Philosophers in all fields often resort to thought experiments in order to highlight paradoxes and throw light on particularly knotty questions. Well-known examples in the field of ethics include the Prisoner’s Dilemma and the Trolley Problem. Less often, a real-life example throws up issues which run even deeper than a made-up thought experiment.
A recent example is the case of Barbara Harris and Project Prevention, reported in-depth in The Guardian earlier this week. Apparently, Project Prevention offers drug addicts £200 or so if they agree to undergo sterilisation. Harris adopted a number of children born to addicts, and took on the mission of preventing such ‘crack babies’ by any means possible.
And it seems that Project Prevention will adopt any tactic, including doling out flyers with the slogan distributing flyers with slogans such as “DON’T Let a Pregnancy get in the way of your crack habit”. It’s hard to believe Harris and her organisation really do take the stance attributed to them. But let’s assume they do.
Their ‘offer’ is very controversial – almost everyone who reads about it intuitively thinks it is wrong. But what ethical issues does it throw up?
Even if we allow Project Prevention’s major premise, that addicts must, at all costs, be prevented from falling pregnant, Harris’ solution is replete with ethical problems.
Firstly, Project Prevention, in offering addicts a sum which might fund a week or two of drug addiction, is stretching the notion of ‘consent’ impossibly far. Indeed, those who take up Project Prevention’s offer tend not to tell their doctor that they have been offered cash to undergo the procedure (if they did, doctors would be bound to refuse the procedure, as they would see the patient’s consent as prejudiced).
Another ethical problem with Project Prevention is that the inducement they offer (a few hundred pounds) is short-term, but encourages people to undergo a medical procedure with long-term consequences – in essence selling off part of their personal autonomy.
A further alarm bell (should one be needed!) is sounded by the fact that Harris seems to despise addicts – she has said: “we have campaigns to spay cats to prevent them from having unwanted kittens, yet we allow these women to have litters of 14 children”. It seems obvious that, if we hold people in contempt, our ethical motives for intervening in their lives are doubtful at best. In this case, Project Prevention seems to be using the bodily autonomy of crack addicts as low value means in a mission to prevent harm to hypothetical babies.
This leads on to another point. Project Prevention effects an irreversible change in an actual human being, in order to prevent harm to a possible human being. This is a controversial area (see Risking Wretched Lives, a recent paper by Michael Gibb). In any case, in the Harris case there is a massive assumption that the to-be-sterilised addict , if not sterilised, would go on to become pregnant (or make another person pregnant).
Finally, many who have written about Project Prevention have raised the spectre of Eugenics. The Nazis were one famous group who wanted to select an ‘ideal’ society. Sterilising addicts could be the thin end of a wedge, where we ended up sterilising one group after another in an attempt to select out undesirable character traits. My view is that the Eugenics objection, though emotionally compelling, is less important than the points above about autonomy and consent.
Can anyone think of any ethical arguments in favour of Project Prevention?
things that might have been otherwise 
If someone wants to live their life in a drug induced state,instead of having a “normal” life, I don’t see why it would be a bad idea to sterilize them (especially if they agree to it). Why put a fetus at risk of having birth defects because the druggie mom couldn’t stop?
Babies that are born with defects, are a burden on families and/or the government. It is very expensive to raise such a child.
People who aren’t under the influence also have a problem with “popping out babies”….there should be free birth control for those people.
I understand that there are some people who are ok with having a child with birth defects….they make the choice to keep it…so that is their responsibility. But people who willingly do drugs, and increase the risk of such, don’t need to have babies.
Having a child is a big responsibility…..and there are too many people who don’t look at it that way.
Hi Trish, thanks for reading and responding.
I was not aware that all/most/a significant number of the accidental babies which drug addicts give birth to are deformed/disabled. If that is true, I suppose it makes things a bit different. I will try to find some evidence for this, though a quick search doesn’t suggest any strong link.
I should think a more plausible reason to encourage addicts not to have children is that they may not be good parents. But this reason is much less clearly-defined than a supposed clinical risk. It seems risky for society to decide who is and isn’t likely to be a good parent, then sterilise accordingly, don’t you think?
Even if there was an inevitable link between drug addiction and the health of babies, I think consent is still a problem. You say ‘if someone wants to live their life in a drug induced state…’ I wonder how many long-term addicts really choose their way of life, even if they willingly took decisions which set them on that path?
The other problem around consent is in saying something like ‘for their own good, let’s encourage these people to get sterilised’ (already morally questionable). That argument, in my view, is totally undercut by the short-term payments Project Prevention offers.
If the people targetted by Project Prevention are capable of informed consent (and medical ethics says they must be), then there shouldn’t be any need to bribe them. And if they are capable of informed consent, and reflective about the consequences of getting pregnant, how about using the money to help them put their life on track, instead of trying to breed them out of society, as it were.
I’d suggest there is a long way between free birth control (the sensible idea you suggest) and sterilisation. Free (and accessible) birth control might have about the same effect, without selling off people’s autonomy.
I agree totally that “not being good parents” would be a better reason to sterilize…..but who’s going to say to someone, “You obviously won’t be a good parent….so lets sterilize you”. Ideally….the person in question would decide on their own…they would not be a good parent, and make that choice on their own.
I don’t say all drug-born babies will be deformed, but I’m sure there is an increase in risk that it would happen if someone is doing drugs.
It boils down to “Choice” really. Having the choice, then acting on it.
The problem is….so many can’t even be responsible enough to make a logical choice.
Hi again Trish.
I think you’ve hit on the main tension: we want people to have maximum choice over their lives, but may need to limit that when their choices cause significant harm to others. A utilitarian would probably suggest weighing the harm of removing the choice against the benefit gained by avoiding the unwanted pregnancy. On the other hand a Kantian would be sceptical of anything which threatened someone’s autonomy…