Patricia Hughes, University of Notre Dame
“Overriding Autonomy: A Comparative Study of Involuntary Sterilization in Peru and the US”
Bio: Trish Hughes is a senior English and pre-professional studies major at the University of Notre Dame. She is a past participant in the Kellogg Institute’s Experience the World fellowship program through which she collected malnutrition data among children in a rural Peruvian community and volunteered in a small medical clinic. Domestically, she has interned at a supportive housing facility for people with HIV/AIDS in Baltimore, Maryland and worked as a medical outreach worker in the migrant farm camps of southern New Jersey. On campus, she is active with the Big Brothers/Big Sisters Association of Notre Dame and is a member of the Notre Dame sailing team. She plans to complete a post-graduate year of service and apply to medical school.
Abstract: From an ethics perspective, a comparison is made of two cases in which beneficence overrides respect for autonomy through the involuntary sterilization of women in Peru and the US. The comparison begins with a discussion of the sterilization of over 300,000 women in Peru under Alberto Fujimori’s administration. The autonomy argument against the mass sterilization is based on the sterilized women’s compromised understanding of the circumstances surrounding the procedure and the health professionals’ use of coercion tactics. The beneficence argument for sterilization stems from Fujimori’s attempt to reduce poverty by moderating population growth through the Peruvian Family Planning Program. The sterilization of Peruvian women under Fujimori is then compared to the sterilization of a six year old Seattle girl who had been diagnosed as having severe developmental delays, referred to as the Ashley case. The sterilization procedure was unprecedented in the US in that it was executed without the required court order. The Ashley case is discussed using a weak autonomy argument, pointing to the substituted judgment of her parents who determined that the removal of her secondary sex characteristics was in her best interest. A stronger beneficence argument is made for the sterilization that rests upon the ability of Ashley’s family to continue to care for her in the home and the cost-effectiveness of the procedure as it compares to a lifetime of hormone injections. The essential comparison highlighted by these cases is that there is an element which makes overriding autonomy unjust in one situation and just in another. It is argued that the patient’s best interests and her capacity for autonomous choice comprise that element.
