March 14, 2003
Legal Adviser for Europe
Center for Reproductive Rights
120 Wall Street, 14th Floor
New York, NY 10005
Dear Ms. Zampas,
On behalf of the Board of Directors of Doctors for Global Health, I am writing to express our concern over the initial findings of your report on the allegations of coerced sterilization of Roma women in Slovakia.
One of our Board Members, Tim Holtz, MD, MPH, participated in the initial fact-finding delegation. Upon review of the final report, the rest of the Board concurs with your findings that there is enough evidence to prompt a more thorough, unbiased investigation into the allegations of 110 Romani women who state that they were coerced into sterilization without their consent.
Further, we find the reaction of the Slovak government to your report troubling. There are no real "emergency" indications for sterilization that would preclude the necessity for obtaining informed consent. The American College of Obstetricians and Gynecologists (ACOG) states: "Special ethical considerations are imposed by the unique attributes of sterilization. The procedure usually is done not for medical indications, but electively for family planning."
We agree that the presence of a signature on a form is not de facto evidence of informed consent, especially if this occurs in a coercive environment, or if the risks and benefits of the procedure are not explained to the patient in language that the patient can comprehend. Indeed, the ethical concept of informed consent requires two elements: free consent and comprehension.
According to ACOG: "Sterilization requires the patient's informed consent, for ethical and medical—legal reasons. The physician performing the procedure has the responsibility of ensuring that the patient is properly counseled concerning the risks and benefits of sterilization and its alternatives. The procedure's intended permanence should be stressed, as well as the possibility of future regret."
Women may be vulnerable to various forms of coercion in their medical decision making. For example, the withholding of other medical care by linking it to the patient's consent to undergo sterilization is ethically unacceptable. Physicians who inject non-medical opinions into their discussions with women about sterilization may be practicing coercion. Specifically, physiciansÕ beliefs about patient compliance with medical care in the future, especially beliefs based on racial or ethnic stereotypes or on socioeconomic considerations, should play no role in decisions about sterilization.
The right to seek or refuse health care is a basic human right. Women in particular have the right to make reproductive choices free from intimidation and coercion. We hope that Slovak authorities will support a full investigation into the grave allegations of human rights violations that your report brought to light.
Wendy Johnson, MD
For the Board of Directors, Doctors for Global Health