Karnataka High Court allows hysterectomy for woman with intellectual disability: Legal and ethical balance
The Karnataka High Court recently permitted the parents of a 23-year-old woman with severe intellectual and developmental disabilities to undergo a total abdominal hysterectomy. The parents had approached the court citing their daughter's inability to manage menstrual hygiene due to cognitive impairments, leading to recurrent infections and medical complications. After a multidisciplinary medical board confirmed the woman lacked capacity to give informed consent and recommended the surgery for her well-being, the court allowed the procedure.
This judgment highlights the complex intersection of law, medicine, and human rights concerning reproductive autonomy of women with intellectual disabilities. Historically, such women have faced forced sterilisations and non-consensual medical procedures, often justified by caregivers as convenience or protection. To prevent this, Indian law requires strict safeguards. Section 10 of the Rights of Persons with Disabilities Act, 2016, prohibits medical procedures leading to infertility without free and informed consent.
However, a legal dilemma arises when a woman's disability is so severe that she cannot give informed consent. In such cases, courts use the 'parens patriae' doctrine, acting as a guardian to determine the 'best interests' of the individual, prioritising health, dignity, and bodily integrity. The court does not simply substitute its own judgment but conducts an inquiry into what course of action serves the person's welfare.
The Supreme Court has also addressed hysterectomies. In the 2023 case Dr Narendra Gupta v. Union of India, the court highlighted unnecessary hysterectomies performed on marginalised women under government schemes, often without informed consent. The court directed strict implementation of the Union Health Ministry's 2022 Guidelines to Prevent Unnecessary Hysterectomies and mandated monitoring committees at national, state, and district levels to audit such surgeries.
Regarding abortion, the Medical Termination of Pregnancy Act, 1971, allows termination with guardian consent for women with mental illness, but not for those with intellectual disabilities. For them, their own consent remains absolute. This legal gap creates challenges when pregnancies result from sexual assault, requiring careful judicial scrutiny to balance protection and autonomy.
