Sterilization Program Not All Itís C.R.A.C.K.ed Up to Be

By Phyllis Griffin Epps

Imagine a world in which a person might sell his or her reproductive capacity for two hundred dollars cash. Perhaps the person sees the advertisement at a neighborhood bus stop and judges the $200 purchase price to be fair and just. Imagine further that, in every instance, the personís judgment was informed by an entrenched habit of abusing chemical substances designed to addle consciousness and impair judgment. Now imagine a world that smiles upon the transaction.

Welcome to our world. In 1997, Barbara Harris formed Children Requiring A Caring Kommunity, or CRACK. A non-profit organization funded largely by private donations, CRACK offers $200 to drug addicts able to document a history of drug abuse and participation in long-term or permanent birth control. CRACK is based on the premise that financial incentives are a proper and desirable means of advancing the social objective of encouraging those without resources to sterilize themselves. The program does not directly purchase the organs from the individual, but does pay money as an incentive or reward to persons who relinquish the physical ability to reproduce. To date, all takers have been female. Caucasians, African Americans, and Latino populations are equally represented. No information regarding the income levels is available.

CRACK aims to aggressively prevent or reduce the tragedy of babies born to drug-addicted women who lack the resources to care for the child or herself.  Evidence suggests that children born to women who ingested illegal drugs before or during pregnancy suffer physical and psychological problems. Supporters of CRACK "believe birth control is a solution to the problem of drug addicted babies" and "ending the cycle of drug-addicted women bearing children" for which they are unwilling or unable to care. Since its inception, CRACK has expanded from California to Illinois and plans to establish a presence in Florida and Washington.

For years scholars have argued the merits of the commodification of bodily organs and the commercialization of the organ donation system. CRACK must take its place within the debate. Current national and state laws permit the donation and sale of regenerative tissue, such as blood, sperm, ovum, hair, cells and other such products of the body. Nonregenerative solid organs, such as the heart, lungs, liver, pancreas, and kidneys, can only be transferred by participation in a volunteer organ donation system. The law prohibits the sale of the latter in an attempt to safeguard the right to bodily integrity and the broader right to privacy recognized in this country. Ethicists note the danger in a market in human tissues from living donors where poor people are induced to offer their organs, or like body materials, for money because they lack other means of sustenance. According to Bernard Dickens, the inducements may cause "an underclass of poor, unemployed or unemployable people to surrender their bodily integrity and take undue health risks for the benefit of wealthy sick people, who may thereby acquire medical advantages that they do not deserve on any prioritizing of merit other than the ability to pay."

CRACK also raises issues regarding informed consent. The legal doctrine of informed consent is based on autonomy. The doctrine assumes that adequate disclosure and competence to make rational decisions will yield the best results for that individual and, by extension, the greater good. Proponents of CRACKís philosophy would probably argue that the paternalism implicit in regulating the ability to sell organs is not justified where directed toward adults deemed capable of rational decision-making. But when people are induced to sell their organs as a means to support themselves or other family members, the voluntary nature of the sale is tainted, if not destroyed. Those who would reduce bodily organs and functions to commodities face the challenge of balancing the values of the marketplace with the morals of society.

How does CRACK measure up against concerns about further reducing the body to a commodity? CRACK neither pays for the sterilization procedure nor receives bodily organs for destruction or future use. CRACK only offers money as an agent to persuade persons to surrender the physical ability to conceive children. That the program targets the poor is evident not only by its own admission but also by the reality that persons with low income are disproportionately likely to respond to the $200 offer. The question is whether society acknowledges that the socio-economically disadvantaged can invoke the same right not to be exploited as that recognized in the young, dependent, disabled, and other populations perceived as vulnerable. The means by which CRACK pursues its objective necessarily reduces the number of healthy babies as well as the number born with special needs. The women who participate do not receive enough money to justify a classification outside of a relatively vulnerable population. Nor do the women receive sufficient resources to treat the conduct that qualifies them for the money, i.e., treatment for drug addiction. Yet each recipient enjoys the right afforded each person to make decisions regarding her bodily integrity. How should society balance the competing forces of autonomy and the prevention of birth defects versus eugenics and exploitation of the poor? The answer will reflect the value society places upon human dignity and perhaps human life itself.