The USA Today recently reported on the difficulties faced by African-Americans seeking healthcare in Alabama. Death rates are higher for most categories of illness in black communities. Oftentimes, physicians are unfamiliar with the obstacles encountered by residents in a particular neighborhood, such as the lack of fresh, healthy food in the grocery stores. USA Today touts a new federal Health and Human Services program as a first step in identifying health disparities. Churches provide support groups that assist in educating people about their health. However, there is little time or money being spent by the Christian community to build clinics in communities such as this one in Alabama. An overall infrastructure for providing charitable ministries is missing.
In Texas, it is common for people to say that if a person wants to have good healthcare they need to pull themselves up by their bootstraps. An African-American friend of mine at Trinity once told me in response, “The problem is, some people don’t have any straps.”
This past fall, I had the privilege of attending the Houston Symphony’s production of
Kaddish. The Kaddish Project seeks to commemorate the noble struggle of individual Holocaust survivors, including four who have made their homes in Houston. Much of my research at Trinity focused on the concept of personhood, that we are more than just biological systems but instead are “someones,” persons. I couldn’t help but think of this as I heard the chorus sing the song of the persecuted Jews: I am someone and “I am here.” Though mocked and beaten in the streets even in the days before World War II, the Jewish people of Europe taught their children that they were of value even though others thought otherwise. The soloists and chorus related the story of one survivor’s recollection of a concentration camp. When the prisoners arrived, those under 14 years of age and over 65 were separated to the left and killed. They were less than optimal for the German labor camp, so they were eliminated. Kaddish led me to reflect on how physicians were a significant part of the German “Final Solution.” They were the ones who deemed the crippled and deformed, the mentally deranged and deficient economic burdens. That’s why I think that as we look for disease and perform technical procedures, it’s important for us to remember that our patients are someones who we must relate to and care for.
In a recent British court case the mother of a 21-year-old woman who was pregnant with her second child asked that doctors perform a sterilization procedure at the time of her planned C-section. The woman has a mental disability and the court is being asked to determine if she is capable of making her own decision regarding sterilization. If it is determined that she is not, her mother is asking for permission for her doctors to sterilize her. The mother says that this would be in her daughter’s best interest due to her inability to care for further children and the likelihood that she would be separated from those children.
This request raises the concern that sterilization of those who had a mental disability was what the eugenics movement of the early 20th century proposed. That attempt to rid society of those who were not desired by preventing their birth showed disrespect for the intrinsic human worth of those with a disability. However, there is a big difference between sterilizing someone in order to decrease the burden on society and doing so because it is in the best interest of the person with the disability. The mother says she desires her daughter to be sterilized for the daughter’s benefit.
The moral difference between the eugenics movement and this mother’s request is one of intent. To sterilize a person who lacks capability to make her own decisions with the sole intent of limiting the number of potentially mentally disabled offspring in society is wrong. To sterilize a person who lacks capability to make her own decisions with the intent of doing what is in her best interest may be right thing to do. If the mother’s intent is not actually her daughter’s best interest, but her own, then it may not be right.
Even though the acts may be the same and the consequences may be the same, intent is the deciding factor in this moral decision.