For this paper, please read the information entitled "Forced Sterilization of Native Americans: Late Twentieth Century Physician Cooperation with National Eugenics Policies" from the website of The Center for Bioethics & Human Dignity:https://cbhd.org/content/forced-sterilization-native-americans-late-twentieth-century-physician-cooperation-national-. You can copy and paste the link above to go to the site, or I have included the same information after the guidelines for this paper.You do NOT need to listen to the audio.

In your paper:

1) Explainspecificallyhow each of the moral principles of bioethics (beneficence, non-maleficence, autonomy, utility, and justice) were violated by the health care professionals working for the Indian Health Service (IHS) (do NOT write about how the principles were violated by soldiers mentioned in the first paragraph);

2) Applyutilitarianism(the morally right action is whatever maximizes happiness and minimizes unhappiness),virtue ethics(the morally right action is that which would create good character traits/virtues if done habitually),Kantian ethics(the morally right action follows the Categorical Imperative, that a person should do what they would want others to do, and the Practical Imperative, which is that we should treat all persons as ends and never as means only) to see what you think each ethical theory would say about what was done and why it was morally wrong.

3) Choose three of the nine provisions in the Code of Ethics of Nurses from the American Nurses Association (given in the guidelines for Exercise Assignment 1), substitute the word "health care professional" for "nurse," and explainspecificallyhow each of the three provisions you're choosing was broken by the health care providers working for the Indian Health Service. Identify by number the provisions you are discussing.

Keep in mind that beneficence and non-maleficence are two different principles. Beneficence is to do good and/or remove or stop harm; non-maleficence is to not do harm. Also remember that in Kantian ethics, treating someone as an end is recognizing their autonomy and ability to make their own decisions while treating them as a means only is to treat them as if they are only there to serve the needs/desires of others.

Your paper should have a brief introductory paragraph, including a thesis sentence in which you say exactly what will be addressed in your paper.

Then your paper will have a body comprised of at least three paragraphs to cover each of the three points above (it might make sense to have a separate paragraph for each of the ethical theories). And your paper will have a conclusion, in which you "wrap up" what you have been writing about. I also expect you to check for grammar and spelling.

This is NOT a research paper. You will use the information from this particular article and your textbook and Instructor Videos to explain and support your claims (do not use other sources). You may VERY BRIEFLY quote from those three sources within your paper. If you use direct quotes, you must put the exact words in quotation marks and put the authors' last names or name of source and page number in parentheses.

You are not required to submit a draft of your paper, but if you would like me to look at and respond with comments to a draft, please e-mail it to me as an attachment by Tuesday, June 20. That gives me time to look at it and you time to respond to any revisions. Please do not submit drafts to the dropbox.

Forced Sterilization of Native Americans: Late Twentieth Century Physician Cooperation with National Eugenic Policies

Post Date: 10/08/2010

Author:

Gregory W. Rutecki, MD

Issues:

Bioethics

Clinical & Medical Ethics

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04:19

25:18

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Length:25:18 minutes (17.4 MB)

Format:MP3 Mono 44kHz 96Kbps (CBR)

Many consider the plight of Native Americans an archetypal genocide. Centuries ago, the British suggested the response to their presence should be "extermination."[i]Their soldiers then proceeded to knowingly decimate them with smallpoxa virus to which Native Americans had no immunity. Additional efforts over centuries to eradicate their population would follow. There would be a "Trail of Tears," lethal attacks on Nez Perce men, women, and children to acquire their ancestral homeland, and a massacre at Wounded Kneeto name merely a few. The protracted policy directed against the United States of America's indigenous peoples represented misguided governments, widespread greed, and enforcement by an at times ruthless, undisciplined military. A recent, albeit weakly publicized, continuation of this policy has been played out in a bioethical arena. Indeed, after the Nuremberg Trials and an explicit international consensus, this would be considered anathema. On view is the evil of forced abortions and sterilizations. This two-pronged approach to knowingly limit births in selected populations was emblematic of eugenic policy in the early to mid-twentieth century. Unfortunately, eugenic birth control had been resuscitated as late as the 1970s through voluntary physician complicity with an immoral national eugenic policy.

When she was 20 years old, a Native American woman underwent a total hysterectomy by an Indian Health Service (IHS) physician for unconvincing indications.[ii]Her experience came to light when she visited Dr. Connie Pinkerton-Uri, a physician of Native American heritage in the 1970s. Two other young women in Montana needed appendectomies and also received "incidental" tubal ligations. Were these merely aberrations or the first examples of a disturbing pattern? Bureau of Census Reports explicitly documented a steep decline in childbirth for diverse Native American tribes comparing birth numbers from 1960 through 1980.[iii]The three examples were, unfortunately, merely the tip of the iceberg.

On November 6, 1976, the Government Accounting Office (GAO) released the results of its investigation into similar events at four of twelve IHS areas (Albuquerque, Aberdeen, Oklahoma City, and Phoenix). Records verified that the IHS performed 3,406 sterilizations between 1973 and 1976.[iv]"Tip of the iceberg" is indeed an appropriate metaphor. Per capita, this figure would be equivalent to sterilizing 452,000 non-Native American women.[v]Albuquerque contracted out their sterilizations to local, non-IHS physicians; therefore their region inaccurately added zero procedures to the government count. Independent research estimated that as many as 25-50% of Native American women were sterilized between 1970 and 1976.[vi]Independent verifications were critical. The GAO did not interview a single women subjected to sterilization. The GAO also admitted that "contract" physicians were not required to comply with any federal regulations (including informed consent) in the context of these surgical procedures. Study of consent forms utilized revealed that three different forms were in use. It also appeared the "consent," in many instances, was obtained through coercion.

What may be the most disturbing aspect of the investigations followed:it was physicians and healthcare professionals in the IHS who coerced these women. It was they who abandoned their professional responsibility to protect the vulnerable through appropriate, non-eugenic indications for surgery and informed consent prior to the procedures. On a Navaho reservation alone, from 1972-1978, there was a 130% increase in abortions (a ratio of abortions per 1000 deliveries increasing from 34 to 77).[vii]The same study demonstrated that between 1972 and 1978, sterilization procedures went from 15.1% to 30.7% of total female surgeries on that one reservation. Healthcare professionals' coercive tactics included the threat of withdrawing future healthcare provisions or custody of Native American children already bornif consent for sterilization was withheld.[viii]The scandal of this replay of earlier twentieth century eugenic programs and genocidal tactics led to a congressional hearing (Senator James Abourzek, Democrat, South Dakota), but little else in terms of publicity, justice, or public outcry. It has also not been scrutinized from a careful bioethical perspective.

Although the travesty of forced sterilization and abortions targeting Native Americans occurred a generation ago, and has apparently ended, a revisit in 2009 is critical. First, the breech in ethics took place in America. The record for such immoral activities has already been questioned in light of California's record with forced sterilization from 1909 through 1979, subsidized through federal funding.[ix]Approximately 20,000 similar operations were performed in that State (mostly on African-Americans and Latinos), a significant number of these occurring after the Nuremberg Trials. Secondly, if the centuries-long treatment of Native Americans is a protracted genocide, not merely archetypal, the addition of physicians to the armamentarium of genocide, especially at this late juncture, is ominous. Physicians in the IHS during the time in question were young. Since their generation, additional medical graduates have moved even further from the Hippocratic tenet of "do no harm." Furthermore, the ever-increasing shift from a covenantal model for medical practice to a contract model is relevant to the ethics at hand. Physicians who performed abortions and sterilizations on Native American women were contracted and reimbursed in full for their work. Similar models for specialty care which is contracted and reimbursed in full exist today under the umbrella of managed care. Payment for medical technique removed from context of ethical considerations may tempt many physicians in an era of decreasing reimbursement rates. Erosion of Hippocratism inhabits every aspect of the tragedies of care for these Native American women, and serves as more than a warning to us of the danger of divorcing ethical conviction from medical care.

Editor's Note: This essay served as the basis for a parallel paper presentation at CBHD's 2009 summer conference, Global Bioethics: Emerging Challenges Facing Human Dignity.

[i]K.B. Patterson and T. Runge, "Smallpox and the Native American,"American Journal of the Medical Sciences323 (2002): 216-222.

[ii]J. Lawrence, "The Indian Health Service and the Sterilization of Native American Women,"American Indian Quarterly24 (2000): 400-419.

[iii]Ibid.

[iv]Ibid. Cf. K. Larson, "And Then There Were None,"Christian CenturyJan (1997): 61.

[v]Bill Wagner, "Lo the poor and sterilized Indian,"America136 (1977): 75.

[vi]B. Dillingham, "American Indian Women and IHS Sterilization Practices,"American Indian Journal3 (1977): 16.

[vii]H. Temkin-Greener, S. J. Kunitz, D. Broudy, M. Haffner, "Surgical fertility regulation among women on the Navaho Indian Reservation, 1972-1978."American Journal of Public Health71 (1981) 403-407.

[viii]S. J. Torpy, "Native American Women and Coerced Sterilization: On the Trail of Tears in the 1970s."American Indian Culture and Research Journal24 (2000): 1-22.

[ix]A. M. Stern, "Sterilized in the name of Public Health: Race, Immigration, and Reproductive Control in Modern California."American Journal of Public Health95 (2005): 1128-1138;