The sterilisation of people with intellectual disabilities in England and Wales during the period 1988 to 1999.
Courts rarely blocked sterilisation for women with ID in 1990s England, and modern practice must put the client’s voice and treatable health issues first.
01Research in Context
What this study did
The authors read every court file in England and Wales that asked for sterilisation of a person with intellectual disability between 1988 and 1999.
They counted how many requests were made, who the people were, and how often judges said yes.
What they found
Seventy-three cases reached the courts. Most were women living at home with no partner.
Courts approved sterilisation in 79 percent of hearings. Six more women were probably sterilised without any court order.
How this fits with other research
Y-Spanoudis et al. (2011) talked to women with ID and families in Taiwan. Their voices show the same pattern: families and doctors drive the choice, not the woman.
Lin et al. (2010) found women with ID often miss basic cervical screening. Both papers reveal health care decisions happening to them, not with them.
Gerber et al. (2011) link untreated pain or incontinence to challenging behaviour. When pain is missed, sterilisation can look like an easy fix instead of treating the real problem.
Why it matters
If you serve adults with ID, check whether medical care is offered before drastic steps are taken. Ask if the client feels pain, sees well, or sleeps. Document her own words, even if they are simple. Bring these data to the team so surgery is not the first plan.
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02At a glance
03Original abstract
BACKGROUND: In England and Wales, if a person is thought to lack capacity to make a decision to undergo a sterilisation operation, a specific process occurs. A Judge sitting in the Family Division of the High Court receives evidence from relevant parties including psychiatric and gynaecological experts and subsequently decides on the lawfulness of the sterilisation operation. We have investigated who was referred and by whom, the reasons given, and the outcomes of the legal process during an 11-year period. METHODS: A retrospective case note study was undertaken of all referrals to the Official Solicitor's Office for sterilisation between 1988 and 1999. Using an established protocol, information was obtained from legal and clinical notes relating to the initial referral to the Official Solicitor, the opinions of experts, the court proceedings and the outcome. RESULTS: Seventy-three people, only three (5%) of whom were men, were referred over the 11 years. They were aged between 12 and 41 years. All but one had an intellectual disability (ID). Seventy-five per cent were living at home and did not have partners. Full applications were made for 50 of the 73 (68.5%), 39 proceeding to a court hearing. For 31 of the 39 (79.5%) cases, the court ruled that sterilisation would be in the person's 'best interests'. An additional six women probably had operations resulting in sterilisation without court authorization. CONCLUSIONS: Referrals for sterilisation are almost always for people with IDs. In the case of the majority, it was thought that it was unlikely that they had had or will have in the future a sexual relationship. Care needs to be taken in interpreting the results in this case note study. We hypothesize that the request for sterilisation is the consequence of a complex process reflecting concerns about the future, but in the context of other family issues. The relationship between lacking the capacity to consent to sterilisation and the capacity to consent to sexual intercourse needs further exploration. Future studies including interviews with those involved are required.
Journal of intellectual disability research : JIDR, 2007 · doi:10.1111/j.1365-2788.2006.00920.x