Sterilization law is the area of law, that concerns a person's purported right to choose or refuse reproductive sterilization and when a given government may limit it. In the United States, it is typically understood to touch on federal and state constitutional law, statutory law, administrative law, and common law. This article primarily focuses on laws concerning compulsory sterilization that have not been repealed or abrogated, i.e. are still good laws, in whole or in part, in each jurisdiction.

Federal law U.S. Supreme Court

In Buck v. Bell, the United States Supreme Court ruled in a majority opinion written by Justice Oliver Wendell Holmes Jr. that a state statute that authorized compulsory sterilization of the unfit, including the intellectually disabled, "for the protection and health of the state" did not violate the Due Process clause of the Fourteenth Amendment to the United States Constitution. This ruling upheld the Act of Virginia (Laws 1924, c. 394), or the Virginia Eugenical Sterilization Act, which allowed the “sexual sterilization of individuals admitted to state institutions in certain cases.”

In Skinner v. State of Oklahoma, the United States Supreme Court ruled that an Oklahoma compulsory sterilization law that applied to "habitual criminals" but exempted those convicted of white-collar crimes violated the Equal Protection Clause of the 14th Amendment.

Stump v. Sparkman (1978) is the leading United States Supreme Court decision on judicial immunity. It involved an Indiana judge who was sued by a young woman who had been sterilized without her knowledge as a minor in accordance with the judge's order. The Supreme Court held that the judge was immune from being sued for issuing the order because it was issued as a judicial function. The case has been called one of the most controversial in recent Supreme Court history.

U.S. District and Appellate Courts In 2007, the United States Court of Appeals for the District of Columbia Circuit heard Doe ex. rel. Tarlow v. District of Columbia. The Court upheld a 2003 District of Columbia statute that stated the conditions for authorizing a non-emergency surgical procedure on a mentally incompetent person. Under the Appellate Court's interpretation of the statute, a court located in the District of Columbia must apply the "best interest of the patient" standard to a person who was never competent, and the court must apply the "known wishes of the patient" standard to a person who was once competent.

In the 2001 case of Vaughn v. Ruoff, a husband and wife sued three social workers for coercing his wife, "diagnosed as mildly retarded", into getting a sterilization as a condition for getting their children back from state custody. The United States Court of Appeals for the Eighth Circuit held that the social workers did not have sovereign immunity and could be sued for violating the couple's Fourteenth Amendment right because the procedural due process requirements for performing a sterilization are clearly established by Buck v. Bell and were not met in this case.

In 1975, in Cox v. Stanton, the United States Court of Appeals for the Fourth Circuit decided the statute of limitations for a lawsuit challenging the legality of a sterilization begins to accrue when the plaintiff discovers the sterilization.

Poe v. Lynchburg Training School & Hospital concerned whether or not patients who had been involuntarily sterilized in Lynchburg Training School and Hospital, a state mental institution in Virginia, as part of a program of eugenics in the early and mid-20th century had their constitutional rights violated.

United States Code Under 22 United States Code section 2151b, foreign aid used for population planning and the combat of HIV, tuberculosis, and malaria may not be used to fund "a program of coercive abortion or involuntary sterilization.22 United States Code section 2151b

Federal programs Department of Veterans Affairs The Veterans Health Administration (VA) permits the sterilization of a patient, who is unable to give informed consent, if the guardian of the patient gives consent to the procedure; a witness, not associated with the VA witnesses the guardian signing the consent form; a healthcare committee completes a finding on the need for the procedure; and the director of the facility approves of the procedure.38 C.F.R. § 17.32 (g)(1)

Federally Assisted Family Planning Projects The Office of the Assistant Secretary for Health, Health Resources and Services Administration, National Institutes of Health, Centers for Disease Control and Prevention, Alcohol, Drug Abuse and Mental Health Administration, and all of their constituent agencies are authorized to perform a sterilization on a patient only if the individual is at least 21 years old, mentally competent, gave informed consent to the procedure, and at least 30 days but not more than 180 days passed since the individual gave consent to the procedure. "Programs or projects to which this subpart applies shall not perform or arrange for the performance of a sterilization of any mentally incompetent individual or institutionalized individual."

Indian Health Service

Indian Health Service (IHS) is an operating division within the United States Department of Health and Human Services. The IHS offers sterilization as a method of family planning. Tubal ligation and vasectomy are the only procedures that may be performed for the primary purpose of sterilization. The IHS requires the patient to give informed consent to the operation, be at least 21 years of age, and not be institutionalized in a correctional or mental health facility.

Medicaid Services A state plan must provide that a Medicaid agency will pay for the sterilization procedure if the individual is at least 21 years old, mentally competent, voluntarily gave informed consent to the procedure, and the procedure must be done for a purpose other than for "rendering the individual permanently incapable of reproducing." Medicaid will not pay "for the sterilization of a mentally incompetent or institutionalized individual."

State law

State sterilization laws are required to be in compliance with the United States Constitution.

Alabama In 1935 Dr W. D. Partlow proposed a bill to sterilize those with hereditary "mental disease". In 1973, the Southern Poverty Law Center filed a lawsuit on behalf of Minnie Lee and Mary Alice Relf. The Relf sisters were sterilized without their informed consent, or the informed consent of their parents, who could not read, further pressured by their reliance on government welfare programs. The Relf v. Weinberger ruling prevented federal funding from being used for involuntary sterilizations. In the 1979 case Hudson v. Hudson, it was ruled that judges could no longer order forced sterilizations unless they were given the jurisdiction to do so in future rulings.

Alaska In 1981 the Alaska Supreme Court held that an Alaskan Superior Court has the authority to order the sterilization of a "mental incompetent" person upon petition by their legal guardian if it is proven with clear and convincing evidence that sterilization is in the intellectually disabled person's best interest.

Arkansas Arkansas Code section 20-49-101 to -207 provides the guidelines for sterilizing an incompetent patient.

In 1991, the Arkansas Supreme Court held the part of the Arkansas sterilization statute that allowed sterilization of an incompetent through direct medical channels, rather than approval from a court, to be unconstitutional because it denied the patient procedural due process.

California

In 2013, the 4th District Court of Appeal held that a developmentally disabled adult with "mild mental retardation" may be reproductively sterilized if the court determines there is clear and convincing evidence that the procedure is medically necessary for the patient. The court held that Probate Code section 2357 regulated the patients court order for medical treatment because the sterilization was incidental to acquiring medical care and not the purpose of the medical treatment; alternatively, Probate Code section 1950 et seq. applies when the objective is to prevent the patient from bearing children.

In 1978, a federal class action lawsuit was brought from Los Angeles County, California, involving the sterilization of Mexican American women. Most of the women were monolingual Spanish speakers and testified that they did not understand that the procedures they were undergoing would affect their ability to become pregnant or sustain a pregnancy.

In 1985, the Supreme Court of California held that a California statute that completely prohibits the sterilization of the developmentally disabled is overbroad and unconstitutional because a mentally incompetent person has a constitutional right to sterilization if a less intrusive method of birth control is not available.

The California Penal Code prohibits inmates from being sterilized unless the procedure is required to protect the life of the inmate or the procedure is necessary for treating a diagnosed condition and the patient gave consent to the procedure.

Colorado Colorado Revised Statutes section 25.5-10-233 governs court-ordered sterilizations.

In 1981, the Colorado Supreme Court held that a district court may authorize the sterilization of a "mentally retarded person" if the court finds with clear and convincing evidence the procedure is medically essential. The Court defined "medically essential" as a procedure that is "clearly necessary, in the opinion of experts, to preserve the life or physical or mental health of the mentally retarded person.

In 1990, the Colorado Supreme Court held that a person "mentally incompetent to make some decisions is not necessarily incompetent . . . to grant or withhold consent to sterilization." Three members of the Court dissented from the majority opinion and stated that the "individual’s capacity to understand the risks of pregnancy and childbirth [should also be part of] the test for determining one’s competence to make a decision regarding sterilization."

Connecticut A person unable to give informed consent may only be sterilized if a Connecticut Probate Court determines it is in the patient's best interest. In general, sterilization is permitted for all individuals 18 and older with their informed consent.

Delaware Throughout its history, Delaware forcibly sterilized over 1,500 people. In October 2023, Delaware fully banned any form of forced sterilization. The repeal did not include an apology to the past victims.

Florida A person unable to give informed consent may only be sterilized or given an abortion with specific authority from the court. The court must find clear and convincing evidence the person is unable to give consent and the procedure is in the best interest of the individual. The statute expressly states that these requirements "are procedural and do not establish any new or independent right to or authority" over the individual regarding abortion or sterilization.

A court may authorize for a surrogate to provide consent to the sterilization or abortion of another person,Fla. Stat. § 765.113 after the surrogate petitions the court, provides supporting documents on the intent of the patient, gives notice to all relevant parties, and a hearing is conducted to review the matter.Florida Probate Rule 5.900

Under Florida statute § 985.18, delinquent children ordered by the court to undergo psychological or physical health exams may not be given a "permanent sterilization" unless the procedure is medically necessary "to protect or preserve the life of the child."Fla. Stat. Ann. § 985.18

Georgia