Judge: Sterilization required court approval

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The Iowa Supreme Court ruled April 18 that a mother who is her son’s guardian violated state law by arranging for her son to have a vasectomy, absent prior court approval.

“A statutory scheme that empowered a court-appointed actor (i.e., a guardian) to have an intellectually disabled person sterilized without some form of judicial review would raise serious due process concerns, in our view,” Judge Edward Mansfield wrote in the ruling.

Maria Kennedy is the legal guardian of her son, Stuart, a 21-year-old man with intellectual disabilities who lives in a group home. In early 2013, Maria became concerned that Stuart was sexually involved with a a co-worker at Sam’s Club, where he currently works. In order to prevent them from procreating, Maria arranged for a doctor’s visit for him to be sterilized. Although Maria argued that Stuart consented to the procedure, he denies this.

Stuart filed a lawsuit, arguing that Iowa guardianship law required that Maria to seek court approval before arranging for him to have the surgery. A lower court ruled in favor of Maria, finding that a vasectomy qualified as neither a “major elective surgery” or a “nonemergency medical surgery” under state law. In doing so, the court noted that the surgery is “approximately a 20-minute procedure which is performed in a doctor’s office as opposed to a surgical center or operating room and it does not require the use of anesthesia.” It also stated that the a vasectomy “is reversible, albeit by a more intrusive procedure which could be deemed to be major elective surgery.”

The Iowa Supreme Court reversed, finding that a vasectomy qualified as both a “major elective surgery” and a “nonemergency medical surgery,” meaning that Maria, as Stuart’s guardian, had to seek a judge’s permission before arranging for the surgery. Although neither term is defined under state law, the Iowa Supreme Court reasoned that a vasectomy is not a “routine procedure,”designed to treat a “specific illness, symptom, complaint or injury.”

Even more significantly, the Iowa Supreme Court recognized that the procedure affects rights long recognized by the Supreme Court as “fundamental.”

“The immediate consequence of the procedure, i.e., loss of the ability to procreate, is certainly important,” the Court stated. “‘Major; is not a word that cries out with precision.”

The case attracted the attention of multiple major disability advocacy groups. In an amicus brief filed on behalf of Stuart, the Disability Rights Iowa and the American Civil Liberties Union of Iowa strongly criticized the lower court’s decision. In particular, they argued that its characterization of the surgery as “reversible” was misleading, since the procedure for it to be reversed is often “expensive and uncertain.” As the advocacy groups sees it, the case of Stuart is just the latest episode of the “shameful history of eugenics in this country.”

“The right to procreate is a basic, constitutionally protected history demanding of the highest procedural safeguards prior to deprivation,” the amicus brief stated.

Disability Rights Iowa is part of the federally funded protection and advocacy system and a member of the National Disability Rights Network.