Sterilisation of incompetent mentally handicapped persons: a model for decision making

Doctors are regularly confronted with requests for sterilisation of mentall y handicapped people who cannot give consent for themselves. They ought to act in a medical vacuum because there doesn't exist a consensus about a mod el for decision making on this matter. In this article a model for decision making is proposed, based on a review of the literature and our own research data. We have attempted to select an d classify certain factors which could enable us to arrive at an ethically justifiable method of making a medical decision. In doing so we distinguish two major criteria: heredity and parenting compe tence, and six minor criteria: conception risk, IQ, age, personality medica l aspects and prognosis and finally support and guidance for the mentally, handicapped person. The major criteria give rise to a "situation of necessi ty" In this situation the physician is confronted with a conflict of values and interests. The minor criteria are of an entirely different ethical ord er. They can only be considered once the major criteria have created a "sit uation of necessity". Ultimately it comes down to deciding whether the benefits of sterilisation outweigh the drawbacks and whether the means are appropriate to the end, wh ere efficient contraception is the end and irreversible sterilisation is th e means.