I have a 17-year-old younger brother who we’ll call Bob. Bob has had low-functioning autism all his life and cannot speak (although he can make humming and grunting noises). However, even though he’s been confirmed by psychologists to have a lower-than-average IQ, he has developed a lot despite his condition. He makes eye contact regularly, he doesn’t mind it if people touch him, he can make his own small meals (like cereal and sandwiches), he can do laundry, he participates in special-needs sports teams, and he communicates perfectly with a special tablet that has a text-to-speech program in it.
Here’s where the conundrum lies: my mother wants Bob to have a vasectomy. This is so if in the event that Bob is sexually abused by anyone, nobody gets pregnant and gets any unfair leverage over Bob. (Example: a woman sexually assaults Bob, gets pregnant, then tries to get child support money because Bob would be the biological father.) Bob, having the mentality of a 7-year-old, knows nothing about sex aside from “don’t let anyone touch your wee-wee or your bottom,” which makes sense since he doesn’t have the mental capacity to understand a sexual or romantic relationship and consent properly.
My parents have already met with a urologist to discuss this last year, and after the urologist went to consult this subject with other doctors and a medical board, it was agreed that Bob should be brought back next year when he’s 18 to do the procedure.
I’ve mostly been on board with this since my mom first decided this last year, but I’m starting to have second thoughts. Is this something that my mom is morally okay to do, or is this a complete breach of my brother’s autonomy? Although my mom is not keeping my brother completely in the dark about it (“The doctor’s going to do surgery on your wee-wee.”), there’s no way for my brother to fully understand what he’ll go through and why. My mom is doing this to protect him, but is this doing more harm than good? I don’t think I have any control over this situation if I was 100% against it, but should I be against it?
To my immense relief, Sparkler, I cannot answer that question.
Because despite what you may have heard, Auntie SparkNotes is not the kind of grand high authority who can tell you what to think about the thorniest and most complex issues of morality, autonomy, and parental responsibility. (At best, I am the kind of authority who can tell you what kind of condiments it is ethically advisable to put on your hot dog.) (NOT KETCHUP.) Everything else is entirely up to you—and you should be prepared to invest some serious time and knowledge-gathering into forming a critical, thoughtful, informed opinion.
Fortunately, there’s no hurry on that front. Because you’re right: until or unless you become his guardian, your brother’s medical care is totally beyond your control. And as much as your ambivalence about this situation is totally valid and understandable, it’s important not to lose sight of that. We’re talking about a decision made by someone who is not you, on behalf of someone who is not you, with the input of a board of professionals whose job it is to weigh the moral, ethical, legal, and medical implications of the situation precisely because it’s so complex. No matter what conclusions you reach vis-a-vis the overall ethics of preventing developmentally disabled adults from having children, and even if you believe that your parents shouldn’t have gotten your brother a vasectomy, it’s ultimately their prerogative to do what they think is best for their kid—and if there’s one thing that’s clear from your letter, it’s that it’s a decision they didn’t make lightly.
With that said, it sounds like your mom has all but invited you to ask her how they came by that decision, and asking would be a great place for you to start—not because she has the objectively correct answer to all these complicated questions, but because understanding her perspective is a good step toward figuring out your own. For instance, the competing causes of your brother’s autonomy vs. his vulnerability to abuse is undoubtedly something that your folks wrestled with themselves; how did they decide where to draw the line? What were their greatest concerns and considerations? Did they learn something along the way that made the decision easier, or more difficult? What ultimately tipped the scales, one way or another?
This may not be the easiest conversation, but it will be useful and valuable—in combination, of course, with your own research. There’s a lot to read and consider on this topic, which encompasses not just issues of bodily autonomy but consent, guardianship, sex education, legal and financial liability, and reproductive rights. People like your brother may be limited in their ability to fully grasp concepts like “vasectomy”, but they’re walking around in adult bodies, often experiencing and acting upon adult sexual impulses—and how to handle that is an ongoing discussion amongst disability advocates and caregivers, because there are no easy solutions. (I know your mom positioned this as a matter of protecting your brother from sexual predators, but the truth is, developmentally disabled adults can and do become sexually active with each other, and they need reliable contraception as much as anyone else. And if a guy doesn’t have the capacity to use condoms effectively and reliably, the only remaining options are either a) vasectomy, or b) restricting his independence and social life to the point where he never has the opportunity to impregnate anyone, which comes with its own set of problems.)
Finally, don’t expect to come through this process having discovered a one-size-fits-all, easy solution to this complex problem—because it doesn’t exist, and if you think you’ve found one, you’ve probably missed something. This is the kind of question that doesn’t have a single right answer. But that’s why what matters is not what you think, but how you think — so that your answer, whatever it is and however it might evolve, will be one you came to thoughtfully, critically, and compassionately.
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