In the fictional dystopia created by Percival Everett, fertility is a hot commodity, and nobody has it… except for Alice Achitophel. However, Alice’s capacity to bear children is not a superpower, but rather an ability that has not yet been taken away from her. The government-mandated sterilizations that set the stage of Zulus may seem like they would cease to exist outside of the surreal chapters of a fiction novel. Sadly, as I will begin to reveal, involuntary sterilization at the hands of the government is no new phenomena. In the 1970s the Indian Health Service is responsible for sterilizing staggering amounts of Native American women without their informed consent.
In Alice’s war-torn reality, the government sees sterilization not only as preventing future progeny, but also as preventing future misery. This misery is a by-product of living on a tainted planet stained from the aftermath of nuclear and chemical warfare. The book’s imagery of once blue skies with a now eternally warm hue leave no question of the extent of the war’s effects. In the novel, the government takes the “courtesy” of sterilizing women in order to prevent future generations from inhabiting this decided wasteland. This motive may appear as an altruistic act of prevention, but it becomes obvious that this action was imposed without consent, as people throughout the story begin to idolize and envy Alice for her ability to bear children.
From the information provided in Zulus, I interpreted that the government assumed its actions to be utilitarian in nature, or in other words, the actions “produce the greatest good for the most people” (Medical Apartheid, 129). The definition quoted above, as well as the concept of utilitarianism were first brought to our attention in chapter 5 of Medical Apartheid, when people began to realize that better medical care coincides with a greater amount of bodies available to doctors in training. In both situations there was a trade-off; in the case of Alice’s society, future generations are spared from misery in exchange for a loss of individual autonomy. I disagree that this school of thought should give anyone, besides the individual, the right to make the choice of whether or not to be sterilized. Sadly, both the government in Zulus and those working for the Indian Health Service, have assumed themselves capable of giving consent for countless women.
In the United Sates, it is estimated that “the Indian Health Service sterilized between 25 and 50 percent of Native American women between 1970 and 1976” as stated by this publication by Jane Lawrence. In this case both a government entity as a whole, and physicians did not get proper consent from the women they sterilized. As mentioned by Lawrence, their “utilitarian” trade-off was limiting the amount of public funding spent on programs like welfare, in exchange for women being stripped of their right to reproduction. It also is noted in this journal that Native American women were particular targets for sterilization, as their birth rates were considerably higher than people in other racial categories. I think no woman should be pressured into having less children then she would like, but if women want to plan their families, there are plenty of reversible birth control options that could be offered to them. However, as Lawrence mentions in her writing, many people thought these women were not capable of properly using birth control (even though low maintenance options like the IUD exist).
In both the case of our own reality and the fictional one of Alice, the governments not only assumed that the sterilizations would benefit society, but they also did not get proper consent from the women. Informed consent, as we have become aware through our discussions in class, is: “A process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a clinical trial. … Patients are also given any new information that might affect their decision to continue.” Consent, as we know from class, can be withdrawn at any time. In Alice’s case, the notices mentioned in the introduction of the novel, were sent out to women and required them to get sterilized, thus completely ignoring this consent process. In the case of Native American women, it is noted by Lawrence that physicians in the Indian Health Service were not required to administer the same consent forms or follow the same procedures for gaining consent. The result, as she mentions, was that consent forms did not always mention the risks of the procedure, alternative forms of birth control, and information stating that their consent could be revoked. Thus, no informed consent was gained from these women.
As brought to light in an excerpt of chapter 9 of Medical Apartheid, informed consent is no new concept by the time the 1970s came around. The book goes further to mention that it has been introduced in 1947 in policies regarding the ethics of using possibly harmful substances on human subjects. Regardless, this blatant lack of either awareness or acknowledgment of informed consent by the supervisors and physicians in the Indian Health Service had catastrophic results. Lawrence states in her writing, that the lowered birthrates of Native Americans destroyed the political balance of power and respect in many communities, not to mention the drastic personal effects that women and their families experienced. In the fictional case of Alice Achitophel, she also experienced the catastrophic effects of sterilization. Throughout Zulus, Alice was constantly sought after and abused by people in her society as nothing more than a breeder for her community while the others “suffered through barren and failing sex” (Zulus, 105).
Although the government enforced sterilization in Zulus, seems surreal, this concept is far too close to the realities of our own country’s not-so-distant past, and possibly present. In both cases governmental entities and the people within them may believe they are practicing utilitarianism in their policies and protecting people from something: whether it be future misery or something as trivial as tax dollars. However, the results of these decisions are not so one-sided. An irreversible and life-altering procedure is not to be the decision of a government, or any person besides the woman who is giving her informed consent. Hopefully, as our society begins to make consent in medicine a more mainstream concept, widespread atrocities like this can be prevented.