Reproduction in mentally retarded females [letter]

Medical psychosocial and legal issues arise when dealing with the menstrual and reproductive function of mentally retarded women. The bioethics committee of the American Academy of Pediatrics has therefore issued guidelines on sterilizing persons with mental handicap. Mental handicap alone justifies neither sterilization nor its denial. Physicians must consult with pediatricians neurologists psychiatrists social workers and lawyers for feedback on whether sterilization would best serve a given patients interest. Where appropriate alternate paths should be considered and training provided in socialization sexual abuse avoidance menstrual hygiene family counseling and sexual education. To further protect the interest of the patient mental incapacity should be permanent; the patient should be likely to be fertile and experience sexual intercourse in the absence of restricted social interaction; and an insupportable burden should exist upon the patient due t menstruation or in the event of child bearing or parenting. Multiple interviews of the patient with trained personnel must ultimately take place to secure informed consent. The potential for conflict of interest and the risk of sterilization abuse must be considered where parents immediate family members or legal guardians hold proxy consent for medical treatment. If interviews are inconclusive as to informed patient consent cases should be referred to courts of law. Mentally handicapped teens accounted for 2.1% of all patients who received abdominal hysterectomies over a 5-year period in India. A debate on these issues is sorely needed in India.