California Female Inmates Sterilized

[thesummerqueen]

http://www.addictinginfo.org/2013/07/08/...n-welfare/

Any of our longer running members remember discussing sterilization (permanent or temporary) a long time ago?

[Tiberius]

The doctor who performed some of them:

“Over a 10-year period, that isn’t a huge amount of money,” Heinrich said, “compared to what you save in welfare paying for these unwanted children – as they procreated more. They all wanted it done,” he said of the sterilizations. “If they come a year or two later saying, ‘Somebody forced me to have this done,’ that’s a lie. That’s somebody looking for the state to give them a handout.”

Bolding mine. We should see the result of an investigation before we start crucifying doctors. If they were performing a procedure which was actually wanted by the patient, then there isn't anything wrong with it.

Note that I'm not saying they wanted it; I'm merely exercising skepticism until we have more evidence. Innocent until proven guilty, and all that.

[Autumnlicious]

Here, have a more reliable source:
http://www.sacbee.com/2013/07/07/5549696...ornia.html

The crux of the issue is, is it forced sterilization or not?

Advocates claim that it is coercive, proponents claim that requesting permission is not coercion.

Regardless, there is a procedural violation as it should be a case-by-case review. Whether or not that is sensible is another matter.
Against:

Crystal Nguyen, a former Valley State Prison inmate who worked in the prison's infirmary during 2007, said she often overheard medical staff asking inmates who had served multiple prison terms to agree to be sterilized.

"I was like, 'Oh my God, that's not right,' " said Nguyen, 28. "Do they think they're animals, and they don't want them to breed anymore?"

One former Valley State inmate who gave birth to a son in October 2006 said the institution's OB-GYN, Dr. James Heinrich, repeatedly pressured her to agree to a tubal ligation.

"As soon as he found out that I had five kids, he suggested that I look into getting it done. The closer I got to my due date, the more he talked about it," said Christina Cordero, 34, who spent two years in prison for auto theft. "He made me feel like a bad mother if I didn't do it."

Cordero, released in 2008 and now living in Upland, agreed to the procedure.

"Today," she said, "I wish I would have never had it done."

For:

In an interview with CIR, Heinrich said he provided an important service to poor women who faced health risks in future pregnancies because of past Caesarean sections. The 69-year-old Bay Area physician denied pressuring anyone and expressed surprise that local contract doctors had charged for the surgeries. He described the $147,460 total as minimal.

"Over a 10-year period, that isn't a huge amount of money," Heinrich said, "compared to what you save in welfare paying for these unwanted children – as they procreated more."

The top medical manager at Valley State Prison from 2005 to 2008 characterized the surgeries as an empowerment issue for female inmates, providing them the same options as women on the outside. Daun Martin, a licensed psychologist, also claimed that some pregnant women, particularly those on drugs or who were homeless, would commit crimes so they could return to prison for better health care.

"Do I criticize those women for manipulating the system because they're pregnant? Absolutely not," said Martin, 73. "But I don't think it should happen. And I'd like to find ways to decrease that."

Procedural violations aside, how does one qualify the difference between coercive and non-coercive recommendations?

In the strictest sense, the against side did agree to such operations. There remains the question of informed consent though.

[orogenicman]

The doctor who performed some of them:

“Over a 10-year period, that isn’t a huge amount of money,” Heinrich said, “compared to what you save in welfare paying for these unwanted children – as they procreated more. They all wanted it done,” he said of the sterilizations. “If they come a year or two later saying, ‘Somebody forced me to have this done,’ that’s a lie. That’s somebody looking for the state to give them a handout.”

Bolding mine. We should see the result of an investigation before we start crucifying doctors. If they were performing a procedure which was actually wanted by the patient, then there isn't anything wrong with it.

Note that I'm not saying they wanted it; I'm merely exercising skepticism until we have more evidence. Innocent until proven guilty, and all that.

I question the ethics as well as the legality of performing such an operation on people who are confined against their will, regardless of whether or not they want it. And mind you, all we have here is the doctor's word that they actually wanted it.

[pineapplebunnybounce]

I question the ethics as well as the legality of performing such an operation on people who are confined against their will, regardless of whether or not they want it. And mind you, all we have here is the doctor's word that they actually wanted it.

if they wanted it, why would it be unethical to perform it? (provided informed consent and so on.)

The way that the doctor presents the option is, to me, the key to whether or not it's ethical. It seems to me that the doctor should have a list of criteria (completely health-based) on who he would recommend tubal ligation to. And he has to make it clear that it is completely up to the patient, and that it would in no way affect the patient's care and privileges at the facility. Also since i think it's a bit inevitable that patients may feel like they have to say yes, or they may not get good treatment if they disagree with the doctor, the doctor should try his best to prevent them feeling this way.

This is how researchers recruit patients into clinical trials, to prevent anyone from feeling like they have to do something they don't want to.

And then of course, the doctor should explain what the procedure does, why he recommends it, what her other options are, side-effects, etc. etc.

I mean doctors usually just recommend things, but in a prison, where the patients are likely to feel like they shouldn't fall out of favour with the doctor, doctors should be extra careful not to cause their patients to feel pressured into a decision.

[Gilgamesh]

The sterilizations performed were not forced, as far as we know. The article did a good job of wording it to make it seem as though they were, though.

I see no problem.

[Ben Davis]

The sterilizations performed were not forced, as far as we know. The article did a good job of wording it to make it seem as though they were, though.

I see no problem.

Irrespective of whether the women were forced or not, due process was not followed so the Health Care Review Committee wasn't able to confirm consent or monitor the process. What this means is that a doctor was making arbitrary decisions on the suitability of particular women to have children and side-stepping all quality controls. That's malpractice.

[orogenicman]

I question the ethics as well as the legality of performing such an operation on people who are confined against their will, regardless of whether or not they want it. And mind you, all we have here is the doctor's word that they actually wanted it.

if they wanted it, why would it be unethical to perform it? (provided informed consent and so on.)

The way that the doctor presents the option is, to me, the key to whether or not it's ethical. It seems to me that the doctor should have a list of criteria (completely health-based) on who he would recommend tubal ligation to. And he has to make it clear that it is completely up to the patient, and that it would in no way affect the patient's care and privileges at the facility. Also since i think it's a bit inevitable that patients may feel like they have to say yes, or they may not get good treatment if they disagree with the doctor, the doctor should try his best to prevent them feeling this way.

This is how researchers recruit patients into clinical trials, to prevent anyone from feeling like they have to do something they don't want to.

And then of course, the doctor should explain what the procedure does, why he recommends it, what her other options are, side-effects, etc. etc.

I mean doctors usually just recommend things, but in a prison, where the patients are likely to feel like they shouldn't fall out of favour with the doctor, doctors should be extra careful not to cause their patients to feel pressured into a decision.

But we are not talking about patients in a clinical trial. We are talking about inmates in a prison. And having a cousin who used to be a psychiatrist at a maximum security prison who committed suicide, one has to wonder about the quality and perhaps even the ethics of healthcare providers at these institutions. I just think it sets a very dangerous precedent.

[thesummerqueen]

Being as our systems are set to "punish you off the streets" instead of "rehabilitate," I'm inclined to agree, Oro.

[Tonus]

Irrespective of whether the women were forced or not, due process was not followed so the Health Care Review Committee wasn't able to confirm consent or monitor the process. What this means is that a doctor was making arbitrary decisions on the suitability of particular women to have children and side-stepping all quality controls. That's malpractice.

I think that this is the issue. There are procedures in place that must be followed before you perform that kind of operation on an inmate, and those were not followed. Which means that there's no paper trail, not even something as obvious as release/consent forms. There's no reason to accept that a charge this serious can be met with "nah, don't worry about it, she said it was okay."