ABSTRACT
This article demonstrates that involuntary sterilisation procedures are generally a manifestation of intersectional discrimination and the medical profession’s use and abuse of power. Accordingly, the article uses the example of involuntary sterilisation to illuminate the multiple forms of discrimination experienced by society’s most marginalised and vulnerable people and to discuss the role of social hierarchy and existing power structures in compounding and perpetuating the expression of discrimination. It begins by referencing the power of law before considering the power of the medical profession in the context of society in general. It then analyses the gendered dimension of this power, specifically considering the example of involuntary sterilisation and discussing the importance of adopting an approach which views this issue through an intersectional lens. Finally, the article invokes a number of specific examples of involuntary sterilisation procedures being performed on marginalised groups of women to make the discussion more tangible.
Notes
6See Section 5 for further discussion of this case study and of the doctrine of informed consent more generally.
10Cochrane, ‘Nine Women Share Their Personal Stories of Abortion’, The Guardian (United Kingdom), 27 October 2006, G2 p 9.
11
Abortion Act 1967 (UK).
12See, for example, Freidson (Citation1970a, Citation1970b): Freidson to a large extent attributed the prestigious position of the medical profession to the reality that modern medicine is based on scientific knowledge. In terms of its dominance within the healthcare industry, Freidson attributed the power of medicine to its autonomy (meaning its propensity for self-regulation) and its dominance (meaning its control of the work of others involved in health care). Further, Freidson predicted that the medical profession would maintain its position of dominance in the future despite significant challenges. As to the doctor–patient relationship, Freidson viewed the prestige of the doctor as contributing to a power dynamic in which the patient is the passive recipient of the doctor’s service, deferring to the doctor’s opinions and feeling too intimidated to question the doctor. This sense of deference and intimidation is not applicable to all doctor–patient relationships but the greater the gap in social status between doctor and patient the greater the likely power imbalance between doctor and patient.
14For information about the Victorian Mental Health Tribunal, see State Government Victoria, Mental Health Review Tribunal, http://www.mht.vic.gov.au/. For a discussion of the evolution of the rights-based movement in mental health law reform and criticisms of it, see McSherry and Weller (Citation2010).
15See, for example, discussion in Cassell (Citation2005), p 329.
20Wolinsky (Citation1993), p 13, poses the question: how can the profession be trusted not to ‘misuse its autonomy and abuse its clientele’? This is perhaps the key question.
45Center for Research on Gender in the Professions (Citation2013), p 10.
46Center for Research on Gender in the Professions (Citation2013), p 10.
47Center for Research on Gender in the Professions (Citation2013), p 10.
48For a more in-depth discussion of ‘working within the system’ versus ‘challenging the system’ in the context of the gendered nature of international law, see Sifris (Citation2014), ch 1.
50See examples in Section 5.
51Eriksson (Citation2000), pp 256–257, Hartmann (Citation1995), p 244. It should be noted that India’s sterilisation campaign of the 1970s disproportionately affected men but that following international outrage the focus shifted to the sterilisation of women. See Moore, ‘Teeming India Engulfed by Soaring Birthrate’ Washington Post (Washington, DC), 21 August 1994, A1, A32.
56Such a ‘matrix of domination’ is not only applicable in the context of involuntary sterilisation. For example, Kimberlé Crenshaw considers the question of intersectionality and hierarchies of power in the context of the incarceration of African-American women in the United States. When discussing the case of Kemba Smith, who almost spent 24 years in prison for playing a minor role in her boyfriend’s drug dealing operation, Crenshaw notes that:
Smith’s story represents compelling evidence of the matrix of domination that Patricia Hill Collins articulates. Here, institutional structures, gender relations, and discretionary decisionmaking all converged to erect a cage in which Kemba Smith may well have spent twenty-four years of her life.
See Crenshaw (
Citation2012), pp 1440–1441 (citations omitted).
57See, for example, Shapiro (Citation1985), Trombley (Citation1988), Corrêa (Citation1994), p 30, Dean et al (Citation2000), Getgen (Citation2009), Parker and Aggleton (Citation2007), Chen (Citation2009), and Bond (Citation2004).
58[1993] 1 SCR 554 at 645–646 (citations omitted).
59For a discussion of the notion that, whereas Kimberlé Crenshaw originally discussed the concept of intersectional discrimination in the context of the experiences of African-American women, it may apply in a number of other contexts such as in relation to the experiences of lesbian women, for example, see Carbado (Citation2013).
61Cook and Cusack (Citation2010) (emphasis added, citation omitted).
67Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 August 2006).
68For a discussion of the involuntary sterilisation of Romani women, see Section 5.2.
72Getgen (Citation2009), p 33, Miranda and Yamin (Citation2004a), p 68, Amnesty International (Citation2004a). It should be noted that there is no consensus as to the number of women subjected to involuntary sterilisation in Peru. See, for example, Knudsen (Citation2006).
80League of Human Rights (Czech Republic) (Citation2007), p 8.
86League of Human Rights (Czech Republic) (Citation2007), pp 8, 12.
88
VC v Slovakia (2011) Eur Court HR 18968/07; NB v Slovakia (2012) Eur Court HR 29518/10; IG and Ors v Slovakia (2012) Eur Court HR 15966/04.
89Article 3 states that ‘[n]o one shall be subjected to torture or to inhuman or degrading treatment or punishment’.
91See, for example, AS v Hungary, Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 Aug 2006); Committee on the Elimination of Racial Discrimination, Concluding Observations on the Czech Republic (19 February–9 March 2007), para 14.
93For a more in-depth discussion of the involuntary sterilisation of HIV-positive women as a form of intersectional discrimination, see Sifris (Citation2015).
94See, for example, Vivo Positivo and Center for Reproductive Rights (Citation2010).
98See, for example, The International Community of Women Living with HIV/AIDS (Citation2009).
99See, for example, Lombard, ‘South Africa: HIV-Positive Women Sterilized Against Their Will’, City Press, 7 June 2010.
100Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS (Citation2006), p 78.
101Committee on the Elimination of Discrimination against Women (Citation1990).
103See, for example, World Health Organisation (Citation2013), p 32.
105Physical and mental health outcomes which are associated with stigmatisation include depression, hypertension, coronary heart disease, and stroke. See Major and O’Brien (Citation2005).
108
Convention on the Rights of Persons with Disabilities, opened for signature 30 March 2007, 2515 UNTS 3 (entered into force 3 May 2008). Section 23(1)(c) states that:
States Parties shall take effective and appropriate measures to eliminate discrimination against persons with disabilities in all matters relating to marriage, family, parenthood and relationships, on an equal basis with others, so as to ensure that … Persons with disabilities, including children, retain their fertility on an equal basis with others.
110Senate Community Affairs References Committee, Parliament of Australia (Citation2013).
111However, it should be noted that while the ‘best interests’ approach dominates the current discourse, eugenics arguments remain a part of the discourse. See Frohmader and Swift (Citation2013), p 8 and Senate Community Affairs References Committee, Parliament of Australia (Citation2013), p 31.
112
Secretary, Dept. of Health and Community Services v JWB and SMB (1992) 175 CLR 218; (1994) 181 CLR 583.
114[2015] VCAT 2051 (30 December 2015).
115
ZEH (Guardianship) [2015] VCAT 2051 (30 December 2015) [67].
117Senate Community Affairs References Committee, Parliament of Australia (Citation2013), p 140.
118Senate Community Affairs References Committee, Parliament of Australia (Citation2013), p 176.
119Senate Community Affairs References Committee, Parliament of Australia (Citation2013), p viii.
120Senate Community Affairs References Committee, Parliament of Australia (Citation2013), p 138.
121Such a ‘best protection of rights test’ would require a decisionmaker to take the course of action which most satisfactorily protects the individual rights of the person with the disability. See Senate Community Affairs References Committee, Parliament of Australia (Citation2013). However, it should be noted that this approach too is not without its critics. For example, in its submission to the Senate Inquiry, Women With Disabilities Australia recommended that Australia prohibit any sterilisation procedure performed without full free and informed consent except whether there is a threat to life. See Women With Disabilities Australia (Citation2013).
124[2015] VCAT 2051 (30 December 2015).
125Committee on the Elimination of Discrimination against Women, Communication No 4/2004, UN Doc A/61/38 (14 August 2006).
126(2011) Eur Court HR 18968/07.
127(2012) Eur Court HR 29518/10.
128(2012) Eur Court HR 15966/04.
130This is a play on words from two of the seminal articles addressing the issue of intersectional discrimination: Crenshaw (Citation1989), pp 139–167 and Crenshaw (Citation1991), pp 1241–1299.
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