Saturday, 6 June 2009

A Tale of Two Decisions

Via CMR, I was made aware of a book review in the June issue of Psychiatric Services, which I gather is the official journal of the American Psychiatric Association. The reviewed book is named Three Generations, No Imbeciles and recounts the history of an infamous US Supreme Court decision from he 1920's, Buck v. Bell, which assured mental institutions of the right to forcibly sterilize their patients (inmates, rather). The decision was outright fraudulent as the poor woman who had brought the case was supplied a lawyer who "was a prominent sterilization advocate with ties to the institution petitioning for her sterilization" and the expert witness "had a eugenics agenda." Justice Oliver Wendell Holmes famously stated in his opinion, "Three generations of imbeciles are enough." (Holmes was, by the way, in his time viewed as a 'progressive'.) The decision resulted in hundreds of thousands of poor and disabled people being coerced into sterilization for 'social purposes' right into the 1970's.

I am not sure whether it is the book itself or the reviewer who makes the connection to another infamous SCOTUS decision, but it is a very interesting one:

This book also resonates with policy questions about the tension between individual autonomy and protecting people with disabilities. Lombardo sees Buck v. Bell and Roe v. Wade as fundamentally opposed because the former gives the power over reproductive decision making to the state and the latter reserves it to the individual. But Roe v. Wade was used to overturn protective state legislation banning sterilization of people with mental retardation and enabling guardians to impose sterilization on their wards (2). Thus each case has been used to support sterilization of people with mental disabilities. Our continuing social ambivalence about these issues makes Lombardo's book starkly relevant today, when women are using the rights they gained under Roe v. Wade to abort fetuses found to have Down's syndrome and the Supreme Court protects hospitals that follow parents' direction to provide only palliative care to infants born disabled when those infants could have been treated and lived (3). Is it hypocritical to criticize the statement that "three generations of imbeciles are enough" when individuals today decide that even one generation is too many?

This is a meticulously detailed and researched history that should be read not only by those who enjoy history but also because, as Lombardo says, "one of the important lessons of the Buck story [is that] a small number of zealous advocates can have an impact on the law that defies both science and conventional wisdom." As Lombardo shows, the move to sterilize "social undesirables" is far from extinct today.

The complete review is available here.

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