In June of this year, a troubling report emerged from the south African country of Namibia. Three women, upon being diagnosed as HIV positive, were subsequently sterilized by their doctors without their knowledge and against their will. Further investigation has revealed that these are not the only cases of forced sterilization of HIV positive women in Namibia, with at least 15 having been reported in the past two years.
Looking at this issue for a moment in the frame of relative ethics, it is clear that forced sterilization of HIV positive women in the United States would be unquestionably unethical, both because it usurps the patient’s free will and because we have developed effective and much less invasive ways of preventing an HIV positive mother from transmitting the disease to her children. In a June 6, 2010 post on the blog “women’sbioethicsproject”, the author Ayesha writes, “I can only surmise that the goal for preventing future pregnancies of these women is to halt this method of potential transmission of the HIV virus…. Does [the high mortality rate of HIV in Namibia] make a doctor’s action to perform a sterilization on an HIV+ woman who may not have consented with capacity and competence, or not consented at all, any easier to understand?” Although Ayesha frames her discussion of the controversy only in terms of questions, reading between the lines suggests that she perhaps believes that the particular circumstances in Namibia make forced sterilization ethically acceptable.
But what in truth are the differences between the United States and Namibia with respect to this issue? For one, performing the procedure without informing and gaining the consent of the patient violates the patient’s integrity and most likely goes against the patient’s wishes no matter what country it takes place in, so on this point alone there is no way to consider what was done in Namibia to be ethical (not to mention the fact that if women find out that they will be forcefully sterilized, they will probably not go get tested for HIV, making the situation even worse).
Taking away the aspect of the sterilization being forced (let’s say the patients did give informed consent), it still strikes me that Namibian doctors who advocate for HIV+ women to sterilize themselves are acting unethically. As we discussed in class, effective protocols to lower the rate of HIV transmission from mother to child have been successfully developed and implemented in Africa. Combining these with a nation-wide program to encourage the use of condoms (which would certainly not be expensive to implement compared to the amount of money the US spends on pharmaceuticals), the transmission rate of HIV could be dramatically reduced in a feasible and effective manner without the invasive and psychologically devastating step of sterilizing HIV positive Namibian women (who most certainly have already endured enough pain in their lives). If it seems that I am exaggerating the impact that widespread condom use can have on decreasing the rate of HIV, consider the fact that from 1991 to 2003, new HIV infections in Thailand declined by 90% largely due to a campaign by schools, businesses, media, and the government to promote condoms (see Mechai Viravaidya’s TED talk for more: http://vodpod.com/watch/4556040-how-mr-condom-made-thailand-a-better-place-mechai-viravaidya-at-ted). If there were absolutely no other choice to stem the tide of HIV in Africa, sterilization of HIV positive women might possibly be an ethical solution, but as it stands today it is unjustifiable anywhere in the world.
Sources:
http://womensbioethics.blogspot.com/2010/06/forced-sterilisation-in-namibia.html
http://www.bbc.co.uk/news/10202429
http://vodpod.com/watch/4556040-how-mr-condom-made-thailand-a-better-place-mechai-viravaidya-at-ted
2 comments:
Wow, this is incredibly shocking and I think a very important issue.
I definitely agree with you in that the sterilization of women who are HIV positive without their consent is extremely unethical on many levels. First off, the women were unaware of the sterilization procedures which disobeys the requirements for informed consent. Secondly, despite the issues of informed consent, there are alternative measures in place to deal with the HIV virus.
But, I think there is something else to this that addresses a deeper concern. Reading this post eerily reminding me of Ashley's treatment, and specifically the violations of Ashley's rights as a woman. When Ashley's parents and doctors decided to remove her uterus and breast buds, they denied her the opportunity to develop to her full potential as a woman. This is the same thing that is happening when women in Namibia are forcibly sterilized. The ability to have children is an essential part of being a woman. When doctors in Namibia take this away from their patients, they are removing an essential right that all women deserve to have. It is important to see this issue through the feminist perspective, because sterilization is a process directly related to one's identity as a woman. In looking at it through this lens, it gives further evidence to why these procedures are extremely unethical.
As someone who is considering going into medicine, I really had a knee-jerk reaction to this. I mean as a doctor you basically have people coming in to see you and placing their utmost trust in you. As a human being it's just wrong to take advantage of that. On the other hand, although I agree that sterilization is a easy (not on the part of the women, though) and guaranteed way to prevent children being born with HIV, so much of medicine is prevention. And that's what the doctors were trying to do, prevent so many children from having to go through that. That said, I think taking away a woman's ability to have children is like taking away a part of her like Cece said. Maybe the doctors were trying to work towards the greater good, but I don't believe in a numerical value to a person's life. I don't believe that messing with one person's life on that level is justified by helping many people when there is still so much research to be done regarding HIV.
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