Sterilizing incompetent drug-addicted women

By Cristiane Avancini Alves

A court in Brazil recently held that the mother of a drug-addicted adult woman (who is pregnant and who already has three children) may seek the court’s authorization for the tubal ligation of her daughter provided the daughter is unable to manage her own affairs. The Brazilian health system has received an increasing number of requests for sterilization in the last years, but according to the Family Planning Law, which is based on the principle of informed consent, sterilizations in such circumstances may only be carried out if the woman is legally incompetent.

Such cases clearly raise a number of concerns. For example, sterilization should generally be considered to be an irreversible procedure which deprives the woman of her fertility, and it does nothing to treat the woman’s addiction or help her avoid resorting to prostitution in order to obtain drugs.

One approach to the problem is so-called “dialogical assistance”. This involves the consideration of each case by physicians, psychiatrists and social workers who assess the woman and establish her competence and informed consent to sterilization, and only then consider approaching the courts to authorize sterilization. This procedure can indicate a practical application of patient autonomy and the beneficence principle in social and legal spheres.