Bioethics @ TIU

Is Involuntary Temporary Reversible Sterilization Always Wrong?

Posted August 1st, 2017 by Mark McQuain

Ever since Janie Valentine’s blog post last week I have been thinking about the problem of repeat drug offenders and their children. My home state is also Tennessee so I read Judge Sam Benningfield’s order (to reduce prison sentences by 30 days for any drug offender willing to “consent” to voluntary temporary sterilization) with particular local and regional interest.

My office practice is on a street with more than one suboxone treatment clinic (a synthetic opioid designed to be used to assist in narcotic withdraw or as a substitute for pain management with less potential for abuse). It is not uncommon for me to see the parking lots of these clinics full of cars, with unsupervised children playing with other unsupervised children in the parking lot while their parents are inside the clinic receiving their treatment. No doubt some of these patients are opioid dependent and not necessarily opioid impaired. My point here is simply to point out the sheer volume of the opioid problem and also to highlight that this represents the families that are doing well. The children are still with their parents and the parents are not (obviously) under the jurisdiction of the court system.

One partner in my practice and his wife are foster parents and have opened their home to children of repeat drug offenders. These children have often been ordered by child protective services to be temporarily removed from their homes because of their parent’s incarceration related to a drug offense or court ordered treatment. The usual placement is a group of 2 or 3 siblings, often with one of the foster children a newborn baby in the throngs of opioid withdrawal. After seeing several iterations of this pattern, I can certainly sympathize with the judge’s moral outrage and frustration at seeing multiple children, often within the same family, born with opioid withdrawal, though I must agree with Janie Valentine and Steve Phillips that in the case of the judge’s court order (now rescinded), such consent is, at best, coerced given the incarceration.

This brings me to the point of today’s blog. Can there be any condition in which it is right to prevent repeat opioid drug offenders from conceiving a child while impaired by opioid addiction? No one will claim that conceiving a child while addicted to opioid drugs results in a desirable outcome for the parent or child. Choosing to avoid conception requires the very planning that opioid addiction frequently impairs. The current epidemic of opioid-addicted newborns proves that expecting voluntary conception avoidance by the opioid impaired is a non-starter. Voluntary reversible forms of sterilization (none are 100% successful at preventing conception) are available but have non-zero barriers (access/cost/side-effects/compliance/efficacy). Reducing the barriers for those willing to choose temporary sterilization seems reasonable. But what about individuals not willing to voluntarily avoid conception while opioid impaired? Does society have any right to temporarily (reversibly) prevent conception for some time frame in someone impaired by opioids? Should this happen after the first birth of an opioid-addicted newborn? Can it happen after the fourth such serial opioid-addicted newborn birth? At what point should autonomy of the opioid impaired yield to avoiding maleficence to a child?

Let me additionally be clear about what I am not asking or claiming. I am not making some eugenics claim that opioid impairment is genetically determined such that eliminating offspring of individuals suffering from opioid impairment somehow reduces the future risk of opioid dependency within the larger population. I am also not claiming that individuals who are currently opioid impaired will always be opioid impaired. I am not claiming that opioid impaired individuals are necessarily permanently bad parents; when not opioid addicted, they may in fact be wonderful parents. Finally, I am not asking that the sterilization be permanent, as I do not think that opioid impairment is permanent.

Again: Can there be any condition that makes it permissible to involuntarily temporarily reversibly sterilize repeat opioid drug offenders to avoid conceiving a child while opioid impaired?

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