Why individual medical liberty isn’t an isolated case

This article features our client Dawn Wooten and was originally published here.

Deep in Ocilla, Georgia, sits the Irwin County Detention Center, a facility contracted with Immigration and Customs Enforcement (ICE) to house female immigrants. Last fall, Dawn Wooten, a nurse and whistleblower working there, accused gynecologist Dr. Mahendra Amin of performing unnecessary surgeries on women — including the involuntary removal of the uterus, ovaries and fallopian tubes — without their consent. Wooten calls Amin the “uterus collector.” Women report going to see the doctor for simple conditions related to diabetes or injured ribs and end up having gynecological operations. In all, 19 women have come forward alleging they were coerced to undergo “medically unnecessary” surgical procedures which may affect their ability to bear children.  Amin denied the allegations, yet independent medical experts from Northwestern, Baylor and Creighton medical schools found clear evidence of medical abuse.

America has a long history of committing egregious reproductive injustices on subsets of people deemed less worthy. It may seem that my previous column, about a vaccination mandate law upheld by the Supreme Court in Jacobson v. Massachusetts, has little to do with reproductive freedom. Unfortunately, the precedent set by Jacobson paved the way to take control of a woman’s right to choose in 1927. In this column, I’ll discuss the impact of that reprehensible decision, how women from marginalized groups do not have reproductive freedom today, and how rolling back abortion rights in Mississippi could become a slippery slope to the loss of much more.

The Eugenics movement, popularized in the 1920s, touted that certain social problems, like poverty and prostitution, were inherited, and therefore, could be eliminated by selective sterilization. The goal of sterilization was to restrict reproduction in “undesirable” populations — the poor, people of color, unmarried women, the disabled, and mentally ill. Teaching hospitals in the South referred to involuntary sterilization operations done on women of color as “Mississippi Appendectomies.” While it is unknown how many Black women and children were sterilized, more than one-third were under the age of 18.

In 1927, Carrie Buck, a poor white woman, was the first to be forcibly sterilized in Virginia under the Eugenical Sterilization Act, passed in 1924. Carrie was born in Charlottesville, Virginia on July 6, 1902, to Emma Buck. After Carrie was placed with foster parents John and Alice Dobbs, Emma Buck was deemed to be a “low grade moron” by authorities and was involuntarily institutionalized at the Virginia State Colony for Epileptics and Feebleminded.

Carrie attended public school through the sixth grade until the Dobbs removed her from school to do more housework at home. In 1923, seventeen-year-old Carrie Buck became pregnant after Clarence Garland, Alice Dobbs’ nephew, raped her. On the grounds she inherited “feeblemindedness” from her mother and was “promiscuous,” John and Alice Dobbs had Buck committed to the same institution as her mother. After Carrie gave birth to her daughter, Vivian, the Dobbs had Carrie declared incompetent and adopted the baby.

The Superintendent of the Virginia State Colony for Epileptics and Feebleminded, where Carrie and her mother, Emma, resided, Albert Sidney Priddy, was a staunch eugenics supporter. Priddy proposed 16 candidates for sterilization due to “genetic inferiority.” Carrie Buck’s legal guardian filed an objection to sterilization in court. Both the Amherst County Circuit Court and the Virginia Supreme Court ruled in the colony’s favor. Then, the case was appealed to the U.S. Supreme Court.

The Court held, by 8-1, that involuntary sterilization did not violate the liberty guarantee of the Fourteenth Amendment. The law served the public health and welfare because “mental defectives” would produce degenerate criminal offspring who would “sap the strength of the state.” Chief Justice Oliver Wendell Holmes Jr., considered to be one of the greatest judges in American history, relied upon the Jacobson precedent to support the majority opinion: “the principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes…Three generations of imbeciles are enough.” Astonishingly, the narrow restriction to individual liberty that justified imposing a monetary fine for vaccine refusal empowered the “state” to force a surgical operation upon a young woman against her will, depriving Carrie Buck of the right to bear children.

This ruling set a precedent on the legality of involuntary sterilization in Virginia and across the nation. This Buck decision — a precedent still not overturned — led to the sterilization of 70,000 Americans women with mental illness or developmental disabilities over the next 50 years. And while we wish reproductive injustice was a thing of the past, this is not true. In the 2020 documentary “Belly of the Beast,” filmmaker Erika Cohn revealed 1,400 women were sterilized between 1997 and 2010 at women’s prisons in California.  According to prison records, the state paid doctors $147,460 to perform tubal ligations that former inmates say were done under coercion. The doctor performing the sterilizations told a reporter the operations were “cheaper than welfare.”

First, the Jacobson and Buck rulings should be a lesson to us that no judicial precedent is isolated. Second, the arc of the moral universe does not always bend toward justice.  Not for Carrie Buck. Not for the inmates in California. And certainly not for detained immigrants in Georgia.

We would be naïve to believe that rolling back abortion rights in Mississippi by the Supreme Court will affect merely one island of independent liberty. In truth, the islands of individual liberty cluster together. Other medical privacy rights are undoubtedly in jeopardy. A woman’s choice whether or not have children should be up to her and her alone, without the overarching influence of the federal government. Bending that moral arc is up to us.