Aysha Gardner ’22 is a junior majoring in biology and history and a 2020-21 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.
In mid-September of 2020, a whistleblower, nurse Dawn Wooten, reported to The Intercept that a doctor was completing gynecological surgeries on women without their consent. According to Wooten, who worked as a nurse in an ICE detention center in Ocilla, Georgia, women have been reporting these unwanted and unnecessary surgeries for years, but they’ve been continuously swept under the rug. This is a clear violation of several ethical principles and these women’s human rights.
Nurse Wooten’s report allowed a total of sixteen women to come forward and state they had an unwanted gynecological procedure, including full hysterectomies in two of the sixteen women. It’s important to note there were numerous other women at the center who claimed they had a forced hysterectomy but did not feel comfortable in coming forward.
One of the sixteen women who came forward was Wendy Dowe, a Jamaican immigrant who was at Irwin County Detention Center in 2019. She claims that Dr. Mahendra Amin completed an unnecessary gynecological procedure. Dr. Amin told her she had a cyst in her uterus the size of a large fruit that needed to be removed. But when Ms. Dowe was deported back to Jamaica her gynecologist reviewed her medical record and told Ms. Dowe that before the procedure, she had common benign cysts that did not need to be surgically removed.
These women’s cases were reviewed by board-certified gynecologists, who agreed that Dr. Amin exaggerated the risks associated with cysts in the uterus and completed surgeries that were not medically necessary. Many of the women who came forward stated Dr. Amin did not clearly explain why they needed to have a procedure. Several of them felt coerced to consent because they met Dr. Amin as a detainee in shackles. Furthermore, many of the women who have spoken out against Dr. Amin did not speak English. They claim when Dr. Amin explained the procedure there was no translator present. Dr. Amin denies all of these claims and stated that every patient was properly treated and gave informed consent.
Dr. Amin is in clear violation of several ethical principles related to informed consent. Informed consent is a lawful and ethical ideal where physicians inform their patients of their illness, possible treatments (including no treatment), and risks and benefits to said treatment. Under this ideal, the physician must allow the patient to make their own autonomous decision about how to proceed. Many women state that they did not know why they had to see Dr. Amin and why they were receiving surgery, supporting the claim that Dr. Amin did not inform his patients of their medical illness. Secondly, Dr. Amin did not notify his patients of other treatment options for their ovarian cysts. Several women attest he offered surgery as the only treatment plan. The review conducted by a board of gynecologists pointed out that many of these surgeries were not medically necessary. Lastly, the patients did not consent to these procedures. As mentioned earlier, several of the women did not have a translator at the time of consultation. Dr. Amin’s negligence in giving informed consent is unethical and illegal.
Dr. Amin took away these women’s right to make medical decisions for themselves, violating their human rights, the principle of autonomy (respecting a person’s decision made about their own life), and nonmaleficence (limiting harm to maximize the benefits). He violated these women’s autonomy by not engaging in a genuine discussion for informed decision-making, and still choosing to proceed with treatment. His unnecessary and unwanted surgeries caused intense harm to these women, emotionally and physically. Because of his actions, many women are at risk of not being able to conceive, breeching nonmaleficence. It is crucial to realize that because these women were immigrants and detainees, that did not give Dr. Amin the right to make medical decisions for them.
The detention center also conducted itself in an unethical manner by sweeping these claims under the rug until nurse Wooten exposed the truth. Irwin County Detention Center is a publicly funded but privately run facility. The detention center receives government funding per detainee. Hence, burying these human rights violations allows the detention center to continue to make money, rather than handling these claims and possibly be shut down. This is extremely unethical because it violates Kantian Ethics. These women were being used as a means to an end of profit. Their intrinsic value was not upheld and respected. The center had an obligation to protect these women from harm, but they failed miserably.
In this situation, the only person who acted ethically and bravely, outside of the women who came forward, was nurse Wooten. She listened to these women’s complaints and tried to stop further atrocities by reporting these unwanted and unnecessary gynecological surgeries to the leadership of the detention center. The facility tried to silence her by demoting Wooten from a full-time to an on-call position. Wooten did not let the center’s intimidation tactics scare her. She quit her job and went to the press. This was extremely courageous of her, especially as a Black woman, where the risks associated with being a whistleblower are even higher for a person of color.
Most women who are in ICE detention camps are immigrants of color, a marginalized community in the United States. This leaves them more vulnerable to abuse than other groups of people. Forced gynecological procedures, especially forced hysterectomies is a long-standing issue in the United States. Thirty-three states had Eugenics boards that allowed legal forcible sterilization of a person (1909-1979). The majority of the people who were sterilized were women of color, the mentally ill, and disabled people. Civil rights activist Fannie Lou Hammer had a hysterectomy without her consent in 1961 while undergoing a procedure for a uterine tumor. This was such a common occurrence that it was coined as the “Mississippi appendectomy” by the Mississippi Black community.
Forced sterilization of women in the United States has a long and terrible history. To stop this from happening we need to shed light on this issue. We need to emphasize and uphold that every person has full autonomy and the right to informed consent. Imprisonment does not negate a patient’s autonomy especially pertaining to invasive procedures. When immigrants and communities of color read stories about forced sterilization it perpetuates the distrust between these marginalized peoples and health care providers. The field of medicine must do better and hold its providers accountable.
As of December 21st, 2020, there were more than forty women who were a part of a class-action lawsuit against the U.S. Immigration and Customs Enforcement for Dr. Amin’s unnecessary and unwanted medical procedures.