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  1. #1
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    Paying Drug Addicts to Get Sterilized

    Project Prevention is a national, non-profit organization that offers cash incentives to drug and
    alcohol-addicted women for being sterilized, and for using long-term birth control.

    This organization pays a single cash incentive of $300.00 to said women for permanent sterilization, and an annual cash incentive of $300.00 for said women who use a long-term, reversible form of birth control, such as Depo-Provera implants.

    Project Prevention has paid clients in 39 states and the District of Columbia.

    http://projectprevention.org

    I support what this organization is trying to do, because the program's goal is to reduce the number of babies that are exposed to drugs, and the female addicts DO have a choice as to whether or not they will be sterilized or use birth control.

    Are you in favor of Project Prevention?

    Why or why not?


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    Re: Paying Drug Addicts to Get Sterilized

    I'm going to go with my gut and say this is absurd, ridiculous, and I'm a bit disgusted. It seems to be like thinly veiled eugenics movement with a minimal cash incentive serving the "greater good". You are really going to pray on the addicts?

    Or they are going to pay them to use their drugs? Are there any studies to the long term effects of the birth control? Does it have conflicts with drugs? Smoking? Could it lead to death or serious injury?

    Instead of paying them to be permanently sterilized (or effectively so), why don't they pay them to come to rehab? Perhaps turn their live off of drugs, be a productive member of society, and raise productive children.

    There are many people who turn their life around after being addicted to drugs and could regret, big time, the choice they made while under the influence of addiction to get rid of their choice to start a family.

    That's my first reaction.

  3. #3
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    Re: Paying Drug Addicts to Get Sterilized

    Seems like a good initiative to me. It's not the state doing it, it's a private charity, and there is no question that these women having children would be (in most cases) a social harm. There is no aspect of eugenics to it, as it is not being forced on them and the incentive is determined by choices, not circumtances of birth. This doesn't preclude getting them in rehab and away from alcohol, but it certainly makes sure that there are less unhealthy and abused kids.
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    I'm going to go with my gut and say this is absurd, ridiculous, and I'm a bit disgusted. It seems to be like thinly veiled eugenics movement with a minimal cash incentive serving the "greater good". You are really going to pray on the addicts?
    The addicts prey on society and their children when they don't use birth control. It doesn't seem any different than encouraging people in bad personal situations to hold off on having kids.
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  5. #5
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by starcreator View Post
    The addicts prey on society and their children when they don't use birth control. It doesn't seem any different than encouraging people in bad personal situations to hold off on having kids.
    I can deal with birth control, if its been studied and would not cause serious conflicts.

    But PERMANENT STERILIZATION for $300? Are you kidding? That's disgusting. Especially when you are offering it people who you KNOW are not in the right frame of mind to make that kind of decision.

    Still, I'd rather see them being paid to go to rehab.

  6. #6
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    You are really going to pray on the addicts?
    How does this "prey" on drug addicts?

    They have a CHOICE as to whether they get sterilized, use birth control, or not.
    Nobody is forcing them to do this.

    I think you are trying to say here that drug addicts are not responsible for their choices or actions.

    Am I correct?

    Quote Originally Posted by thegreenape
    Or they are going to pay them to use their drugs?
    Nobody is forcing these addicts to use drugs.

    It is certainly their choice to use drugs, and it is their choice to use their money as they wish to, regardless of how the money was obtained.

    Quote Originally Posted by thegreenape
    Are there any studies to the long term effects of the birth control? Could it lead to death or serious injury?
    Those would possibly be valid points if female drug addicts were being FORCED to use birth control.

    However, I must emphasize again that Project Prevention is TOTALLY VOLUNTARY.
    No one is being FORCED to enter the program.

    Instead of paying them to be permanently sterilized (or effectively so), why don't they pay them to come to rehab?
    You mentioned above that Project Prevention is "paying them to use their drugs".
    If they are paid to come to rehab, isn't there also a probability that they would use that money to buy drugs?

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  7. #7
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    Still, I'd rather see them being paid to go to rehab.
    Isn't the success rate of rehab very awful?

  8. #8
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    But PERMANENT STERILIZATION for $300? Are you kidding? That's disgusting. Especially when you are offering it people who you KNOW are not in the right frame of mind to make that kind of decision.
    I think you are saying again here that drug addicts SHOULD NOT BE HELD RESPONSIBLE for their actions.

    Is that correct?
    "As long as I have a voice, I will speak for those who have none".

  9. #9
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by Scarlett44 View Post
    I think you are saying again here that drug addicts SHOULD NOT BE HELD RESPONSIBLE for their actions.

    Is that correct?
    No, I am not saying that they shouldn't be held responsible for their actions. But taking advantage of an addiction and saying "I'll give you money so you can't reproduce because your an addict" isn't having them take responsibility at all.

    Rehab makes people aware of their choices, understand what those choices mean, and dealing with the consequences. Paying people you not to reproduce ignores responsibility and just makes everyone outside the situation feel better.

    So you consider permanent sterilization being held responsible for their actions?

    My point about "giving them a choice" is that we know addiction is a disease. So giving someone a choice when they are addicted to something is very different than giving a sober person a choice about a long term choice.

    Why not place effort on having the person get better?

    As I said, I have no problem with the birth control. That seems like a responsible idea.

    I definitely have a problem with the permanent sterilization. I mean, an addict at 18 could say "**** it, i dont want kids" . 5 years later, they are 23, sober, and say "man, i wish i could have kids but i made a stupid decision when i was 18". That is not something i would want to offer anyone in such a vulnerable state.

  10. #10
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    No, I am not saying that they shouldn't be held responsible for their actions. But taking advantage of an addiction and saying "I'll give you money so you can't reproduce because your an addict" isn't having them take responsibility at all.
    Then perhaps you are saying that drug addicts are too incompetant to make their own decisions.

    Am I correct now?

    Giving someone a CHOICE is not taking advantage of them, unless they are too incompetant to understand
    the choice they are making.

    Also, you fail to take into account that the goal of Project Prevention is to prevent the births of
    substance-affected babies.


    Said babies are innocent victims of drug abuse.
    They did not choose to use the drugs, but they will certainly suffer because of their mother's choice to use.

    Quote Originally Posted by thegreenape
    Paying people you not to reproduce ignores responsibility and just makes everyone outside the situation feel better.
    I will venture to say here, that reducing the number of substance-affected babies would generally be seen as a "good thing".

    I don't think you can disagree with that.

    Quote Originally Posted by the greenape
    So you consider permanent sterilization being held responsible for their actions?
    Last time I checked, every adult person is held responsible for their own CHOICES, unless they are too incompetant to make a choice for themselves.

    Do you believe that all drug-addicted people are too incompetant to make a choice?

    Quote Originally Posted by the greenape
    My point about "giving them a choice" is that we know addiction is a disease.
    To be consistent in this line of logic, you would then have to say that anyone with a "disease" is too incompetant to make their own decisions.

    Is that what you are saying?

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  11. #11
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    Re: Paying Drug Addicts to Get Sterilized

    The first thing that came to mind was whether or not these women actually have the mental capacity to understand what they are agreeing to.

    Prolonged drug use and consumption of alcohol will damage your brain, and could possibly impair the way you think.

    Do these women fully understand what they are getting themselves into? It seems to me that all they will see is cash waved under their noses, something to buy another bottle of grog or another fix. They MUST understand what they are consenting to.

    That is my only concern.
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  12. #12
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by Tarja Turunen View Post
    The first thing that came to mind was whether or not these women actually have the mental capacity to understand what they are agreeing to.

    Prolonged drug use and consumption of alcohol will damage your brain, and could possibly impair the way you think.

    Do these women fully understand what they are getting themselves into? It seems to me that all they will see is cash waved under their noses, something to buy another bottle of grog or another fix. They MUST understand what they are consenting to.

    That is my only concern.
    I guess that would be an issue that would vary on an individual basis. Any medical professionals involved in the procedure have a legal obligation to ensure that consent is obtained. If they have any suspicion that the patient might not be fit to provide informed consent then they face legal and ethical consequences of going through with the procedure.
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  13. #13
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    Re: Paying Drug Addicts to Get Sterilized

    Scarlett, I have been nodding and agreeing with basically every argument you have made to this point, as my sentiments mirror yours. There is a huge need to reduce the numbers of drug-affected babies, and a very good way to do this is by encouraging drug users to use birth control or be sterilized.

    Now to address the others' points. Without knowing the specifics of the program regarding the individual approach each counselor takes to talking about the idea with drug abusers, I'd have to say that unless they're literally "trying to pull a fast one" on the drug users and bundle them all off to teaching hospitals for budding gynaecologists to practice their "spays," there is nothing unethical about encouraging a tubal ligation or "having one's tubes tied." Clamping the fallopian tubes is a reversible procedure that provides nearly perfect long-term contraception for women. With the exception that there is a surgical procedure involved (usually done by minimally invasive laparoscopy now), I see no reason that it shouldn't be encouraged every bit as much as long-term depo-Provera shots (which can have some long-term health risks for people who smoke, etc) under the right circumstances.

    However, even the risks of depo Provera aren't as great as the risks involved in becoming pregnant and either having multiple babies (a dangerous process under the best of circumstances, let alone under the effects of drugs) or having multiple abortions. A pregnant mother on cocaine, for example, is much more likely to have life-threatening complications than someone who is not on drugs. So, by encouraging these women to take some action to ensure they don't endanger themselves and their potential babies by using drugs while pregnant, they are actually doing these women a great service and possibly saving their lives.

    While I can't say for sure, if I were a counselor, I would not be encouraging a 23-year-old to get sterilized unless she already had 4 or 5 kids she couldn't support and was in such bad physical shape from her drug abuse that she couldn't safely be pregnant. I would encourage her to go on depo-Provera and get multiple 300 dollar checks instead of just the one for the sterilization. If she gets her life straight in time to have a few healthy children, then so much the better. Provera has no long-term effects on fertility once treatment has stopped. In the case of a 35-year-old, however, I might have a different approach, since her risk of dying from a complication of pregnancy is *much* greater than a younger woman and is multiplied by her drug abuse. In her case, I *would* advocate sterilization. Her years of risk-free childbearing are almost over anyway, and it's not likely she'll get her life together in time to safely bear healthy children (considering that by age 40, an otherwise healthy woman's risk of having a Down syndrome baby is 12-14 times that of a 20-24 year old and gets worse with every year after 40 until menopause).

    I was with you on every point you made, Scarlett, until you got to this one:

    Quote Originally Posted by Scarlett44 View Post
    To be consistent in this line of logic, you would then have to say that anyone with a "disease" is too incompetant to make their own decisions.

    Is that what you are saying?

    .
    Not that I agree with the viewpoint you're challenging, but to be fair, this is an inaccurate characterization of the argument I believe was being made, in that it generalizes too much. I believe that the argument being made is that drug addicts, since they have a disease that affects their mental capacity (specifically, addiction), their ability to consent to something like sterilization is in doubt, because one can't be sure that they're thinking about anything except getting money for their next hit. Greenape, please correct me if I'm wrong about your argument.

    To address that argument, however, I propose that any ethical organization would carefully train its employees to be particularly stringent in assessing capacity to consent before allowing such procedures to happen. In the case of Provera, the burden becomes much less, barring any prohibitive medical concerns (history of DVT, smoking, genetic hypercoagulability disorders, etc.), in that at the end of the dosing period, the woman has had no net change in her body and can freely have any children she wants. As for the sterilization without consent, I simply can't see any responsible surgeon being willing to perform sterilizations on the drug-addicted without ironclad guarantees that the patients had all freely and knowingly consented to the procedure. To do otherwise would be to invite disaster in the form of dozens of junkies suing the doctor for malpractice - and likely winning enough money to keep them in China White (or whatever poison of choice they do) until it puts them in an early grave. I know I wouldn't if I were the surgeon. The benefit is too small to justify the risk, especially since it's entirely likely that anyone doing these operations is doing them on a pro bono basis as a public service.

  14. #14
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    Still, I'd rather see them being paid to go to rehab.
    The problem with this position is that as Lord Infamous brought up, rehab has a relatively low long-term success rate for hard drug users, unless some pretty significant changes occur in their psychosocial environment outside the wards. A person can "get clean" on the wards, be totally ready to make a new start, and fall right off the wagon when the stress of trying to be clean hits them all at once. Being a drug addict ruins your life. You have to be able to face those ruins and start building your life over from scratch, without the only coping tool you ever had, to permanently get off drugs. This is one of the biggest reasons that people have such a low success rate in getting off drugs when they go back to the same situation they left before.

    Also, monetary gain is not a strong enough incentive to motivate someone to permanently give up drugs, especially not a measly 300 dollars, even if you gave it to them every month. A welfare bum could get more than that by applying for it and still go get drugs. That solution is just not effective. The only truly effective approach to getting off drugs has to start with the user himself making a hard decision to be drug free for the rest of his life, for his own reasons and not because anyone told him to or offered him a reward. It's the desire for instant gratification and undeserved rewards that often leads to drug addiction in the first place, so offering a "cookie" to someone if they'll quit is just feeding that mentality.

    The purpose of encouraging birth control/sterilization is not one of total rehabilitation of drug users. That's too ambitious for one small organization to accomplish... or even large organizations, for that matter. The idea here is "damage control." They are trying to limit the social and economic damage that drug abusers inflict upon the public by their irresponsible habits (which frequently include promiscuity, leading to more pregnancies). Once a drug addict decides it's time to quit, they will. In the meantime, this charity's aim is to keep them from hurting themselves or other people simply by sleeping with others irresponsibly. I think it's a very worthwhile goal, personally.

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    Re: Paying Drug Addicts to Get Sterilized

    Talthas,

    You've described what I meant by disease very well. Thanks for responding for me!

    As to you other point...

    I agree that rehab isn't the most effective of treatments but it can work. Perhaps the group can at least offer it to the people when they come in to receive their money for the birth control.

    Like I said, I have no problem with using long term birth control or any reversable procedure; I think it can help the cause, reduce risk of both the potential mother and the potential baby, while alleviating burden on general society.

    I will never agree with the idea of permanentsterilization being offered to someone with an addiction who, most likely, isn't going to be in the best frame of mind to make long term decision like this. I'm sorry but this just shouldn't be an option. What is the point of this option when you can do long term birth control? Where does this fit in? How do you justify it?

    However, if you do justify permanent sterilization as an option, why is it just women? It would more effective to permanently sterilize men who can produce a whole lot more babies than one women.

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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    I definitely have a problem with the permanent sterilization. I mean, an addict at 18 could say "**** it, i dont want kids" . 5 years later, they are 23, sober, and say "man, i wish i could have kids but i made a stupid decision when i was 18". That is not something i would want to offer anyone in such a vulnerable state.
    Question. Would you advocate "voluntary" sterilization as a condition of parole to convicted sex offenders?
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  17. #17
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by ladyphoenix View Post
    Question. Would you advocate "voluntary" sterilization as a condition of parole to convicted sex offenders?
    Perhaps, but I don't see it to be analogous.

    Sex offenders are imprisioned because they committed a crime of sexual nature, which, may have had absolutely nothing to do with reproducing. Moreoever, you would still be able to commit sex offenses if you were sterile or not; I would say that it could be a potential benefit to a sex offender who then has less "risk" than before.

    So the sterilization of sex offenders wouldn't actually be preventing more sexual offense at all.

    But this is off-topic and has a totally different set of issues than the OP.

  18. #18
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    What is the point of this option when you can do long term birth control? Where does this fit in? How do you justify it?
    Excellent question. My reasoning is this: effective long-term contraception therapy exists only in the form of hormone replacement or intrauterine/permanent barrier devices (in general terms).

    Hormone replacement therapy, especially something like a depo-provera shot (which only has to be given 3-4 times a year), is quite effective, but there are long-term consequences to health for using hormone therapy, such as an increase in the rate of breast cancer, a predisposition to blood clots (which can cause heart attacks, strokes, and other problems), and a few other things as well.

    Permanent intrauterine (IUD) /barrier devices require professional insertion and/or fitting by a gynaecologist and are pretty time-intensive as far as clinical time goes. They also require re-fitting every few years or so. Furthermore, IUD can cause periods to be more painful with heavier bleeding, are prone to increased incidence of infection (especially among IV drug users, who are more susceptible to all types of infection), and can be dislodged by careless hands or particularly rough sex (not to get too graphic here, but use your imagination). While they are properly in place they are highly effective, but when they are not, they pose a significant health risk to the woman, including Toxic Shock Syndrome, uterine perforation, sepsis, etc. This is generally not a problem because most women with IUD are good about following up with doctors when they notice problems. Drug users, however, would not be so good about that and may wait until it's too late to avoid serious damage or even death before going to see someone. Both IUD and hormone shots require good follow-up compliance, which leads me to the next point.


    Repeated clinic visits aren't always appealing to people who would rather be on drugs instead of sitting in a free clinic for hours. Compliance is a huge issue when you're dealing with an irresponsible and largely undereducated segment of the population. Permanent sterilization solves all of these problems. Here's how:

    In cases where a patient is unlikely to be compliant with medical instructions, there is a greatly increased risk that a) the therapy will be ineffective and/or b) that there will be dangerous complications that go undetected long enough to do harm. In cases like this, it is better to advocate a more permanent solution: sterilization. It requires only one visit, no follow-up (except to get your sutures out in a week), and is a "fix-and-forget" solution. To be honest, this is quite perfect for your average drug abuser, who can often barely think past where they're going to get their next fix. So, by advocating a more permanent solution, you make it a lot more likely that the patient will avoid complications and still have effective treatment (i.e. contraception). Everybody wins. There's even a "compromise" of sorts, in that instead of an actual tubal ligation (where you cut and cauterize the fallopian tubes), clips can be placed over each tube, thus blocking it off and preventing ova from getting down or sperm from getting up. A potentially life-threatening complication of this is the possibility that if a conception *does* occur, it's much more likely to be ectopic (outside the uterus) and pose a highly dangerous situation for both mother and child. This situation isn't very likely, but it's still something that must be considered. The benefit to this approach is that the clips can be removed in the same way they were placed when a woman wants to have children, and there is a high degree of success with having children afterward, compared with "reversals" of other sterilization procedures.


    Quote Originally Posted by thegreenape
    However, if you do justify permanent sterilization as an option, why is it just women? It would more effective to permanently sterilize men who can produce a whole lot more babies than one women.
    You're absolutely right. A vasectomy would be a wonderful idea for male drug abusers. I would heartily advocate this approach as an adjunct to treating women (but not as a substitute), because it makes an even further reduction in the number of drug-abuse affected children with minimal impact to the health of the people so treated. Treating only one or the other only solves half the problem. Good point.

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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by thegreenape View Post
    Perhaps, but I don't see it to be analogous.

    ...

    But this is off-topic and has a totally different set of issues than the OP.
    No, it's not a totally different set of issues. You have someone in a very vulnerable place, someone who's been locked in a cage, who you know desperately wants out, and you're saying, "Sure, we'll give you what you want, all we ask is that you get sterilized first." It just so happens that one person wants phsycial freedom and another one wants to feed a drug habit. They are both, by all definitions, more dangrous to themselves and others being given that which they desire (freedom for the sex offender and more drugs for the drug addict). They are both guilty of "crimes" against other people, per the assessments of most of the people who've commented here.

    The situations are almost identical. What makes the sex offender less worthy of your moral outrage? They both are being exploited beacause of their respective weaknesses. Or are you placing another qualifier on this? Something other than exploitation, perhaps?
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    Re: Paying Drug Addicts to Get Sterilized

    Quote Originally Posted by Talthas View Post
    There's even a "compromise" of sorts, in that instead of an actual tubal ligation (where you cut and cauterize the fallopian tubes), clips can be placed over each tube, thus blocking it off and preventing ova from getting down or sperm from getting up. A potentially life-threatening complication of this is the possibility that if a conception *does* occur, it's much more likely to be ectopic (outside the uterus) and pose a highly dangerous situation for both mother and child. This situation isn't very likely, but it's still something that must be considered. The benefit to this approach is that the clips can be removed in the same way they were placed when a woman wants to have children, and there is a high degree of success with having children afterward, compared with "reversals" of other sterilization procedures.
    This seems like a good compromise to me.

    I cannot bring myself to agree with irreversible contraception due to the fact that people, however unlikely, do become sober and do want to start a life after their addiction. To have an addict make a permanent decision while in the midst of their addiction seems unethical and wrong. Especially so since the people offering the choice are fully aware of the fact that the addict isn't going to be making decisions for the right reasons.

    Again, if there was a a reversible technique for men, I think it should also be offered.

 

 
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