Society of Bioethics and Medicine
Coerced Sterilization in ICE Detention Centers: When Does Consent not Matter?
By - Liza Roychowdhury, Edited By - Jacquelyn Tang
In September 2020, a nurse from an immigrant detention center in Georgia filed a whistleblower complaint, stating that the Irwin Detention Center violated federal laws related to unsafe medical care during the COVID-19 pandemic. (Miroff 2020) The whistleblower also stated that the detention center was conducting questionable hysterectomy procedures on immigrant women without their consent and raised concerns about the rate at which hysterectomies were being performed on immigrant women at the facility (Treisman 2020). Hysterectomies is a surgical operation which removes the uterus. Many of the women subjected to the sterilization expressed their concerns about whether or not they fully consented to the procedure. In the complaint, a detained immigrant told Project South, a nonprofit advocacy group based in Atlanta, that she talked to five other women while in that detention facility who were genuinely confused about why the hysterectomy was required. Dr. Marendra Amin, the physician who was accused of performing these hysterectomies, was known to be the “uterus collector” by several detained women. Activists and grassroots organizations have called for the dismissal of Dr. Amin and the holding of the Irwin Detention Center responsible for neglecting their immigrant detainees' health during the pandemic (Treisman 2020). The lawsuit remains pending to this day, with Irwin Detention Center forcing to stop deportations for the entire duration of the trial. Many have further claimed that these alleged sterilizations of immigrant detainees were a repeat of the United States’ own history of forced eugenic sterilization against racial minorities (ACLU 2021).
When it comes to racial inequality, the United States holds double standards for its citizens for medical care--especially for our unwanted population: the incarcerated and detained. In 1927, the Supreme Court ruled 8-1 that the state had the right to forcefully sterilize a person if they are considered unfit to reproduce. The case centered on a woman named Carrie Buck who was declared "feebleminded" by Virginia. Buck v. Bell was centered around the American eugenics movement, which used biological determinism and actively sought to "breed out" undesirable characteristics. Black, indigenous, and other women of color and immigrants and those with disabilities were frequently considered "feebleminded" and subject to forced sterilization. Through the 20th century, federally-funded eugenics boards operated in 32 states, ordering sterilizations for women and sometimes men deemed “undesirable.” Tens of thousands of forced sterilizations were performed throughout the United States in the last century. In the 1930s, California’s eugenics board passed the Asexualization Acts, which resulted in 20,000 men and women losing the capacity to reproduce. These measures had actually directly influenced the Nazi eugenicists to do the same in Europe. To this day, Buck v. Bell has never been overturned by the Supreme Court. In 2001, the Eighth Circuit Court of Appeals further ruled that “involuntary sterilization is not always unconstitutional.”
Physicians may find themselves in an ethical dilemma when treating prisoners: treat and improve their health or follow the law by listening to detention authorities who might not share the same interests in protecting their inmates? This could violate ethical oaths, and breach fundamental rights. The case of immigrant detention centers may be ethically questionable for physicians, given the reports of inhumane, overcrowded, unsanitary detention centers, and allegations of poor medical care for detainees (Spiegel, Paul, et al, 2019). The Hippocratic oath, which physicians take pledge, also expresses that physicians may not use their “medical knowledge to violate human rights and civil liberties, even under threat.” The lack of informed consent during sterilization of detained immigrant women can preclude physicians from providing the highest standard of care. Physicians could be violating not only their medical licenses but fundamental human rights by performing unwanted sterilization without the detainee’s consent.
What even allows a physician to conduct a hysterectomy on an immigrant woman without her consent? Unless, the physician is able to think that the consent of a detained immigrant woman does not hold equal or valid under the Hippocratic oath?
Preventing outbreaks of COVID-19 in prisons, jails, and detention centers is a sound and efficient public health strategy, since those facilities have some of the highest transmission rates of the virus. Furthermore, more than 40% of individuals in prisons have a chronic medical condition, making them predisposed to worsened COVID-19 outcomes. Correctional and detention centers are designed to provide poorly ventilated cells with limited space and infrastructure to socially isolate people (Accorsi 2020). Within these horrifying living conditions, Detained and incarcerated women often have miscarriages and undergo invasive and unnecessary procedures when they are unable to express their own concerns due to language barriers and fear of deportation (Albaladejo 2020). Detained individuals should not be harmed or abused or neglected, especially during an ongoing global pandemic.
Incarcerated and confined individuals should not be deprived of adequate healthcare in U.S. correctional facilities nor should physicians violate their oath in order to fulfill detention authorities' obligations. Physicians and other healthcare professionals must insist on following clinical independence requirements to ensure that they can provide the highest possible standard of care with no strings attached. Physicians and other healthcare professionals, using their medical verdict, should be able to transparently inform authorities to change any living or medical conditions which could impede their patients’ health, regardless of their carceral status. Additionally, to guarantee that detainees are safeguarded from medical negligence or abuse, an autonomous health oversight service should be organized to monitor all aspects of preventive and curative healthcare services related to detention and correctional facilities with special procedures. These procedures include observing health care professionals’ capacity in their ability to uphold their responsibilities toward detained patients. This governing body would analyze the safety of these facilities and hold the Border Patrol, correctional, and detention facilities accountable for any kind of suspected medical violations. Physicians not only have a responsibility to provide the highest standard of care to its patients, but to advocate for society’s most vulnerable populations. We need to deal with detainees as patients and most importantly, as humans.
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