The Indian Express (5 February 1994) featured a story on proposed surgery on mentally handicapped women that weekend at the Sassoon General Hospital in Poona . Dr. Shirish Sheth, consultant obstetrician and gynecologist in Bombay was to remove the uterus from each of several such women.

The rationale for these operations was two-fold:

1. these women, whose mental age was between two and three years, were unable to attend to their personal hygeine and often smeared themselves and their surroundings with menstrual fluid;
2. they were subject to rape and unwanted pregnancy. Removal of the uterus would stop menstruation and prevent pregnancy. Ms. Vandana Khullar, Director in charge of the welfare of women, children and the handicapped in Maharashtra pointed out that the guardians of such women were often unwilling to attend to them or children born to them. She claimed that removal of the uterus did not eliminate femininity.

These operations infuriated several groups working on behalf of women. Claiming that keeping these women clean during the three or four days when they were menstruating each month was not an unsurmountable problem, they felt that removal of the womb would further encourage antisocial elements and worsen the probability of rape. They asked for a ban on such operations and pleaded for better care of such women instead. Chief Minister Sharad Pawar ordered an immediate stoppage of these operations.

The issue focusses attention on the following ethical considerations:

1. Who was the competent authority to decide the mental age of these women? What were the tests used for the purpose? Was the evaluation made by disinterested experts on more than one occasion and suitably documented?
2. Has the inability of these women to attend to their personal hygeine been confirmed after all possible help was made available to these women on a continuing basis?
3. Who is the competent authority to permit such operations? Did the legal guardians offer appropriate, informed consent? Have these been documented in the presence of disinterested witnesses?
4. The statement that removal of the womb does not deprive a woman of her femininity smacks of insensitivity. There is ample documentation of the deep sense of despair experienced by women who have been deprived of this organ.
5. What are the legal precedents on which the present action of removal of the uterus from women unable to protest or resist has been based?
6. Is it not more logical and humane for society to offer better care to such women? They should be kept clean not only during menstruation but at all times. They also need continued protection from men who abuse them sexually.

Families with mentally handicapped girls deserve compassion. Provided ethical guidelines are followed, society will sanction every possible help. The present furore follows an absence of such guidelines. It is high time that the medical profession sets its own house in order and formulates ethical principles governing conduct in this and other similar matters. If this is not done we shall continue to see interference by powerful politicians in matters medical as was seen here. The outbreak of fury at these operations is, in part, against the perception by the state of these women as ‘disposables’. Whilst the situation may not be as bad as that in Bogota or Cali in Colombia, it is a step in that direction.

(We are seeking the views of Dr. Shirish Sheth, the federation of obstetricians and legal experts on this issue. Editor)