A reader writes:
I am beginning to feel a certain skepticism about this story because all the reporting comes from a single source, the Center for Investigative Reporting. Everything else is repetition and commentary. Even the original story seems cagey about distinguishing between failure to get voluntary, informed consent from the patients and failure to get advance approval from the state. Some of the republications have headlines alleging forced sterilization, but on careful reading the story lacks even a single claim that this took place. A passage deep in the story caught my eye:
Heinrich said he offered tubal ligations only to pregnant inmates with a history of at least three C-sections. Additional pregnancies would be dangerous for these women, Heinrich said, because scar tissue inside the uterus could tear. … ‘It was a medical problem that we had to make them aware of,’ Heinrich said. ‘It’s up to the doctor who’s delivering (your baby) … to make you aware of what’s going on. We’re at risk for not telling them.’
That is only one of the doctors involved, and he might not be telling the truth, but wouldn’t it cast a different light on the subject if all the patients who had tubal ligations had them during repeat C-sections based on a doctor’s recommendation that they were medically indicated because of a danger from future pregnancies? If you read the story carefully, it contains no instance of anyone claiming that a tubal ligation was performed without consent.
One former inmate claims that she often overheard medical staff asking other women to consent. Another says that Dr. Heinrich “pressured” her to have a tubal ligation but she refused. A third says she did not receive sufficient explanation but she consented and is glad she did. Moreover, Dr. Heinrich’s boneheaded statements about how the procedures saved the state money don’t read like the ravings of a eugenics zealot; they read like the nervous defense of someone who thinks he’s being accused of swindling the state by performing procedures it hasn’t agreed to pay for.
The more I reread the original story – as opposed to the abbreviated versions and horrified reaction pieces – the more I begin to wonder whether the real scandal might be that California is making its prisoners jump through hoops for a medical procedure that doctors would make available to private patients as a matter of course if they thought it was medically indicated. The risk of serious complication goes up quickly as the number of prior C-sections increases. (See, for example, ACOG’s opinion on why women planning to have several children should not have elective C-sections.) This case really could be one only of failure to put through paperwork, with doctors who delivered babies by C-section urging in good faith tubal ligations that they thought were medically justified.
It is unfortunate that some patients later felt pressured or inadequately informed, but that is common in every kind of medical practice. I just don’t see the similarity to sterilization scandals of an earlier era. Given the many recent examples of how stories sometimes fizzle when other reporters take a fresh look and all the information comes out, it would be good so see some genuine journalistic follow-up, not just spate of shocked commentary assuming the worst.
Another reader:
The original article says the woman who delivered her sixth child in prison was sorry she couldn’t have more. What about the life or the newborn and the other five? A mother in prison is not taking care of her children. It’s not uncommon for both parents to be in prison. Often the public pays for this, not only the costs of incarceration and (if the inmates are lucky) programming aimed at improving their life skills, but also for care of the children’s food, clothing, medical care, and shelter.
Then there are the women who have their parental rights terminated for abuse or neglect of their children. I have encountered many such cases over many years. It is not uncommon for there to be several children involved. They are usually put up for adoption by relatives, if they are sober, or by others, often with an incentive of payments to care for the kids until they age out of the system at 18. Meanwhile, the mom and dad who have lost their parental rights to those children can go right ahead and have more children. In Alaska that entitles the parents to another Permanent Fund Dividend check in the fall, which is usually enough to buy a fair amount of drugs and alcohol.
Let’s be clear. We are not talking about parents with somewhat below average parenting skills, or people who are poor or “marginalized” unfairly. Rather, these are parents who often have serious drug and alcohol addictions, who invite friends over to their house to drink, do meth, smoke pot or crack, who may or may not think to lock the children in the back of the house while the party is going on, which may be days. Many children witness their parents stoned out cold, or screwing each other, or screwing strangers, or fighting – verbally and physically. Other out-of-control adults may abuse the children while mom and dad are otherwise occupied.
This sordid side of bad parenting is never talked about by the so-called pro-life advocates, for whom every baby conceived should be born, no matter into what misery. It would be nice if the ardent opponents of abortion gave a damn about the kind of life many children are brought into, their privation, pain, and suffering at the hands of feckless or evil adults. But seemingly once they are born, the right-to-lifers wash their hands of them and instruct them to pull themselves up by their own Pampers. If pro-lifers were advocating for helping parents overcome addictions and learn live skills aimed at improving these children’s lives, I would be much more sympathetic to their cause. But they’re not. Those are “liberal” causes. For the so-called conservatives, after birth, you’re on your own. Be responsible and independent, kid. Dickens wrote about such people.
