Eugenic sterilization in California: practicing “good medicine”

Please note that this post is from 2016. Evaluate with care and in light of later events.

Indiana may have passed the first sterilization law in 1907, but before World War II, it was California that led the nation in eugenic sterilizations. The goal? To “apply science to social problems”:¹

Such legislation was part of a wave of Progressive Era public health activism that encompassed pure food, vaccination, and occupational safety. … [It] granted the medical superintendents of asylums and prisons the authority to “asexualize” a patient or inmate if such action would improve his or her “physical, mental, or moral condition.”²

The drive drew deeply on previous struggles around the extent of a state’s “police power” to protect the public welfare, especially around the issue of compulsory vaccination.

Thus, the Supreme Court’s holding in Jacobson v. Massachusetts, 197 U.S. 11 (1905) — in which the Court upheld mandatory smallpox vaccinations in epidemic conditions as a reasonable exercise of the police power — formed a strong precedent for eugenic sterilizations done for the good of the public. Justice Oliver Wendell Holmes famously made the connection in Buck v. Bell, 274 U.S. 200 (1927) writing:

It is better for the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough.³

In short, sterilization of an individual was justified on the basis of public health and welfare — the state’s police power.

Some states applied sterilization measures for punitive reasons (and note that 1942’s Skinner v. Oklahoma, 316 U.S. 535 (1942), rejected use of sterilization for only certain kinds of convicted criminals, but did not overturn Buck v. Bell), but California — emphasizing health over penal rationals — “consistently described [sterilization] as a public health strategy that could breed out undesirable defects from the populace and fortify the state as a whole.”⁴

California stayed at or near the top of such sterilizations until after World War II. By the 1950s, such activities were dropping in the West, but “[o]n the basis of a revamped rationale of bad parenthood and population burden, sterilizations increased in the 1950s and 1960s in southern states such as North Carolina and Virginia.”⁵ In the South, and despite Skinner v. Oklahoma, a punitive “edge” emerged, focused on punishing those who bore illegitimate children “or as extortion to ensure ongoing receipt of family assistance.”⁶

California “never explicitly endorsed a punitive model,” but as worries about “overpopulation, welfare dependency, and illegitimacy” combined in the 1960s with a reviling of the “reproductive tendencies of working-class Mexican-origin women” and an increasing acceptance of birth control and sterilization — the last rather ironically driven by feminist arguments for individual autonomy over one’s own body — eugenic-like sterilization re-emerged in at least one Los Angeles hospital.⁷

In 1978, ten women sterilized at Los Angeles’ County General Hospital filed suit, arguing in Madrigal v. Quilligan essentially that they had been sterilized without effective or informed consent, violating their right to bear children⁸ (constitutionally at least an aspect of the right to privacy, according to Roe v. Wade, 410 U.S. 113, 152-53, citing Skinner, 316 U.S. at 541-42).

The hospital defense was, in essence, simple:

Dr. E.J. Quilligan, the head of County Hospital’s obstetrics unit (and a pioneer in lifesaving fetal-monitoring technology) told a reporter, “We were practicing good medicine.”⁹

The women lost their case. The judge found that, in essence, the physicians had acted in good faith and intended no harm. The resentment and anger of the plaintiffs was due to a combination of a “breakdown in communication” along with the Mexican-American women’s “natural[] inclination towards large families.”¹⁰

Problems persisted, but the case drew attention and oversight, and widespread violations of informed consent in sterilization procedures fell off by the 1980s.¹¹

Concurrent with the drop was a marked increase in the requirements overall for proper and effective informed consent for medical procedures, so whether the problem of unwanted sterilizations is traceable to a reduction in racist-driven eugenics-based thinking or an increase in informed-consent requirements (and corresponding victories in other contexts by other kinds of plaintiffs in informed-consent cases) is an open question.