II. THE BASIS
FOR AFRICAN AMERICAN DISTRUST
SLAVERY, SEGREGATION AND RACISM: TRUSTING THE HEALTH CARE SYSTEM AIN'T ALWAYS EASY!
AN AFRICAN AMERICAN PERSPECTIVE ON BIOETHICS
R. Randall , 15 St. Louis U. Pub. L. Rev. 191 -235 (1996)
African Americans' distrust of the health care system is built out of
a history that includes experimentation, the Sickle Cell Screening Initiative,
Family Planning/Involuntary Sterilization, and the participation of the
medical system in the justification of racism and discrimination in society.
A. Experimentation and Teaching Materials
The distrust of the American health care system is grounded in the knowledge
that the health care system has been built on bodies of African Americans.
For instance, the nineteenth century marked the rise of modern U.S. medicine.
The advances in medicine were legion:
Advances in basic sciences such as pathology, histology, physiology
and pharmacology; the introduction of the statistics and the numerical
methods which forever changed the nature and scope of clinical medicine
and public health; the clinical acceptance of vaccination for smallpox;
introduction of the stethoscope; . . . controlling puerperal fever; rapid
advances in clinical schools . . . laboratory medicine . . . and publication
of Percival's CODE OF MEDICAL ETHICS. (19)
However, during the same period the American health care system evidenced
a lack of attachment to esoteric research and pure science that resulted
in American physicians performing "bold, occasionally brilliant, clinical
medical feats which were not being performed anywhere else on earth."
Then and today it seems to be of little importance that those "bold, occasionally
brilliant . . . medical feats" occurred on Blacks and the poor. Understanding
the extent of the experimentation is important for understanding the basis
of the distrust of African Americans. Slaves served both as instructional
material for teaching medical students and as a source of entertainment
at medical conventions.
(21) Fo r instance, enslaved
albinos and Siamese twins were often displayed at medical society meetings
as freaks and sports.
1. Experimentation During Slavery
In the 1800s, Dr. McDowell successfully performed the removal of an
ovarian tumor, a dangerous and radical surgery which he perfected on slaves.
In 1800, hundreds of slaves, including two hundred slaves of Thomas Jefferson,
were inoculated with smallpox to test the safety of a new vaccine. (24)
Dr. Crawford Long, probably the first physician to use ether agent as a
general anesthetic, conducted a large percentage of his early experiments
on slaves. (25) To determine which medication would
allow a person to withstand high temperatures, Dr. Thomas Hamilton placed
slaves in an open-pit oven which was constructed to contain heat with only
the slaves' heads above ground. (26) Dr. Walter F.
Jones used a group of slaves to test a remedy for typhoid pneumonia which
involved pouring five gallons of boiling water on the spinal column. (27)
Slaves actually suspected physicians of killing slaves or letting them
die for purposes of dissection. (28) While these rumors
were never documented, slaves' bodies were dug up and sold to medical schools.
(29) Dr. Alexander Somervail, after accidentally discovering
how to relieve the suppression of urine, tested his theory on other Black
patients. (30) Robert Jennings is credited with the
development of a successful vaccination against typhoid infection that
resulted from his successful experimentation on thirty slaves and free
Blacks. (31) Dr. P.C. Spencer, who gained notoriety
with his discovery of an efficient and relatively safe technique for treating
painful bladder stones, perfected his technique by performing the painful
experimental surgery on slaves. (32) Dr. Marion Sims--considered
the father of gynecological surgery--perfected the techniques for gynecological
surgery on slaves. (33) He addicted the women to narcotics
in order to sedate and immobilize them post-operatively. (34)
Furthermore, he performed the surgery repeatedly on the same women. (35)
Though the social norms have changed dramatically, Sims is still revered
as a hero and an icon; the complete picture of him as a person who abused
and exploited slaves is usually never portrayed. (36)
2. Post-slavery Experimentation
The most well known post-slavery experiment is the Tuskegee Syphilis
Experiment which the United States engineered from 1932 through 1972. (37)
The Tuskegee Experiment involved four hundred African American men in a
government-sponsored study to research the effects of untreated syphilis.
While the men were not deliberately exposed to syphilis, as some rumors
maintained, they were never told that they were not being treated or that
effective treatment was available. (39) Furthermore,
even though the experiment was regularly reported over the course of the
forty years, there was no outcry from the medical establishment.
The effects of the Tuskegee Syphilis Experiment of maintaining and strengthening
the distrust in the health care system can not be underestimated. The Tuskegee
study served to reinforce the belief in the African American community
that the distrust of the medical system was not merely an historical issue.
The Tuskegee Syphilis Experiment is not the only evidence of post-slavery
abuse. In 1963, the United States Public Health Service, the American Cancer
Society, and the Jewish Chronic Disease Hospital of Brooklyn, New York,
participated in an experiment in which three physicians injected live cancer
cells into twenty-two chronically ill and debilitated African American
patients. (42) The patients did not consent, nor were
they aware that they were being injected with these cells. (43)
In 1972, twenty women, primarily poor, young, and Black, were bused from
Chicago to Philadelphia to receive abortions in an outpatient clinic where
a new experimental medical device, called the Super Coil, was being used
to induce the abortion. (44) A complication of using
Super Coil was uncontrollable bleeding that would eventually lead to shock
and would require a total abdominal hysterectomy. (45)
During the 1970s, the government collected blood samples from seven thousand
Black youths. Parents were told that their children were being tested for
anemia, but instead, the government was looking for signs that the children
were genetically predisposed to criminal activity. (46)
A similar experiment was performed on six thousand young men--approximately
85 percent of whom were Black--housed in Maryland state institutions for
abandoned or delinquent children. (47) The children's
confidentiality was not protected and the blood-test results were passed
to the courts to use as they saw fit. (48) At least
eighty-two charity patients were exposed to full-body radiation at the
University of Cincinnati Medical Center. (49) The
patients were exposed to radiation ten times the level believed to be safe
at the time; twenty-five patients died. Three-quarters of the patients
in the study were Black men and women. The consent signatures were forged.
Many women of color have been sterilized without their informed consent
so that medical residents could gain additional experience in performing
tubal ligations and hysterectomies. (51)
3. Prison and Military Abuse
One area of significant post-slavery abuse has been the experimentation
that has occurred in prisons. Because African Americans make up forty-four
percent of all prisoners--almost four times our proportion in the general
population-- we are overrepresented in any prison abuse. (52)
In 1962, at least 396 inmates at the Ohio State Prison were injected with
live cancer cells so researchers could study the progression of the disease.
Between 1963 and 1971, radioactive thymidine, a genetic compound, was injected
into the testicles of more than one hundred prisoners at the Oregon State
Penitentiary to see whether the rate of sperm production was affected by
exposure to steroidal hormones. (54) Throughout Alabama
between 1967 and 1969, inmates were used in flawed blood plasma trials.
The study was managed by Dr. Austin R. Stough at Kilby, Draper, and McAlester
prisons. There was no informed consent, and no accurate records were kept.
(55) At a California medical facility between 1967
and 1968, prisoners were paralyzed with succinylcholine, a neuromuscular
compound. Because their breathing capacity was shut down, many likened
the experience to drowning. When five of the sixty-four prisoners refused
to participate in the experiment, the institution's special treatment board
gave "permission" for prisoners to be injected against their will. (56)
In 1990, 1.7 million soldiers--twenty-two percent of whom were Black--were
forced to take experimental vaccines under federal law. The law stipulates
that soldiers cannot refuse to participate in the government's medical
The above instances of slavery and post-slavery abuses are cited not
because they are the only instances of experimentation and abuse of African
Americans, but because they are some of the most famous. (58)
While many Blacks may not be able to give you the details of the experimentation
and abuse, the instances are a part of the collective Black consciousness
which still influence African Americans' reaction to the health care system.
B. Sickle-Cell Screening
The debacle of sickle-cell screening in the 1970s also increased the
distrust of the medical system, as did medical experimentation. (59)
Although sickle- cell disease has been described since 1910, it did not
become a priority for federal or private funding until the 1970s. (60)
In the 1970s, large scale screening was undertaken with the goal of changing
African American mating behavior. (61) Unfortunately,
the initiative promoted confusion regarding the difference between carriers
and those with the disease. (62) This confusion resulted
in widespread discrimination against African Americans. (63)
Some states passed legislation requiring all African American children
entering school to be screened for the sickle-cell trait, even though there
was no treatment or cure for the sickle-cell disease. (64)
Some states required prisoners to be tested, even though there would be
no opportunity for them to pass on the trait. (65)
Job and insurance discrimination were both real and attempted. (66)
The military considered banning all African Americans from the armed services.
African American airline stewardesses were fired. Insurance rates went
up for carriers. Some companies refused to insure carriers. (67)
During that period, many African Americans came to believe that the sickle-cell
screening initiative was merely a disguised genocide attempt, since often
the only advice given to African Americans with the trait was, "Don't have
C. Family Planning and Involuntary Sterilization
Family planning initiatives have been described as another attempt to
reduce the Black population. (69) This view is not
without credibility. The fact is that the historical roots of family planning
and birth control have been centered in controlling the population growth
of African Americans. Margaret Sanger, considered the "mother of family
planning and reproductive freedom," supported and promoted the use of reproductive
technology to diminish the reproductive liberty of African Americans. (70)
We do not want word to go out that we want to exterminate the Negro
population and the [Negro] minister is the man who can straighten out that
idea if it ever occurs to any of their more rebellious members. (71)
Throughout United States history, family planning and birth control
have been used to limit the population size of African Americans. In the
1930s, the government funded the first birth control clinics as a way of
lowering the Black birthrate:
In 1939, the Birth Control Federation of America planned a "Negro Project"
designed to limit reproduction by blacks who "still breed carelessly and
disastrously, with the result that the increase among Negroes, even more
than among whites, is from that portion of the population least intelligent
and fit, and least able to rear children properly."
In fact, the early birth control movement included strong factions advocating
eugenics or compulsory sterilization. (73)
In the 1960s, the government expanded the subsidization of family planning
clinics as a way to reduce the number of persons on welfare. (74)
In so doing, the number of clinics were proportional to the number of Blacks
and Hispanics in a community. (75)
In the 1970s, some doctors would only deliver babies or perform abortions
on pregnant African American women if the women consented to sterilization.
Other women were threatened with the withdrawal of their welfare benefits
if they did not agree to sterilization. (77) In a
case brought by poor teenage African American women in Alabama, a federal
district court found that an estimated 100,000 to 150,000 poor women were
sterilized annually under federally funded programs. (78)
In the 1970s and 1980s, Public Assistance officials tricked African
American welfare recipients into having their teenage daughters sterilized.
A 1982 study determined that only twenty-five percent of White women were
sterilized, compared to thirty-four percent of African American women.
(80) African American women of all marital statuses
were more likely than White women to use sterilization as a contraceptive
method. (81) Further, African Americans in the South
have the highest rates of hysterectomy and tubal ligation in the United
Today, some individual doctors encourage African American women to be
sterilized because they view the women's family sizes as excessive and
believe that they are incapable of using contraceptives. (83)
Furthermore, the federal government still subsidizes sterilizations for
women eligible for Medicaid coverage, though it will not pay for abortions.
Thus, African Americans' distrust of family planning is justified.
D. Participation in Justifying Racism
Louis Agassiz, Samuel George Mortion, Samuel Cartwright, and Josiah
Clark were the leading U.S. academic physicians to advocate the theory
that Blacks were biologically inferior to Whites. (85)
In fact, many physicians used their science to create elaborate theoretical
systems to justify the difference in the medical treatment of Blacks and
Whites. (86) They advocated for the establishment
of uniquely Southern-oriented medical education to address the unique diseases
of Black slaves, such as drapetomania--the disease causing negroes to run
away. (87) Furthermore, it is important to illustrate
that these men did not represent the lunatic fringe. Their ideas were widely
held and accepted. For instance, Oliver Wendell Holmes, Dean of Harvard's
Medical School from 1847 to 1853, believed in and promoted the scientific
value of the work of these "scientists." In fact, Holmes held such regard
for Samuel Morton's work that he considered Morton's research "permanent
data for all future students of Ethnology . . . ."
|FN18. Id. at 347-50.
FN19. MICHAEL BYRD & LINDA C. CLAYTON, RACE AND HEALTH CARE, BLACK
HEALTH IN THE JACKSONIAN AND ANTEBELLUM PERIODS, 1812-46: GROWTH, CHANGE
AND MANIFEST DESTINY (1996) (unpublished manuscript, on file with the Saint
Louis University Public Law Review).
FN21. Dula, supra note 1, at 347-48; see also TODD L. SAVITT, MEDICINE
AND SLAVERY: THE DISEASES AND HEALTH CARE OF BLACKS IN ANTEBELLUM VIRGINIA
282 (1978). "Slaves and the free poor of both races had little choice in
the matter; the former had to abide by the master's decision, and the latter,
by the physician's (since treatment was without charge)." Id. Access to
medical facilities were often expanded to Blacks in order to have a constant
flow of Blacks to be used as subjects for clinical instruction. Id. For
example, in Virginia in 1853 through 1854, there was a proposal to establish
the "Virginia Free Hospital" solely for Blacks. Id. at 285. Even though
the proposal was never put into effect, "the state legislature deemed the
[Medical College of Virginia's] need for clinical material sufficiently
important enough to appropriate $30,000 toward the construction of a new
hospital in 1860." Id. at 286 (citation omitted).
FN22. Dula, supra note 1, at 347-48.
FN23. BYARD & CLAYTON, supra note 19, at 19.
FN24. Dula, supra note 1, at 348. Jefferson's efforts to sanction smallpox
vaccination began in the spring of 1801 when he received some untested
cowpox vaccine from Dr. Benjamin Waterhouse of Boston and forwarded a portion
of it to a Washington physician. SAVITT, supra note 21, at 294-95. Although
the physician's results with the vaccine were unsuccessful, Jefferson nevertheless
decided to conduct his own experiment by vaccinating two hundred slaves
belonging to him, his son-in-law, and his neighbors. Id. at 295.
FN25. BYRD & CLAYTON, supra note 19, at 24.
FN26. Dula, supra note 1, at 348; see also PATRICIA A. TURNER, I HEARD
IT THROUGH THE GRAPEVINE: RUMOR IN AFRICAN-AMERICAN CULTURE 67-70 (1993);
GLADYS- MARIE FRY, NIGHT RIDERS IN BLACK FOLK HISTORY 170-212 (1975); SAVITT,
supra note 21, at 293-301.
FN27. SAVITT, supra note 21, at 299.
FN28. Dula, supra note 1, at 348.
FN30. SAVITT, supra note 21, at 300.
FN31. Id. at 298-99.
FN32. Id. at 301.
FN33. BYRD & CLAYTON, supra note 19, at 20; Diana E. Axelsen, Women
as Victims of Medical Experimentation: J. Marion Sims' Surgery on Slave
Women, 1845-1850, 2 SAGE 10-13 (1985).
FN34. BYRD & CLAYTON, supra note 19, at 20-23.
FN35. Id. In fact, one slave, Anarcha, underwent twenty-nine major experimental
surgeries over several years. Id.
FN36. Id. See generally GEORGE A. BENDER, GREAT MOMENTS IN MEDICINE
236-44 (1966) (depicting the forerunners of gynecologic sciences); ALBERT
S. LYONS, M.D. & R. JOSEPH PETRUCELLI, II, M.D., MEDICINE: AN ILLUSTRATED
HISTORY 523, 531 (1987); DEBORAH K. MCGREGOR, SEXUAL SURGERY AND THE ORIGINS
OF GYNECOLOGY: J. MARION SIMS, HIS HOSPITAL, AND HIS PATIENTS (1989) (discussing
Dr. Sims, his origins, and the birth of gynecology).
FN37. Dula, supra note 1, at 348-49; Stephen B. Thomas & Sandra
Crouse Quinn, The Tuskegee Syphilis Study, 1932 to 1972: Implications for
HIV Education and AIDS Risk Education Programs in the Black Community,
81 AM. J. PUB. HEALTH 1499 (1991).
FN38. Dula, supra note 1, at 348-49.
FN40. Id. at 348; Jean Heller, Syphilis Victims in U.S. Study Went Untreated
for 40 Years, N.Y. TIMES, July 26, 1972, at A1.
FN41. On July 23, 1973, attorney Fred Gray filed a $1.8 billion class
action civil suit in the United States District Court of Alabama on behalf
of all the Tuskegee Experiment participants. Thomas & Quinn, supra
note 37, at 1502. In the complaint, the plaintiffs demanded $3 million
in damages for each living participant and a similar amount for the heirs
of the deceased. JAMES H. JONES, BAD BLOOD: THE TUSKEGEE SYPHILIS EXPERIMENT
216 (1981). Among the defendants named in the complaint were the U.S. Government,
U.S. Public Health Services, the Center for Disease Control, and the State
of Alabama. Id. In December 1974, the U.S. Government agreed to pay a sum
totaling $10 million in an out-of-court settlement. Id. at 217. The plaintiffs
agreed to cease further action for a cash payment of $37,000 to each living
syphilitic alive on July 23, 1973; $15,000 to the heirs of the deceased;
$16,000 to every member of the living controls alive as of July 23, 1973;
and $5,000 to the heirs of deceased controls. Id. All participants and
heirs had a three-year statute of limitations during which to file claims.
Id. Unfortunately, in spite of attempted efforts by the Public Health Service
to locate surviving participants and heirs, many of the four hundred syphilitic
actives were never located. Id.
FN42. Harriet A. Washington, Tuskegee Experiment Was But One Medical
Study That Exploited African-Americans [sic] Infamous Research, BALT. SUN,
Mar. 19, 1995, at 1F.
FN51. Deborah Larned, The Epidemic in Unnecessary Hysterectomy, in SEIZING
OUR BODIES: THE POLITICS OF WOMEN'S HEALTH 202 (Claudia Dreifus ed., 1977).
See generally Andrea Asaro, The Judicial Portrayal of the Physician in
Abortion and Sterilization Decisions: The Use and Abuse of Medical Discretion,
6 HARV. WOMEN'S L.J. 51, 93-101 (1983) (analyzing the relationship between
the judiciary and physicians in abortion and sterilization cases); Dick
Grosboll, Sterilization Abuse: Current State of the Law and Remedies for
Abuse, 10 GOLDEN GATE UNIV. L. REV. 1147, 1153-56 (1980) (discussing the
historical perspective and current state-of-law involving low-income sterilization
FN52. Washington, supra note 42, at 1F.
FN55. Dr. Stough was expelled several times from hospitals and prisons
after men became sick and died from a variety of diseases stemming from
his experiments. Id.
FN57. 21 C.F.R. s 50.23(d) (1995).
FN58. JONES, supra note 41 (discussing discriminatory medical practices
in the United States as "race medicine"). See generally Robert M. Veatch,
Ethical Principles in Medical Experimentation, in ETHICAL AND LEGAL ISSUES
OF SOCIAL EXPERIMENTATION 22-24 (Alice M. Rivlin et al. eds., 1974); Franz
J. Ingelfinger et al., The Poor, in NATIONAL ACADEMY OF SCIENCE, EXPERIMENTS
AND RESEARCH WITH HUMANS: VALUES IN CONFLICT 150 (1975).
FN59. Dula, supra note 1, at 349; Leslie Roberts, One Worked; The Other
Didn't, 247 SCIENCE 18 (1990) (reporting that charges of racism were leveled
at those who advocated that African Americans with sickle-cell anemia avoid
FN60. Dula, supra note 1, at 349; see also Todd L. Savitt & Morton
F. Goldberg, Herrick's 1910 Case Report of Sickle Cell Anemia: The Rest
of the Story, 261 JAMA 266, 266-71 (1989); Robert B. Scott, Health Care
Priority and Sickle Cell Anemia, 214 JAMA 731, 731-34 (1970).
FN61. Dula, supra note 1, at 349.
FN64. Id.; see also PHILLIP REILLY, GENETICS, LAW, AND SOCIAL POLICY
67-68, 77- 78 (1977) (highlighting the danger of legislative misunderstanding
of genetics); Charles F. Whitten, M.D., Sickle-Cell Programming--An Imperiled
Promise, 288 NEW ENG. J. MED. 318, 318-19 (1973) (discussing the negative
aspects of the implementation of the sickle-cell testing program); Ira
M. Rutkow & Jeffrey M. Lipton, Some Negative Aspects of State Health
Departments' Policies Related to Screening for Sickle Cell Anemia, 64 AM.
J. PUB. HEALTH 217, 217-21 (1974) (analyzing the results of a survey mailed
to all state Departments of Health).
FN65. Dula, supra note 1, at 349; see also Rutkow & Lipton, supra
note 64, at 219.
FN66. Dula, supra note 1, at 349.
FN67. Id.; see also Lori B. Andrews, Confidentiality of Genetic Information
in the Workplace, 17 AM. J.L. & MED. 75, 107-08 (1991) (discussing
the employment discrimination in the 1970s faced by African Americans with
the sickle-cell trait); Larry Gostin, Genetic Discrimination: The Use of
Genetically Based Diagnostic and Prognostic Tests by Employers and Insurers,
17 AM. J.L. & MED. 109, 138-39 (1991) (discussing Smith v. Olin Chem.
Corp., 555 F.2d 1283 (5th Cir. 1977), in which an employer fired a worker
with sickle-cell anemia because of concerns about the worker's health).
FN68. Dula, supra note 1, at 349; see also James E. Bowman, Genetic
Screening Programs and Public Policy, 38 PHYLON 117, 117-42 (1977) (discussing
genetic screening programs, criticizing many of them as disguised scholarly
research and labeling them as covers for racism). Genocide has been defined
to include acts such as "imposing measures intended to prevent births within
the group." Convention on the Prevention and Punishment of the Crime of
Genocide, Dec. 9, 1948, art. II(d), 78 U.N.T.S. 277. According to the Convention,
"group" includes a national, ethnic, racial, or religious group. Id. In
1986, the United States ratified the Genocide Convention. 132 CONG. REC.
FN69. See ROBERT G. WEISBORD, GENOCIDE? BIRTH CONTROL AND THE BLACK
AMERICAN (1975) (discussing the view held by some Blacks that family-planning
programs are a potential means of race genocide); see also KAY MILLS, THIS
LITTLE LIGHT OF MINE: THE LIFE OF FANNIE LOU HAMER 274 (1993) (discussing
Black activist Fannie Lou Hamer's view of abortion and birth control as
a form of genocide); William A. Darity & Castellano B. Turner, Family
Planning, Race Consciousness and the Fear of Race Genocide, 62 AM. J. PUB.
HEALTH 1454, 1454-56 (1972) (discussing the view held by some Blacks that
family-planning programs are a potential means of race genocide).
FN70. LINDA GORDON, WOMAN'S BODY, WOMAN'S RIGHT: A SOCIAL HISTORY OF
BIRTH CONTROL IN AMERICA 281-83, 332-33 (1976). By 1919, the influence
of the eugenics campaign on the birth control movement headed by Margaret
Sanger was clear. Sanger stated the following in an article published in
the American Birth Control League's journal: "More children from the fit,
less from the unfit--that is the chief issue of birth control." Id. at
FN71. Id. at 332-33 (citation omitted).
FN72. Dorothy E. Roberts, Crime, Race and Reproduction, 67 TUL. L. REV.
1945, 1970-71 (1993) (citation omitted); see also GORDON, supra note 70,
at 332 (stating that the "Negro Project" was intended to regulate the "mass
of Negroes . . . particularly in the South, [who] still breed carelessly
and disastrously, with the result that the increase among Negroes, even
more than among whites, is from that portion of the population least intelligent
and fit, and least able to rear children properly.").
FN73. Charlotte Rutherford, Reproductive Freedoms and African American
Women, 4 YALE J.L. & FEMINISM 255, 273 (1992). Sanger promoted the
use of sterilization, abortion, and contraception to eliminate "human weeds."
See GEORGE GRANT, GRAND ILLUSIONS: THE LEGACY OF PLANNED PARENTHOOD 63,
65 (2d ed. 1992) (relating the Margaret Sanger story). In addition, other
eugenicists were a significant part of the American Birth Control League.
GORDON, supra note 70, at 82-83.
FN74. Dula, supra note 1, at 349-50.
FN75. Id. at 350.
FN76. Roberts, supra note 72, at 1971; see also Walker v. Pierce, 560
F.2d 609, 613 (4th Cir. 1977) (reversing judgment against a doctor who
required Medicaid recipients to consent to undergo tubal ligation before
he would deliver their third child), cert. denied, 434 U.S. 1075 (1978);
Laurie Nsiah-Jefferson, Reproductive Laws, Women of Color, and Low-Income
Women, 11 WOMEN'S RTS. L. REP. 15, 30-31 (1989) (setting forth statistics
demonstrating the disproportionate sterilization of minority women, particularly
FN77. Roberts, supra note 72, at 1971; see also Cox v. Stanton, 529
F.2d 47 (4th Cir. 1975) (reversing dismissal of a claim brought by a Black
woman who was permanently sterilized after she agreed to temporary sterilization
when threatened with termination of welfare benefits).
FN78. See Relf v. Weinberger, 372 F. Supp. 1196, 1199 (D.D.C. 1974),
vacated, 565 F.2d 722 (D.C. Cir. 1977)
FN79. Dula, supra note 1, at 350.
FN80. Nsiah-Jefferson, supra note 76, at 31.
FN83. Roberts, supra note 72, at 1971.
FN84. See, e.g., Rutherford, supra note 73, at 274. Compare 42 C.F.R.
s 441.253 (1994) (authorizing federal funding for sterilizations) with
42 C.F.R. ss 441.202-.203 (1994) (denying federal funding for abortions
unless the life of the mother is endangered).
FN85. BYRD & CLAYTON, supra note 19, at 65-73.