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Paying Substance Misusers to be Sterilised

Enter here to explore ethical issues and discuss the meaning and source of morality.
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getreal
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Paying Substance Misusers to be Sterilised

#1 Post by getreal » April 27th, 2010, 1:40 pm

Barbara Harris, who set up this organisation in the US has been featured in the media today as she wants to bring her project to the UK. From their website
Our Mission
Project Prevention offers cash incentives to women that are addicted to drugs and/or alcohol to use long-term or permanent birth control.

Project Prevention is a national, 501 (C) 3 organization that has paid clients in 39 states and the District of Columbia.

Our mission is to reduce the number of substance exposed births to zero.

Because every baby deserves a sober start!
I'm unsure how I feel about this; on the one hand, I can appreciate this is a pragmatic approach to a dreadful problem, while on the other, I worry that the women involved are in no fit state to throw away their opportunity to be mothers by having the juicy carrot of cash dangled in front of them (everyone involved accepts the money will be spent on drugs/alcohol).
At the moment, on balance, I think the pragmatic approach is perhaps the best of two awful choises. All children deserve the best start in life possible, and while not all women with substance misuse problems will necessarily make bad mothers (and I accept that for some it will prove to be the turning point in their lives) and not all women without such issues will be good mothers, giving birth to damaged children and/or fucking up their lives as they grow up, can be avoided for some. Surely that's a good thing?
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

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Paolo
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Re: Paying Substance Misusers to be Sterilised

#2 Post by Paolo » April 27th, 2010, 4:34 pm

The trouble being that people who misuse substances when younger can kick their habit and want kids later when they've matured a bit. I'd rather see the money go towards programmes to help people kick bad habits and the follow-up support to get them set on a new path.

I can't believe I'm saying that. I'd normally be the first to suggest that everyone on the planet was sterilised...

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Paolo
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Re: Paying Substance Misusers to be Sterilised

#3 Post by Paolo » April 27th, 2010, 5:00 pm

Our mission is to reduce the number of substance exposed births to zero.
So are they paying off smokers too? They should be, given that smoking is known to cause birth defects.
Paolo wrote:I can't believe I'm saying that. I'd normally be the first to suggest that everyone on the planet was sterilised...
I've worked out why I'm not keen. This whole idea strikes me as being disguised eugenics, where "unfit" parents are pre-identified for sterilisation on the basis of something they do that is strongly correlated with their socioeconomic situation. I think it's better to change a person's socioeconomic situation so that their behaviour changes - it's harder work than selective breeding, but it's less ethically suspect.

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getreal
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Re: Paying Substance Misusers to be Sterilised

#4 Post by getreal » April 27th, 2010, 5:25 pm

They have been accused of promoting eugenics (though don't we all, to a degree when ,as a society, we are more than happy to "allow" terminations for foetal abnormalities untill quite late into pregnancy? But that's another discussion) which they refute. I also believe that the vast majority of people who take up their offer opt for long term contraception, rather than sterilisation. Would you still say what you do if they were only offering this (i think it lasts 3 years)?
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

Fia
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Re: Paying Substance Misusers to be Sterilised

#5 Post by Fia » April 27th, 2010, 6:43 pm

Paolo wrote:So are they paying off smokers too? They should be, given that smoking is known to cause birth defects.
And caffeine imbibers, runny cheese and liver eaters, monosodium glutamate addicts...
I agree this smacks of eugenics. For that reason alone I would still say no even if this is all the "help" these potential mothers are offered. Encouragement, education and tangible support, yes.
getreal wrote:not all women with substance misuse problems will necessarily make bad mothers

Quite. And not all bad mothers are substance misusers.

I think it's a short sighted and short term solution for a problem which should be tackled from a completely different direction.

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getreal
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Re: Paying Substance Misusers to be Sterilised

#6 Post by getreal » April 27th, 2010, 9:27 pm

I know what you are saying, Fia, but the problems faced by babies and children of substance misusers are happening now and are pretty grim. The organisation is not saying this is the answer to substance misuse, they seem to be pretty clear that they are only offering a possible option to one of the associated problems. Unfortunatly the approaches (to substance misuse) which have the most success are the ones which are politically unpalatable (methadone/prescribed heroin/users rooms - to name 3) and I can't see any politician taking a serious approach to the issue anytime soon. Meanwhile all these children are suffering the consequences of our inability as a nation, to face up to this very complex issue.

As for the eugenics argument, surely we already practice this to a certain extent?
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

Fia
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Re: Paying Substance Misusers to be Sterilised

#7 Post by Fia » April 27th, 2010, 9:57 pm

As for the eugenics argument, surely we already practice this to a certain extent?
:shrug: Could you explain what you mean, please getreal?

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getreal
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Re: Paying Substance Misusers to be Sterilised

#8 Post by getreal » April 27th, 2010, 10:00 pm

We routinely test for "foetal abnormalities". All pregnant women are offered a number of these tests. If any of them test positive, they can choose to abort the foetus. Isn't this eugenics?
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

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Paolo
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Re: Paying Substance Misusers to be Sterilised

#9 Post by Paolo » April 27th, 2010, 10:11 pm

getreal wrote:They have been accused of promoting eugenics (though don't we all, to a degree when ,as a society, we are more than happy to "allow" terminations for foetal abnormalities untill quite late into pregnancy? But that's another discussion) which they refute.
Of course they refute it, but it's hard to see how bribing members of an undesirable "underclass" to be sterilised can be considered anything else.
getreal wrote:I also believe that the vast majority of people who take up their offer opt for long term contraception, rather than sterilisation. Would you still say what you do if they were only offering this (i think it lasts 3 years)?
Long term contraception I have fewer concerns about. If they only offered that I don't think it's a bad idea.
getreal wrote:As for the eugenics argument, surely we already practice this to a certain extent?
Hmm, to a certain extent maybe. I would argue that there's a difference between the case-by-case termination of a particular pregnancy because of identified health issues that will impact on the lifelong well-being of an individual child and its parents, compared to the complete sterilisation of a person based on a transitory socioeconomic and behavioural situation.

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getreal
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Re: Paying Substance Misusers to be Sterilised

#10 Post by getreal » April 27th, 2010, 10:18 pm

I would argue that there's a difference between the case-by-case termination of a particular pregnancy because of identified health issues that will impact on the lifelong well-being of an individual child and its parents, compared to the complete sterilisation of a person based on a transitory socioeconomic and behavioural situation.
Why? The impact on a family from the birth of a sibling with Downs Syndrome could be positive, the birth of a baby to a woman with a heroin habit leading a chaotic lifestyle could never be seen as positive in any way. Substance misuse has massive and always negative effects on both ther user and their families. It may be "transitory" but the effects on any children born will not be.
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

Manuel
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Re: Paying Substance Misusers to be Sterilised

#11 Post by Manuel » April 27th, 2010, 10:35 pm

Paolo wrote:I've worked out why I'm not keen. This whole idea strikes me as being disguised eugenics, where "unfit" parents are pre-identified for sterilisation on the basis of something they do that is strongly correlated with their socioeconomic situation. I think it's better to change a person's socioeconomic situation so that their behaviour changes - it's harder work than selective breeding, but it's less ethically suspect.
Although drug taking is indeed strongly correlated with ones socioeconomic situation, I personally still would class it as being ones personal choice, a treat for themselves, something quite selfish for the user. Measure this against perhaps stealing food or clothes for themselves or their family, taking something which nobody would deny is a necessity for reasonable living. Personally I don't see socioeconomics as a valid excuse for personal choice here.

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Paolo
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Re: Paying Substance Misusers to be Sterilised

#12 Post by Paolo » April 28th, 2010, 8:22 am

getreal wrote:
I would argue that there's a difference between the case-by-case termination of a particular pregnancy because of identified health issues that will impact on the lifelong well-being of an individual child and its parents, compared to the complete sterilisation of a person based on a transitory socioeconomic and behavioural situation.
Why? The impact on a family from the birth of a sibling with Downs Syndrome could be positive, the birth of a baby to a woman with a heroin habit leading a chaotic lifestyle could never be seen as positive in any way. Substance misuse has massive and always negative effects on both ther user and their families. It may be "transitory" but the effects on any children born will not be.
First and foremost the difference is that termination of a specific pregnancy entails a decision that has implications largely restricted to that pregnancy and the emotional issues associated with the decision to terminate. Sterilisation has long term implications that reach far beyond the scope of one pregnancy - it means that children are not an option even if circumstances change. It also implies that there is no chance that the woman will ever overcome substance abuse, which is hardly supportive.

I would also say that eugenics is not interested in the impact on families - it's about selective breeding of human populations. Individual terminations are far less important that sterilisation, since the parents are able to produce offspring after a termination (assuming there are no complications arising that lead to sterility). This means that the parents can still contribute genes to the population, whereas with sterilisation they cannot.

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Re: Paying Substance Misusers to be Sterilised

#13 Post by Paolo » April 28th, 2010, 8:40 am

Manuel wrote:
Paolo wrote:I've worked out why I'm not keen. This whole idea strikes me as being disguised eugenics, where "unfit" parents are pre-identified for sterilisation on the basis of something they do that is strongly correlated with their socioeconomic situation. I think it's better to change a person's socioeconomic situation so that their behaviour changes - it's harder work than selective breeding, but it's less ethically suspect.
Although drug taking is indeed strongly correlated with ones socioeconomic situation, I personally still would class it as being ones personal choice, a treat for themselves, something quite selfish for the user. Measure this against perhaps stealing food or clothes for themselves or their family, taking something which nobody would deny is a necessity for reasonable living. Personally I don't see socioeconomics as a valid excuse for personal choice here.
There is a difference between use and abuse of substances. Few people make an active choice to abuse alcohol or drugs, usually abuse is a result of other underlying problems that are socioeconomic. From a eugenicist's perspective, drug abusers can be reasonably conflated with an "underclass", so sterilising them (rather than addressing the underlying reasons) becomes a means to reduce the genetic contribution of people who a eugenicist might consider to be inferior (or genetically predisposed to substance abuse). This is selective outbreeding.

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Re: Paying Substance Misusers to be Sterilised

#14 Post by Nick » April 28th, 2010, 10:31 am

I heard an interview about this on Radio 4 some months ago, but whether it's the same outfit I don't know. A factor which is relevant is that the women who chose this solution were one hell of a way down, and had often had several terminations already or had given up for adoption one or indeed several children. Very often homeless, involved in prostitution, sometimes in danger of dying themselves, the service was portrayed as pretty much the last chance saloon.

Being male, I'm conscious that my view is less relevant than if I were female, but I had a generaly favourable impression. The service was primarily concerned with the welfare of the women themselves. There was some concern for not wanting to bring into the world disfunctional children, but it certainly did not come across as a 'law and order' issue. Like others I would prefer long term contraception to sterilisation, but for some, that would be the best solution.

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Re: Paying Substance Misusers to be Sterilised

#15 Post by getreal » April 28th, 2010, 12:06 pm

I would also say that eugenics is not interested in the impact on families - it's about selective breeding of human populations. Individual terminations are far less important that sterilisation, since the parents are able to produce offspring after a termination (assuming there are no complications arising that lead to sterility). This means that the parents can still contribute genes to the population, whereas with sterilisation they cannot.
I would argue that the mere fact that our system allows abortion for foetal abnormality as a matter of course implies that those foetuses are less valuable to society than "normal" ones. As far as I am aware, late abortion is only permitted where there is grave danger to the mother OR foetal abnormality. Don't you think the cost to society in caring for such an individual is not a factor? As a side issue, women with learning disabilities are not encouraged to have children and are often given long term contraception when they cannot understand the implications. This is artificial selection. Isn't this also a form of eugenics?

Personally, I think most western societies practice eugenics to some degree, but they are being dishonest about it.
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

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Paolo
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Re: Paying Substance Misusers to be Sterilised

#16 Post by Paolo » April 28th, 2010, 12:09 pm

I must admit that I am playing devil's advocate here, since I think that voluntary sterilisation is probably a fairly sound practical option for most of the people likely to be involved in this campaign. However, the fact that something is practical, pragmatic or sensible doesn't mean that it lacks unsavory connotations.

Here's a question for everyone: if one group proposes a short-to-middle-term practical solution to a problem for benign reasons, but that solution has associated long-term outcomes that directly correspond with a malign philosophy, by which standard should that solution (and the group that proposed it) be judged? Should we consider that an apparently benign group may have a malign underlying philosophy (or members with that philosophy), or is it better to accept their efforts at face value and ignore the potential for a malign ulterior motive?

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Re: Paying Substance Misusers to be Sterilised

#17 Post by philbo » April 28th, 2010, 12:21 pm

Nick wrote:I heard an interview about this on Radio 4 some months ago, but whether it's the same outfit I don't know. A factor which is relevant is that the women who chose this solution were one hell of a way down, and had often had several terminations already or had given up for adoption one or indeed several children. Very often homeless, involved in prostitution, sometimes in danger of dying themselves, the service was portrayed as pretty much the last chance saloon.

Being male, I'm conscious that my view is less relevant than if I were female, but I had a generaly favourable impression. The service was primarily concerned with the welfare of the women themselves. There was some concern for not wanting to bring into the world disfunctional children, but it certainly did not come across as a 'law and order' issue. Like others I would prefer long term contraception to sterilisation, but for some, that would be the best solution.
+1

I remember what was probably the same interview - I started off being fully anti ("They want to do WHAT??"), but the woman involved knocked down most of my prejudices. Not 100% comfortable with the payment side of it, either, but from a purely pragmatic view, I can see where they're coming from.

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Re: Paying Substance Misusers to be Sterilised

#18 Post by Paolo » April 28th, 2010, 1:37 pm

getreal wrote:I would argue that the mere fact that our system allows abortion for foetal abnormality as a matter of course implies that those foetuses are less valuable to society than "normal" ones. As far as I am aware, late abortion is only permitted where there is grave danger to the mother OR foetal abnormality. Don't you think the cost to society in caring for such an individual is not a factor? As a side issue, women with learning disabilities are not encouraged to have children and are often given long term contraception when they cannot understand the implications. This is artificial selection. Isn't this also a form of eugenics?

Personally, I think most western societies practice eugenics to some degree, but they are being dishonest about it.
This is a slightly different debate, since you're not talking about social eugenics (where an "underclass" is not permitted to breed), you're talking about biological eugenics and its social repurcussions. Society views those born with biological abnormalities as being something of a burden, but I would also argue that modern society provides far greater support and opportunities for those with disability than previous cultures have done, giving them a longer more inclusive life than was previously possible. More disabled children survive now than ever before due to modern medicine (the same modern medicine that allows the foetal screening that informs terminations), so isn’t that artificial selection in the opposite direction of the argument you are proposing?

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Re: Paying Substance Misusers to be Sterilised

#19 Post by getreal » April 28th, 2010, 4:42 pm

as far as I am aware, the incidence of learning disability is actually decreasing, while the prevelence increases. This is due to the universal availability of pre natal screening and abortion and safer parturition resulting in less people with disabiliries being born, while improvements in health and social care is increasing the life expectancy of those with a disability.

I shall try to back this up with evidence-I haven't the time at the moment.
"It's hard to put a leash on a dog once you've put a crown on his head"-Tyrion Lannister.

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Re: Paying Substance Misusers to be Sterilised

#20 Post by Paolo » April 28th, 2010, 9:48 pm

Sounds right - fewer people being born with disabilities, but more surviving. For example, according to Mittler this resulted in there being four times as many Down's Syndrome people in 1979 than there were in the 1930s. This trend seems to be continuing from what I've seen reported.

So although birth rate is lower, the population is larger thanks to society offering more effective support.

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