The wicked witch is almost dead: Buck v. Bell and the sterilization of handicapped persons.
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For much of the 20th century, the practice of sterilization was a common accompaniment to institutionalization for individuals with mental retardation. Following the Supreme Court's decision in Buck v. Bell (1927) supporting the practice, numerous states passed legislation and, consequently, over 60,000 individuals with mental retardation were sterilized in this country. In the present study we analyzed data on 212 individuals in Virginia who were sterilized. Our focus included gender, age at and date of sterilization, level of mental retardation, and location of subsequent discharge. The nature of these findings within the general context of the practice of sterilization was discussed.
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The foregoing discussion was intended as a review of the pertinent literature of involuntary sterilization. It is by no means all-inclusive (the number of cases precludes an exhaustive compendium) but does include those cases that, in the authors' opinion, are most representative of the contemporary attitude of the courts. The discussion has been confined primarily to the legal aspects of involuntary sterilization. We have omitted any substantial discussion of the moral and ethical aspects of this complex topic but acknowledge the intimate role these issues may play in any decision to undertake involuntary sterilization. As outlined, the presence or absence of statutory guidelines mandates in part the legal channels to be pursued. In the presence of statutes for involuntary sterilization, strict adherence to the specified requirements provides the optimal means of protecting the legal interests of all involved parties. In the absence of statutory guidelines, extreme caution must be exercised. In these circumstances, a validly executed court order observing procedural due process should provide optimal protection of patient and physician interests. The decisions of New Jersey and Alaska courts represent one potential method of securing a consent by use of the parens patriae doctrine. Recent notable efforts at a state level to dispense with lengthy hearings and implement committee review have been encouraging and await further trials to determine their ultimate role in authorizing sterilization of mental incompetents. Given the current legal climate and available avenues, parental substituted consent without adequate hearing and due process should not be considered a fulfillment of legal responsibilities.
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