UK court order requiring contraceptive device for disabled woman is ‘deeply problematic’, says bioethicist

royal court of justice The Royal Courts of Justice, London. Editorial | Willy Barton / Shutterstock

A British judge's order requiring a contraceptive device be implanted in a woman with learning disabilities against her will is "deeply problematic," a bioethicist has said.

Justice Gwynneth Knowles issued a written ruling April 21 after a hearing at the Court of Protection in London that took place via Skype due to the coronavirus lockdown.

The BBC reported that the judge decided that an implanted contraceptive device would be in the best interests of the woman, who cannot be named for legal reasons.

She said the woman, who is in her 20s and pregnant, lacked the mental capacity to make decisions about contraception. The court heard that the woman had given birth to a number of children, who have been taken into foster care. Specialists noted that she had suffered from a number of health problems and argued that further pregnancies could present significant risks.

According to the BBC, the woman agreed to having a contraceptive injection every three months, but did not want to be fitted with a contraceptive device.

The Oxford University Hospitals NHS Foundation Trust, which is responsible for the woman's care, argued that she might miss the quarterly appointments and should therefore be fitted with the device.

The judge said the device should be fitted when the woman undergoes a planned Cesarean section, the BBC reported.

Michael Wee, education and research officer at the Anscombe Bioethics Centre in Oxford, argued that the ruling was "morally inappropriate" and "heavy-handed".

"This judgment is deeply problematic because it raises fundamental questions of whether contraception should be seen as an acceptable medical or social intervention to solve a problem, and whether it is the kind of intervention that the state or the judiciary should ever encourage or compel by law."

"This is a case concerning a person lacking the relevant mental capacity for the decision at hand, which is whether to have a contraceptive device fitted or not. Under the Mental Capacity Act 2005, in such cases the Court of Protection takes on the role of determining what is in the person's best interests," he said.

"Sometimes, the courts do side with the wishes and feelings of those who lack capacity, as when the Court of Appeal overturned a forced abortion ruling last year. But this is not a given, as the courts may decide that the gravity of the situation ultimately outweighs the person's wishes and feelings in determining their best interests."

Wee, who was appointed as a member of the Pontifical Academy for Life in February, noted that the judge accepted four points advanced by the specialists. First, that a pregnancy in the near future would pose a serious health risk. Second, that the woman was likely to become pregnant again in the absence of contraception. Third, that the woman lacked the capacity to make decisions about contraception and, fourth, that she might not comply with the requirement for regular injections.

"On this basis, the judge concluded that an intrauterine contraceptive device (IUD) would be in the woman's best interests," he said.

"It is unfortunately easy to see contraception as a quick-fix solution -- one that conveniently erases fertility from the picture, without seeking to address underlying questions of what is appropriate and responsible sexual behavior, and what social support can be provided for vulnerable people."

He added: "It is odd that there is no consideration of whether the woman is mentally capable of consenting to sex, even though the judge accepted evidence that the woman does not have capacity to make decisions about contraception."

"Consent to intercourse and consent to contraception are surely intimately linked, and if there is any doubt about the woman's capacity to have genuinely consensual intercourse then this raises serious questions of abuse and other safeguarding issues relating to any previous, ongoing and future sexual relationships. Contraception does not solve, and may even entrench, such a dangerous situation."

Wee concluded: "Additionally, one must not forget that IUDs can prevent the implantation of an embryo, thus leading to the loss of human life. It is therefore especially morally inappropriate for a court to intervene in this heavy-handed way." 

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