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Sterilization, forced abortion are never the answer, bioethicist says

A 32-year-old pregnant woman from Massachusetts, known only as Mary Moe, is at the center of a heated battle over abortion and sterilization, in a case so complex you could use it to teach an entire course on bioethics.

Moe suffers from severe schizophrenia and bipolar mood disorder. She has been pregnant before: The first time she had an abortion, and the second pregnancy resulted in a boy now being raised by Moe’s parents. Between her abortion and the birth of her son, she suffered what court papers refer to as a “psychotic break," and had to be hospitalized. She now takes medication, but her diseases are so severe that she is still not in touch with reality.

Forced abortion for mentally ill woman? No way, court says

At a court hearing last December the state Department of Mental Health asked that her parents be made her guardians. The parents wanted their daughter, then two months pregnant, to have an abortion. During that hearing doctors testified that the drugs Moe is taking threatened the health of her fetus. They also said stopping them would place her at serious risk of going "deeper into madness."  

The judge found the argument for an abortion persuasive. She ordered that Moe's parents be appointed as co-guardians, and said they could do whatever was necessary including having their daughter "coaxed, bribed, or even enticed ... by ruse" into a hospital where the abortion could be performed. The judge added that Moe should be sterilized after the abortion so that the same situation did not come up again.

The decision was immediately appealed. Now, a Massachusetts appellate court has overturned the lower court, and sterilization is off the table. The appellate court said that if Moe were competent she would not want an abortion, since she has said she does not want one. So no abortion is in store either.

Did the appellate court make the right decision? I think so -- but for the wrong reasons.

The state of North Carolina just paid out big sums of money to people who had been sterilized without their consent in the 1960s and 1970s. Sterilization has been abused again and again in this and other countries. There is no reversing it. Whatever needs to be done to help Moe, it is not sterilizing her.

If she is not to be sterilized, can severely mentally ill persons like Moe be told never to have sex? The court didn't broach the subject, but it is a key ethical question.

It is probably impossible to prevent Moe from having sex.  But given her mental state she is hardly capable of consent.  I think she needs to be on permanent birth control until and unless she somehow recovers from her mental illnesses. Then, and only then, should she be free to have a child.

What about the abortion? She cannot consent to it. The Massachusetts courts are trying to guess what she would want if she were competent using some of her statements to guide them. That is a hopeless quest. Moe is too sick to tell us anything. And, despite the judges’ efforts, it is pointless to pretend to know her wishes about this pregnancy.

Her poor parents do not want to worry about their daughter, raise one of her children and find themselves with another. But their stake in all this disqualifies them to decide what ought to happen.

What we are left with when autonomy is gone and family are conflicted is trying to do what is best for Moe and her fetus. I do not think an abortion clearly meets that principle.

If Moe’s medicines put the fetus at risk, then try to lower the dose. If Moe herself becomes even more impaired, stop. If Moe cannot possibly raise the baby and her parents cannot either, then adoption is the best road to follow.

Allowing Mary Moe to become pregnant again is not in her best interest. Ending the life of her fetus when she cannot tell us what to do is not in the best interest of the fetus. There is a lot to think about in the case of Moe, but forced sterilization and non-consensual abortion should not be part of that thinking.

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