Julian Sheather: Should we pay drug addicts to be sterilised?

Barbara Harris is a concerned American. After adopting four children from a crack-addicted mother, she tried to change the law in California. She wanted to make it mandatory for every mother giving birth to a drug-addicted child to use long term birth control. When the Bill failed Barbara Harris set up the charity ‘Project Prevention’. It offers $300 to men and women who are addicted to drugs or alcohol if they will practice such birth control. They have so far paid 3,338 clients, including 1,260 who had tubal ligation and 47 who had vasectomies. ‘Project Prevention’ has now arrived in the UK. Reactions have been polar. ‘Eugenics’, screamed the drug charity Release, likening the project to the Final Solution. ‘Why stop at drug addicts?’ blogged Professor Julian Savalescu. Make it available to everybody and those least likely to make competent parents will conveniently drop out of the gene pool: smaller planet, happier children.

The problem that Ms Harris is trying to address is a real one. A small number of drug-addicted women give birth to a succession of drug-dependent children who are taken into foster care. It is by any standards an appalling start in life. There is a certain red-necked, it does what it says on the can appeal to Ms Harris’s response. Her championing the rights of the un-born over the rights of addict mothers also has a certain populist appeal. But is it justified?

One starting point is the question of competence to consent. As even Project Prevention admits, the money will almost always go to feed the addict’s habit. Would the addiction render consent invalid? Is the payment a coercive means of getting people to agree to a sterilisation they would otherwise not contemplate? Does the craving always overmaster the addict’s reasoned assessment of his own interests? Furthermore, addiction is treatable. Addicts get clean. Lives change for the better. Is providing an incentive for treatment that forecloses future options ethical or should the presumption be in favour of shorter-term solutions?

The explicit focus of Project Prevention is the wellbeing of future children, children as yet un-conceived. This creates a problem, the sort of problem that philosophers love and most normal people find extremely irritating. It is known as the non-identity problem. An action is ordinarily said to be good if it is good for someone. The trouble is that an action whose focus is preventing the births of future children cannot be said to be good for those children. This is so for two main reasons. Firstly, if the children are not conceived they cannot be said to have been harmed, or, for that matter benefited. And secondly, if we accept that almost any life is better than no life,  then the fact of bringing someone into being does not, of itself, harm that person. The child born as the result of that particular coupling could not have been born otherwise. We cannot say therefore that the child would benefit if her mother waited to conceive, because the resulting child would be a different one, hence the non-identity problem. Personally I am not convinced. Despite Project Prevention’s stated aims, I find it hard to imagine that giving birth to a succession of children who are taken into care does anything but harm the parents. I think it is also reasonable to say that, all other things being equal, a world without crack-addicted babies would be a better one, even though it can be a struggle to identify individuals who have benefited personally.

The eugenics argument seems to me the least convincing. Few causes are strengthened by drawing comparisons with the Holocaust. It hides the real issues behind a smoke of fabricated outrage and serves only to degrade our moral currency. If drug addicts didn’t give birth to sick children, I cannot see Project Prevention taking an interest. I may not necessarily agree with Ms Harris – the consent issue, for example, might be eased if they directed addicts toward shorter term or reversible interventions, thereby permitting future choices – but I see no good reason to accuse her in such shrill terms.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.