The influential Swiss Academy for Medical Sciences, has caused a furore by recommending that the sterilisation of mentally handicapped people without their consent be allowed in specific circumstances.This content was published on February 24, 2000 - 11:35
The influential Swiss Academy for Medical Sciences says the sterilisation of mentally handicapped people without their consent is acceptable in specific circumstances. However, it emphasises that the welfare of the patient must be considered paramount at all times.
Enforced surgical sterilisation of the mentally handicapped is not illegal in Switzerland. However, the Academy published directives in 1981 which told the medical profession that such procedures were unacceptable and should not be carried out.
The new position was laid down in fresh directives published in the Swiss Medical Journal on Thursday. The Academy says they reflect changes in society and people's opinions, as well as medical progress. The recommendations are not binding, but are usually acted upon by doctors.
While the 1981 directives made mental capacity the sole criteria for determining whether or not a sterilisation should be carried out, the new recommendations focus on the overall well-being of the patient.
They suggest that sterilisations should be considered if they benefit the physical or psychological health of patients, even if those patients are unable to make decisions for themselves. However, the academy also says that surgery should only be undertaken if reversible methods of contraception prove impracticable.
"We had to take into account the bioethics convention for Europe, which says
that something can only be done if it is in the best interests of the person in
question," said Ursula Steiner, a psychiatrist who headed the panel that drew up the new guidelines
She said the new position "protects disabled people and ensures that third persons, like parents and those who care for these mentally disabled people don't impose their will on them."·
The directives set a number of conditions which must be fulfilled before any operation can be carried out. There must be an independent psychiatric review of the patient, a second opinion from someone outside the medical profession, and written consent from a legal representative.
Steiner said that a scandal in Sweden, where more than 60,000 women considered socially unfit had been forcibly sterilised, had prompted the academy to rethink its guidelines.
"We realised that we had to refine the recommendations, go into more detail, and look at what the ethical problems were in these situations," she told Swissinfo, adding that, rather than the medical profession issuing guidelines, the government ought to play a greater role.
The reaction from campaigners for the disabled was one of anger and sadness.
Richard Werli, of the Centre for Independent Living, favoured the old recommentations: "Until now, the rules...have been quite clear: when we don't know the opinion of the person, we can't carry out the operations. That at least protectsed them from any invasive action."·
Werli told Swissinfo that the new guidelines left the mentally disabled "even less protected than they had been until now."
"We have to understand that most of the so-called mentally disabled are well capable of very good judgement, given the opportunity to learn, and if given the counselling," Werli said. "So we demand that before any action is taken, there is extensive counselling that gives the person the chance to build independent opinion."
From staff and wire reports