with the male, but this is disposed of in one sentence: if you want to find out whether the man is to blame, the author says, just let him have intercourse with another woman and see whether that produces a satisfactory result . The writer also acknowledges that the problem may lie in a failure of two otherwise healthy partners to match sexually, or as he puts it, to ‘run at the same pace’ ἲσοδρομῆσαι during intercourse, but he does not go into this possibility at great length , and he proceeds to discuss further particulars on the female side. (shrink)

Does the contemporary Natural Law position that only heterosexual couples are capable of marriage rest upon an “arbitrary and irrational distinction between same-sex couples and sterile heterosexual couples?” Anderson :759–775, 2013: 759). There are many who think so. In a recent article in these pages, Erik Anderson offers his case that these critics are correct. In what follows I examine Anderson’s argument and conclude that, whether or not one ultimately agrees with the New Natural Law account of marriage, the distinction (...) found there between same sex couples and sterile heterosexual couples is neither arbitrary nor irrational. (shrink)

We cannot easily condemn in principle a policy where people are non-voluntarily sterilized with their informed consent (where they accept sterilization, if they do, in order to avoid punishment). There are conceivable circumstances where such a policy would be morally acceptable. One such conceivable circumstance is the one (incorrectly, as it were) believed by most decent advocates of eugenics in the late nineteenth and early twentieth century to exist: to wit, a situation where the human race as such is (...) facing a threat. Perhaps today's Chinese experience with a threat of overpopulation is a more realistic example? Finally, there is some room for a kind of non-voluntary (and coercive) sterilization without informed consent. I think of people who are severely mentally retarded, and who cannot understand how sexual intercourse relates to conception. If some of these persons are fertile and sexually active, it may very well be the morally right thing to do to sterilize these persons, in their own best interest, but without their consent - if necessary even through coercive means. (shrink)

1 This book is the product of a one-year project conducted by the Hastings Center, Institute of Society, Ethics and the Life Sciences, during 1976-1977. The Behavior Control Research Group-an ongoing, interdisciplinary working group com posed of philosophers, psychiatrists, psychologists, social sci entists, and lawyers-met four times over the course of the year with special consultants with expertise in the field of mental retardation. At those meetings, participants gave in formal presentations, which were followed by group discus sion. As the (...) project progressed, formal papers were delivered and subjected to further critical commentary. This volume, in two related parts, represents the deliberations of the group as a whole, and then offers individual papers prepared by some scholars in order to give a sense of the kind of specific arguments on which the general conclusions were based. We undertook the project to examine: (1) questions of competence and consent; and (2) the practical implications, lThe project, entitled "Ethical Issues in the Care and Treatment of the Mildly Mentally Retarded," was supported by the EVI5T program of the National Science Foundation under Grant No. 05576-14793. Any Opinions, findings, conclusions, or recommendations expressed herein are those of the authors and do not necessarily reflect the views of the National Science Foundation. ix x PREFACE in terms of care and treatment, that evolve from differing definitions and models applied to mental retardation. (shrink)